After “Jim”* (names have been changed to protect identity) had passed his boards, he opened a healthcare practice and brought his old college friend “Bob” in to manage the business. Although Jim was the sole owner, Bob was well compensated. The practice grew to a staff of more than 50 and prospered. Then, for no obvious reason, profits took a downturn. Rob Benedetti and Joyce Perrone of PROMISE Consulting Inc., Pittsburgh, Pennsylvania, were called in to investigate.