Winston-Salem, N.C., medical practice illustrates industry business challenges.

Byline: M. Paul Jackson

Dec. 6--Listen to Doug Miyazaki talk long enough and he begins to sound like a business executive.

Miyazaki keeps an information sheet near his desk, which tracks the health-insurance premium costs of his employees. His office has to regularly deal with late payments from customers, as well as high prices for new equipment and overhead costs. This year, he's had to eliminate some positions in his office.

But Miyazaki wasn't trained as a business executive. He's an obstetrician-gynecologist.

More and more, private practice physicians like Miyazaki are under pressure to think like small-business owners, as rising health-care costs and liability insurance premiums push doctors to cut expenses, physicians and health-care experts said.

For …