In the great contemporary musical, “Fiddler on the Roof,” the central character, Tevye, constantly ruminates over decisions, as in “…on the other hand… .” Both cash and insurance practices make sense, given the appropriate passions, strengths and skill sets. Some doctors see less hassle and more opportunity in going cash. Others see consistency and stability in insurance, opting to acquire the training and knowledge that is required to establish a comfort level with the strictures and structures of medical necessity. The key consideration is to know where you want to go and how to get there, and to get help in reaching your objectives if you need it.