Despite the financial challenges involved, some physicians are rejecting patients from health maintenance organizations. With an overwhelming number of Americans enrolled in managed care plans, the doctors recognize that they risk going out of business. But many who have chosen an independent route say that avoiding the paperwork and prior-approval hassles associated with HMOs is worth the risk.

• In 1998, only 14 percent of employees in large firms were covered by traditional insurance -- and in some areas of the country more than 90 percent of residents with insurance are now covered by managed-care plans.

• California, Arizona, Colorado and Washington state have 90 percent or more of their insured residents in HMOs, and nearly half of the lower 48 states have enrollment of 80 percent or more.

• By contrast, only 48 percent are enrolled in Wyoming and 58 percent in South Dakota.

• In a 1997 American Medical Association survey, 92 percent of doctors said they had at least one managed care contract.

Some doctors who have chosen to practice say they can limit their patient load to 18 or so a day -- while many managed care doctors reportedly see three times that many.

Source: Julie Appleby, "Sick and Tired of HMOs," USA Today, May 18, 1999.