Balancing the roles of physician and business owner is "extremely challenging" to one-fourth of urologists in private practice, according to an American Express survey.

"One in five [urologists] say they would not have opened their own medical practice if they fully understood the business challenges of running a practice when they began their careers," said J. Max Reiboldt, CPA, medical practice management specialist and author of "Financial Management of the Medical Practice."

The Medical Practice Monitor by OPEN, American Express' division for small business, is based on 356 online interviews with medical doctors, regardless of specialty. In addition, 100 urologists, 106 oncologists, 101 rheumatologists, and 100 dentists in private practice were surveyed.

More than half of urologists surveyed (55%) spend at least 7 hours each week on managing the business of their practice, and one-fifth say they or their partners spend at least 21 hours on the management of their practice. Many would like to improve their business skills, including financial management, business management, and human resources.

Almost all (98%) say it's extremely important for medical students to learn business skills while they are in medical school.