Many practices are reporting lower January production than in years past, due to a convergence of several factors. First, consumer confidence plunged in January, primarily due to the end of the Social Security payroll tax cut. Employees’ share of Social Security taxes rose from 4.2% to 6.2% beginning in January, which will take $2,000 in cash out of a family’s bank account for a couple with combined earnings of $100,000. Also, flexible spending account (FSA) limits were slashed from $5,000 to $2,500 beginning this year, forcing patients seeking big-ticket cosmetic, oral surgery, periodontic, and/or orthodontic procedures to pay more out of their pocket on an after-tax basis. Finally, many patients are still paralyzed by the uncertainty surrounding the ongoing budget/spending/debt ceiling political debacle.