Diane,
I've been using TotalMD for a few years and I absolutely love it. I've used a half dozen other companies in the past and none of them come close to TotalMD in my opinion but everyone can have their own opinion. I love the ease of use of the software. I have never seen a software that can allow me to work as quickly as I can in TotalMD. I also think their support is awesome (but fortunately I don't have to talk to them very often). Their pricing seems to really benefit billing services as well since they don't charge by provider. They are also a very responsive and accessible company and seem to add features to the software according to the requests of the customer (or at least that is how I felt when I suggested some features and then they were in the next version of the software. I really don't think there are any downsides but one downside that a person mentioned to me in the past was the fact they don't have a built in clearinghouse and the customer has to choose their own. I personally love that because when I had a bad experience a couple of years ago with my clearinghouse I was able to switch without a problem and still keep TotalMD. So that is a perfect example of how everyone has their own opinions. When I first went with them I was a little concerned that it was a new company (started somewhere around 2004 or 2005) but I'm not worried about that anymore but that could also be a concern I suppose. Hopefully someone else will chime in with their opinion.