Before he became a cardiologist, Mitin Patel had a background in biomedical engineering. So he was generally competent at dealing with service issues with the information technology at Cardiac Care, his one-doctor office in Cottonwood, Arizona. But being comfortable with handling all his employees' technology problems was another matter. "It came to a point where anything that went wrong, they were calling Dr. Patel," he says.

With a small office in a rural area, he couldn't hire a full-time IT person to lighten the load. And if the nature of the problem or his own press of duties required an outside technician to come on-site, Patel's distance from the nearest big cities, Flagstaff or Phoenix, could amount to hundreds of dollars in travel time on top of technician fees. "That was becoming extremely expensive," Patel says.

Two years ago, Patel heard about managed IT services at a medical conference. Two weeks later, he'd hired a remote PC support provider to make sure upgrades of operating and applications software on Cardiac Care's five servers and 30 PCs were up to date and its firewall, anti-virus, backup and disaster recovery services were at the ready.

The change has been more than a relief. It's also improved his business' profitability, Patel believes. "I was spending two or three hours a week on IT when I could have been seeing patients," he says. "The return on investment is remarkable."

Remote PC support provides Patel with peace of mind and the ability to focus on caring for patients and running the rest of his practice. "I don't have to worry about anything," he says. "It's been a fantastic godsend."

Few business owners like Patel have experienced the benefit, however. While more than half of small- and medium-sized businesses outsource hardware maintenance and management, only 6 percent outsource managed IT services, according to a report by research firm Forrester. The reasons, according to Forrester, are concerns about cost, quality and scalability along with simple lack of awareness.

Most small business that outsource IT services start to consider it after experiencing some kind of specific problem while doing the job internally, says Justin Beck, vice president of marketing for DirectPointe, a managed IT services provider in Logan, Utah. "It's generally a compelling event that makes them look," Beck says. "Maybe they've had an IT person who's going to resign or hasn't been doing a good job. They may have had a data loss. Something says we need to find a way to get a more consistent level of service or cost."

Resource constraints often underlie small businesses' moves to outsourced IT services, according to Ron Culler, chief information officer of Secure Designs, a Greensboro, North Carolina, provider of managed IT security services. "Most small businesses do not have a dedicated IT person," he says. "Those that do, that person is typically overworked, underpaid and under trained."

Outsourcing managed IT services can require a significant financial commitment. Fees for typical small businesses range from a few hundred dollars to a few thousand dollars monthly, based on flat monthly amounts, with added charges for well-defined instances. However, this means costs are predictable. For the one to three years of the typical contract, the owner can expect that the monthly fee will be the total outlay for IT services. "It's a known quantity for the business," Culler says.

Most small business owners will have to get used to the idea that their IT services will be provided remotely. Service personnel typically access servers and PCs through the web, with help desk services available by phone or email 24 hours a day. That may sound cumbersome, but Beck says his company typically answers help desk calls within 30 seconds. "Often we're able to respond faster than someone right there in the same office," he says.

Managed IT services aren't for everyone. For small business owners with the expertise, inclination and opportunity to do it themselves, or the resources to hire dedicated and capable staff, the job may best be handled internally. But it's a safe bet that many more small businesses will be trying out remote PC support and other managed IT services. Providers are improving IT services, including check sheet-style offerings that allow small business owners to sign up for just the services they need. "Some are a la carte and it's $10 for this, $50 for this, per month," says Culler. On-site services, the most expensive, are billed by providers at $75 to $100 per hour of technician time.

Outsourcing managed IT services probably does makes sense for many small business owners who have better things to do than set up VPN connections, worry whether customer records are safe from hackers and deal with employees' computer hassles. That includes Patel. "If anything happens in my office," he says, "my staff doesn't come to me anymore."