WHITE MARSH, Md. — Small business owners are feeling the economic pressure and searching for ways to survive in an increasingly challenging marketplace.

WATCH: Local small business owners navigate economic uncertainty Local small business owners navigate economic uncertainty

Hiring has slowed across the region. Businesses are cutting back on expenses, and families are making difficult choices about their spending priorities. This economic reality is forcing small business owners like physician Charis James to make tough decisions about their operations.

James has lost nearly 30% of the patients in her direct pay medical practice since the beginning of summer.

"A lot of people have had to make decisions to kind of slow down on that journey to get themselves healthy because they had to

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