But when it's not a matter of dollars, what IS the difference?
Those new shoes are an expense (unless you have no shoes at all). If you have to make room for them in a closet already jammed with shoes, then they're an expense. Period.
An efficient patient management system backed up in the cloud is an investment. It may cost money to purchase and maintain, but it makes your practice function more efficiently, saves both your staff and your patients time and keeps your records from falling prey to loss, misfiling and for the most part, physical loss or hacking. Not to mention you HAVE to do the EMR thing anyway.
Marketing your business, however you do it, is an investment.
So, go for the expensive card stock, pay well for a web site that works for you 24/7, incentivize your staff, hire a photo tech or pay to train a staff member, pop for the unexpected bonus, offer your patients loyalty incentives and serve good coffee in real cups.