>>Here, the E/R MD's are independent contractors and we get a separate bill from them.

And the same fee is levied when they're on a salary. Ask yourself why physicians are willing to give up the alleged $117K for an afternoon and go onto salary, and the truth starts to out. Fact is that most physicians prefer doctoring to admin. The rapid conversion from independent professional to salaried employee shows that mammon is not the primary concern for young and female physicians: they go for flexibility of hours, the certainty of finishing at 4:30pm in the afternoon and better lifestyle, something that never can be undone once it starts. I'll tell you what comes next: a series of administrators who expect to treat physicians like factory workers because they're on a salary and therefore are underlings. The result always is an increase in cost while the responsible manager banks a bonus for any short term gain, makes the entry in their CV and moves on. You have this ahead of you in the US: a marked increase in prices despite paying physicians less and less while delegating more and more to apparently lesser paid caregivers.