>>At the VA, the MD's are salaried. They're thorough, careful people but are very low key about screenings and are skeptical about the same meds that the "entrepreneurs" push constantly.

But as society changes, you need to ask why the people we want as doctors would do it. I can't find the citation, but a very wise man once said "beware the poor doctor." I agree: doctors used to be amongst the best paid which made it easier to behave in a selfless fashion, but now are also rans compared to the B graders who went to business school and the A class boys and girls who didn't get into medicine but did law. You can argue that it ought to be a vocation, but you'd want to be a nun with no offspring to live that reality in 2015. My point: be careful what you wish for. There was a time when physicians could obtain 80% of the diagnosis by interacting with the patient. Replace that with barrages of expensive tests and a) costs skyrocket and b) it's no longer a vocation to tick boxes and listen to the machine that goes ping rather than the patient who only gets to talk to the harried physician assistant with her e-clipboard. We're at a crossroads IMHO and shifting physicians to salaries encourages newcomer know-all managers to think of docs as commodity workers and here we go.