>>As I said once before, when I and other patients (who generate income for the MD) have to wait till the MD plows through the line of pharma reps lined up in his office, I can only make one of two conclusions:
>>a. the MD is running his office for the benefit of mankind because he inherited zillions
>>b. he's getting more income from the pharma reps than from the saps waiting in his office.

How about

c. The physician is expected by you to stay current wrt drugs and available therapies and since (unlike a lawyer) the physician does not get to charge you for such "research," it gets interleaved into the working day.

FWIW, your physician's license depends on being able to demonstrate sufficient CME (continuing medical education) activity. And while pharma investment in CME has no regulatory limits, the ACA includes a provision requiring pharma to document every exchange of value in excess of $10. So there's another positive ACA attribute making backhanders more difficult.

Meanwhile almost all employed physicians, most hospital physicians and an increasing number of self-employed clinic physicians, no longer allow pharma reps to visit. Almost 2/3 of physicians in Vermont refuse to see reps while New Jersey lags in the bottom 3 with only 26% refusing. The only state worse than NJ is Mississippi. I'm expecting these numbers to increase rapidly now that internet and ACCME are making efficient CME more accessible.

Certainly I agree that if you are on time for an appointment and you're made to wait for people you presume are pharma reps to troop through, that's pretty poor.