>>I really did answer your question.
>>A long time ago I learned that there is usually a reverse correlation between the amount of time I spend on a project and the value of the outcome to the client.
>>The notion that time = value might relate to manufacturing widgets but it certainly doesn't apply to professional services.
>>Ethics, creativity and skill, in that order, trump time.
>>Anyone who saw what happened to the accounting giant Arthur Andersen can attest to that.
>>It often occurs to me that I do some of my best work for the client while the clock isn't running.

When I trained we believed that history is 80% of the diagnosis. Taking a history takes time. Not enough time means tick every box on the form means increased cost means more patient dissatisfaction because they perceive the doctor rushed them through and didn't really listen. But spend longer with each patient, and the insurer or Medicare won't reimburse you more. You'll just be driven out of business or your spouse leaves you in disgust because you can't afford kids. So tick, tick, tick goes the pen and ka-ching ka-ching ka-ching goes the cost of care.

>>Yes, I'm complaining about medical costs.
>>They are outrageous.

They are outrageous. But if you try to reduce cost by rationing physician income or time, IME the cost increases. The physicians abandon ship and/or payers discover the hard way that whenever you replace a physician, the individual income of the newcomers may be less but you need far more of them, and either they adopt fads (immunization is dangerous! Home birth is best!) or they elevate box ticking to a fine art and then they demand more pay because of their enormous responsibility and then comes the claims of liability for burnout and suddenly you realize your costs have quadrupled. I don't practice any more, but I'm privileged to have spent 25 years watching this stuff and I've seen this pattern repeatedly.

>>An X-Ray that costs $1,500 is intuitively obscene.

Not just intuitively: of course it's obscene. But the degree of horror doesn't map to equally outrageous blaming.

FWIW, some years back Japan unexpectedly set a cap on the cost of CT scans. After much wailing and predictions that CT scans would become unavailable to Japanese patients, Japanese tech companies came up with scanners compatible with a cost of around $200 for a CT scan in 2018 compared to $4K in the US.

This contradicts the market doctrine that centralized control over prices distorts the market and damages consumers. Yet as they say in science, the animal is always right. But science also says don't target the physicians for things like scan prices, unless you want your costs to go up and up.

>>Compensating pharma reps based on the number of prescriptions their assigned MD's write is obscene.

If you can dismantle opportunity of undue influence over physicians to score prescriptions, it's just the standard sales territory model, surely. FWIW, New Jersey recently passed legislation limiting interactions between pharma and physicians. $15 meal, anybody? That's the maximum now permitted. Perhaps going too far, since ethical physicians also learn about new therapies by attending sponsored conferences. For comparison, consultant physicians in socialized systems can be allocated $20K or more per annum in addition to their salary, to cover CME (continuing medical education). So that's a realistic cost to stay up to date in 2018. IMHO medicine carries an unusually high education cost and unusually high community vested interest that it does occur, so reasonably it should be a ring fenced budget. Split it out from overall income so it can't be spent on little Johnny's orthodontics this year and medical associations can set reporting standards. Works well everywhere else.