I think it's easy to blame the providers because 1) they are the "face" of the system and 2) they are relatively well-paid, but many times (especially in the emergency department) they don't even get a say in the price.
As another poster mentioned, physician salaries account for 8-10% of medical costs, but more importantly decreasing those salaries may not even decrease the cost that patients see.
Let's take the ED as an example... For the past several years, the average salary of an ED provider has been decreasing (due to the increase of physician assistants / nurse practitioners, who are paid less), but the cost-per-visit to an ED increased 235% between 2008-2017 even though ED utilization remained stable [1].
In the last decade, a lot of small physician-owned emergency medicine groups have been bought up by large corporations or health systems. As these large groups proliferate, they raise prices (to the tunes of 2x or more) [2, 3, 4], pay their employees the same or less, and take the rest as profit. So even if provider salaries go down (which these large groups often do anyways after a consolidation), little would change for the patient.
While some of these groups are led by a CEO with a MD, the physicians and other providers who actually see patients do not have a say in how things are run. In fact, some of these groups don't even show the providers how much they are billing for each patient, so it's really hard for them to do much about it [5].
But couldn't physicians/PAs/NPs protest, quit, or even start a competitor--shouldn't they? However, the larger markets (where the majority of patients are) are typically also the most concentrated, so sometimes it's the choice of one large group vs. another large group. I suppose one could move to a different town, but it's hard to uproot a family, and furthermore since these large areas are more desirable there's no shortage of folks who would take their place. And unfortunately for several specialties (EM included) it's very difficult to start a competitor, since one would also need to either secure a hospital contract (not happening if the competitors are health systems) or build their own facility ($$$$$).
None of this is meant to dismiss the issue, and I think physicians will continue to feel the brunt of the blame as long as prices remain high, but I hope it sheds a different perspective onto the issue.
As another poster mentioned, physician salaries account for 8-10% of medical costs, but more importantly decreasing those salaries may not even decrease the cost that patients see.
Let's take the ED as an example... For the past several years, the average salary of an ED provider has been decreasing (due to the increase of physician assistants / nurse practitioners, who are paid less), but the cost-per-visit to an ED increased 235% between 2008-2017 even though ED utilization remained stable [1].
In the last decade, a lot of small physician-owned emergency medicine groups have been bought up by large corporations or health systems. As these large groups proliferate, they raise prices (to the tunes of 2x or more) [2, 3, 4], pay their employees the same or less, and take the rest as profit. So even if provider salaries go down (which these large groups often do anyways after a consolidation), little would change for the patient.
While some of these groups are led by a CEO with a MD, the physicians and other providers who actually see patients do not have a say in how things are run. In fact, some of these groups don't even show the providers how much they are billing for each patient, so it's really hard for them to do much about it [5].
But couldn't physicians/PAs/NPs protest, quit, or even start a competitor--shouldn't they? However, the larger markets (where the majority of patients are) are typically also the most concentrated, so sometimes it's the choice of one large group vs. another large group. I suppose one could move to a different town, but it's hard to uproot a family, and furthermore since these large areas are more desirable there's no shortage of folks who would take their place. And unfortunately for several specialties (EM included) it's very difficult to start a competitor, since one would also need to either secure a hospital contract (not happening if the competitors are health systems) or build their own facility ($$$$$).
None of this is meant to dismiss the issue, and I think physicians will continue to feel the brunt of the blame as long as prices remain high, but I hope it sheds a different perspective onto the issue.
Disclosure: Am in healthcare.
Sources: 1. https://www.healthcostinstitute.org/images/pdfs/ARM2019_ER_P... 2. https://www.nytimes.com/2017/07/24/upshot/the-company-behind... 3. https://www.reuters.com/article/us-unitedhealth-envision-hlt... 4. https://www.mass.gov/files/documents/2019/02/20/2018%20Cost%... 5. https://www.aaem.org/resources/key-issues/corporate-practice...