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This. But also add medical facilities like hospitals, medical equipment manufacturers, and drug companies.

A lot of times people equate the entire charge they receive with the physician fee. But only a portion of that is actually for the physician. In a hospital stay you'll often get a separate much smaller bill that's actually for the physician, the main bill has nothing to do with them and is entirely from the facility and other costs.

To give some perspective, for a brand new patient outpatient visit for a very complex and likely multiple medical issues involving multiple medications, some of which are high risk, likely an hour long visit minimum if not more. Highest the physician can bill is about the equivalent of 200 bucks (like 6 rvus). More typical visits would be closer to like 60 dollars. Rest of the fee is the facility or games the hospital is playing to get your insurance company to cough up. What the physician themselves can actually bill is quite strictly regulated, and even that portion rarely goes directly to the physician nowadays (physicians are mostly employees now who don't get the fees directly, their employer does). Their fee makes up more of the charge in a outpatient visit, but for a hospital stay the physician fees are usually a single digit percentage of the total cost. These issues are also why you see concierge medical clinics opening up where they just take cash, because the actual amount physicians themselves can bill isn't that big. Oh and the fee is supposed to cover not just the appointment, but all the time they take documenting a visit note (which is gonna take a while for a complex one hour visit), all the prepatory work for the visit, communicating with other health care providers or pharmacies etc, and any follow up care or questions.

Not to mention the pressures from above with employers forcing doctors to see more and more patients in a shorter time. Anyways, point is, doctor isn't to blame here. We need socialized medicine or something like it badly.