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I was just listing that there are many other things that are expected to be included in the relatively small physician fee (usually about $60 in the end for a typical visit). When I referred to the communicating with pharmacies part to give you more detail, I mean writing all the orders for lab tests and medications, communication with the pharmacy about any issues that arise. Many medications aren't very straightforward to send to the pharmacy. They can involve additional paperwork from the insurance company or the drug manufacturer first that a doctor needs to fill out first. A lot of newer drugs must be routed through particular specialty pharmacies and they have their own special procedures that must be followed. Some drugs have programs with the company the doctor has to be enrolled in/compelte to certify education in their drug, some have their own special consents. Another reason many physicians don't work on their own anymore is just obtaining medications for patients has become its own herculean task, so many medical departments now have a medication access team of full time employees that just specialize in getting medications started for patients and making sure all these different things are taken care of.

But the point of it all really is, in many cases there's just as much work behind the scenes for the doctor, if not more so, than the actual time spent during the appointment, all also expected to be covered by a relatively small fee. And all of that starts compounding even worse the shorter the appointments are as that background work from even more patients builds up, and that's yet another pressure squeezing in on time with patients.