I'd say the root cause are the reimbursement models in the US, and the players contributing to that are the Government and Payers, along with Physicians themselves by way of lobbies and professional societies.
Providers are trained and incentivized (primarily) to treat acute illness, often in a reactive way. Particularly those providers with the highest compensation (sub-specialists, proceduralists, etc...). I don't feel like we hear a lot of complaints from those providers. They make a lot of money, and are not typically responsible for the long-term care or management of the patient. Any metrics they are responsible for are usually process type measures around safety and individual procedure outcomes, and a lot of that is handled by their larger care team.
Where we hear the most dissatisfaction are from the providers such as primary care, internal medicine, pediatrics, general cardiology, etc... who have the biggest responsibility of caring proactively for populations of patients. However, to do that effectively, requires more data input, more population health-level review of care gaps, more coordination among their care team and specialists, etc... all the while making significantly less than their sub-specialized peers.
What we need to do is find a way to balance the reimbursement model, and better reward those providers who have the true impact on the health outcomes of our populations, not on individuals or elective procedures. Or better yet, providers who are trying prevent patients from moving up that health acuity pyramid into more costly and comorbid cohorts.
I often wish I could gauge how providers actually feel about the situation. Like if we removed the price controls and quality measures that cause most of the overhead, would you be willing to sacrifice half of your total lifetime compensation? If you make more than a quarter million dollars a year, would you be willing to sacrifice two thirds or three quarters of your lifetime compensation? If you make over half a million a year, would you be willing to forgo four fifths or more of your lifetime income? That’s what doctors work environment and compensation look like in countries that don’t have this administrative overhead - they don’t have it because their doctors don’t get paid an exorbitant amount because their doctors can’t price gouge.
Health CARE is what happens between a clinician and a patient. Its amazing and beautiful that some humans will pay hundreds of thousands of dollars and devote a decade of their lives to learn how to care for others. The business of healthcare delivery now has too many layers to be cost-effective. Each of us could probably get a PhD in healthcare delivery economics and fall into only two categories: Free Market or Single Payer.
If you say it is insurers or the government it must come back to physicians themselves. Health care insurance was started by none other than the AMA in 1939. They created Blue Shield because...get this...health care costs were to high and they came up with the insurance idea to better market their services. Unions back then jumped on the idea as a good employee benefit. AHA started Blue Cross in 1941 for hospital care for the same reason. As for Medicare/Medicaid in 1966 AMA was strongly against it but demanded that their be separate Part A and Part B components, which has made payment and administration very complex. Try today to take away Medicare from docs and 90% would march on congress. MD millionaires did not exist before commercial insurance or Medicare. Be careful what you wish for.
We wouldn’t have insurance companies and the associated overhead if physicians hadn’t pushed so hard to keep healthcare compensation private.
This is a complicated sociotechnical problem. The government made a lot of rules about billing and quality measurements. The insurers copied those rules. The EHR vendors codified those rules into existing EHRs poorly. The healthcare organizations are merging to deal with complexity of these rules. The docs are selling out because the rules are too complex. The docs want to get paid the same as always, but the work/patient has increased significantly. The patients see tv, YouTube, and google and are being unrealistic in their demands. Unraveling this mess will be hard.