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Notes -
I don't necessarily have a problem with physicians themselves so much as this attitude that seems to be shared by so many of my partner's colleagues that nothing can possibly be done to fix these systems and instead all the complaints are about individual doctors or features of the system. I've spoken to developers of Epic or one of the Epic competitors briefly and they also noted Doctors are generally hesitant to streamline processes(and working in a heavily regulated industry myself I understand the people aren't the only source of change resistance). But when you have someone who received a decade or more of education personally spending most of their time doing tasks a bright high school student could accomplish it's time to seriously consider burning the whole thing down and restarting.
Maybe you've been burned by incremental changes not panning out in the past but you need to understand that from the outside looking in the whole system is insane and every anecdote I hear only further cements this view. Maybe people in the medical field are just so used to dollar amounts not meaning anything that they truly believe it is reasonable for packing a nose bleed to cost $500 but that's a rate for like, world's greatest expert to fly in and consult in any other field. I'm willing to believe you that there is some important art involved here but if that's how much it's worth to do that service there should be vocational classes for it and someone without an advanced degree should be doing it. The average hourly wage in the united states is something like $30/hour if we call the bandages a hundred bucks that is 13 hours of average wage to pack a nose, someone could make the average American hourly wage and do this procedure 3 times a week to be working full time. Obviously none of this is that simple but do you not see how this doesn't pass the smell test(no pun intended)?
These days physicians aren't in charge of anything, we've been pushed out of administrative and leadership roles (for a combination of reasons including legislation and the fact that nurses are scrambling for admin roles etc. etc.).
I'm not sure that's the correct read from the Epic devs you've spoken to, it's pretty common to use Epic installs as a way to hone broken processes but that's in the limited domains where physicians have control over workflow, which isn't too much. The admin side of things do want to make things more efficient and sometimes that works but other times things are weird for a reason (such as excessive regulatory burden) and people coming in from non healthcare business just can't get the complexity through their heads (Epic is generally good about this, but Apple and Google both dipped into healthcare IT and fled for a reason).
It is true that lots of doctors have limited technical ability and don't elect to use tools like hotkeys and that's probably what the devs are talking about. It's also true that doctors spend a lot of time complaining about documentation and administrative burden but then don't optimize their personal workflow. That's not a new problem though.
Re: the 500 dollar rate. The PA isn't getting paid that, 450+ dollars of that fee is going into whoever owns the PA (likely a private equity backed practice management group these days). Also possible that the charge is that high as part of the insurance negotiation dance and whoever owns the PA is just an asshole (again more likely with the outside investment). Also possible that OP is confused and it's supposed to be overall professional fee charge for the facility the ED is an extremely high level of care and the average patient might be using the services of 30+ employees or something else crazy like that (a lot of which is invisible like the cleaning staff and unit clerks).
People aren't supposed to go to the ED unless they need it.
Also for a lot of visits you don't pay for the service you got, you pay for the rule out (which may or may not involve additional testing).
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