Your reprint of the investigative piece from The New York Times misses the mark. Physicians account for about 15 percent to 19 percent of health care expenditures thus they cannot themselves be a major factor in driving up health care costs.
In the current marketplace, physician fees are set by Medicare rates, commercial plans are usually tied to that rate. The high cost of medical care is largely the result of public expectations of unlimited access to the highest quality care at very little out of pocket expense. I expect Ms. Little (the patient) was told that she could have the tumor cut out or have a more expensive but cosmetically more acceptable Mohs surgery.
Specialty practice involves the application of special skills, usually learned by extra training (in my case, six years compared to the three for primary care; most of that time requiring call every other night), the assumption of increased risk and liability and a requirement to be available for emergencies nights and weekends.
In terms of the entrepreneurial nature of medicine, I like many other providers, am guilty. I can assure you these endeavors are not a major source of revenue but in our case allow us to ensure a quality service.