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Notes -
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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