The volume of patients seen and RVU compensation can impact physicians' total income, and may create conflicts of interest that can potentially compromise patient care. For example, physicians may feel pressured to see a higher volume of patients or perform more procedures in order to meet productivity targets or generate more income, even if it may not be in the best interest of the patients. This can result in overutilization of services, unnecessary tests or procedures, and potential overbilling, which can negatively impact patient outcomes and increase healthcare costs. 

It is important for patients to be aware of the different compensation methods for physicians and how they may impact their care. It is also crucial for physicians to prioritize patient needs and adhere to evidence-based guidelines, rather than financial incentives, in order to ensure high-quality and patient-centered care. Healthcare organizations and policymakers should also consider the impact of compensation methods on patient care and work towards aligning incentives with the best interests of patients. 

The pricing of prescription medications is often opaque, with multiple stakeholders involved, including pharmaceutical manufacturers, pharmacies, health insurance carriers, and Pharmacy Benefit Managers (PBMs). PBMs are third-party entities that manage prescription drug benefits on behalf of health insurance plans and employers. However, PBMs have been criticized for their lack of transparency and how they profit at the expense of employers and employees. 

PBMs negotiate discounts and rebates with pharmaceutical manufacturers and pharmacies to determine the prices of prescription medications that are covered by health insurance plans. These negotiated prices are often complex, with various rebates, discounts, and fees involved, making it difficult for employers and employees to understand the true cost of medications. 

PBMs typically retain a portion of these discounts and rebates as their profit, which is not always disclosed to employers or employees. This lack of transparency can result in higher drug costs for employers and employees, as PBMs may prioritize their own profits over finding the best prices for medications. Additionally, PBMs may engage in practices such as "spread pricing," where they charge employers and employees a higher price for a medication than what they actually pay the pharmacy, pocketing the difference as profit. 

Furthermore, PBMs may also favor higher-priced medications that generate larger rebates or discounts, rather than lower-priced, equally effective medications, which can drive up overall drug costs. This can result in higher out-of-pocket expenses for employees and increased healthcare costs for employers. 

The lack of transparency in the pricing of prescription medications and the practices of PBMs can make it challenging for employers and employees to fully understand the true cost of medications and make informed decisions about their healthcare. It can also result in higher costs for both employers and employees, as PBMs may prioritize their own profits over finding the most cost-effective medications. As such, increased transparency and accountability in the pricing and reimbursement practices of prescription medications, including the role of PBMs, are important to ensure that employers and employees can access affordable and high-quality healthcare.