[Calavar]

Insurance based reimbursement is not financially lucrative for physicians. That's why plastic surgeons, who take almost entirely out of pocket payments, are the highest paid physicians.

As for why US salaries are so high, it's because the training it so much longer and more expensive than it is in other countries. The most common training scheme for general practitioners internationally is 6 years of medical school + 1 year of internship. In the US, it is 4 years of undergrad + 4 years of medical school + 3 years of residency. Add on the ridiculous pricing for higher education in the US (public medical schools charge about 50k/year, and since medical school is a type of graduate degree, med students do not qualify for subsidized Stafford loans) and it would be financially untenable to be a physician in the US if salaries were the same as they are in Europe.