Actually, at least in the medicine systems I know (France and Belgium) doctors can either be independent or employed. It's about 50% each in both countries. In

Actually, at least in the medicine systems I know (France and Belgium) doctors can either be independent or employed. It's about 50% each in both countries. Independents are paid more when they do more stuff, but employed doctors are usually paid a fixed salary depending on fixed work hours. Depending on the system, the practice either bills patients directly per consultation, or the social security organization, or gets a fixed income from social security or from the ministry of health that does not directly depend from how many patients they see. All three systems exist. Best practices and procedures are usually handled at the hospital or... "medical house" (maison médicale or wijkgezondheidscentrum, the place where several non-independent doctors work as a team) level. It is indeed not something that really gets standardised at a higher level, although doctors also have a number of mandatory meetings that get conducted with attendees from different practices and that help with diffusing procedures, best practices and knowledge. They don't all get in sync at the same time, but knowledges and best practices do diffuse through all doctors. Although independents usually try to attend the bare minimum because meetings directly translate to missed income for them. I don't think the current model is wrong, although I think independent doctors are ill equipped to stay up to date, and not enough incentivised to do so.