I think you are somewhat missing my main point. Doing well financially does not necessarily mean receiving the highest salary. Business acumen means that you have the skills and the drive to not rely only on your income. That's why someone who is making far less money than you are can be more financially successful - and I know several people like that.
Anyone who relies on salary alone is not going to become wealthy. Since doctors are still in the top 10% or so of income earners in USA, they are in the best position to make their money work for them.
Also, it is NOT up to your accountant to save you money. Your accountant is not your personal consultant. All he does is ask you to give him your financial statements, Quicken, Quickbooks, etc, and
based on that he tries to save you as much money as possible. He only works with whatever you give him. "Garbage in, garbage out" is completely apropos here. It is really up to you to be financially involved in other areas as to allow not only for additional tax breaks, but additional income. I disagree with you that "all savvy doctors have sold their moral compass to the highest bidder." Besides being a blanket statement, it reveals a certain level of inflexibility. What makes you think that the only way you can make extra money must be related to medicine?
Since you may disregard arguments from someone who is not aged enough, I refer you to a very bright attending right here on SDN: Andrew Doan. Read these posts by him (and threads too):
Post 22,
For those seeking financial independence
It's interesting to see how many people don't get what he's trying to say. They blame the books for not being "specific" enough, etc. But, you either get it or you don't. And many don't.
One more observation: I assume that you have been practicing for many years. Since the compensation for primary doctors didn't change overnight, it means that you have had a chance to work under the previous system which according to you was much more generous to primary doctors. Judging by your posts, I assume that you really have not accumulated enough wealth, even during those years when you were compensated enough. This again illustrates my point that if you don't manage your money properly, it doesn't really matter if you make a lot of money or not. You should probably be happy that your income is in the top 10% of US because you if you made as much money as those with masters degrees or Ph.D.s (average of about 60K), I doubt you could make ends meet.
Just to be clear, I agree with you that given the expense and duration of medical education, primary doctors are not compensated enough. But my point is that even with that income you have many options to explore secondary sources of income without having to impugn morality.