I haven’t come across a single doctor in Germany who didn’t have at least one office assistant to handle incoming patients, schedule appointments and do the bookkeeping. Most doctors seem to have more though these days as the administrative burden has increased. There’s also a trend for doctors to share office space and have a joint office and reception (also to reduce cost).

That makes sense. But many U.S. medical offices have people devoted entirely to billing insurance companies and fighting with them over what will be covered.

Exactly, plus all the people at the insurance company that are paid to try to find ways to NOT cover it or to pay at a lower billing code.