Consider that even if a married couple maintain strictly separate accounts, negotiate with one another about how much of each partners' money should be spent on this or that expenditure, and live separate financial lives, in a lot of places it's still all marital property. So in the event of the (very real and frequent) diverging life goals you raise, all the hardball they played with each other doesn't even matter. I don't have the password to your bank account where you keep "your" cash, but just wait until I call my lawyer to claw back my half of our marital property!

This seems like the healthiest approach I've seen so far in the thread. Honestly surprised hearing about managing incentives, and accounting for this and that. My wife and I also just have one big pot of money. We budget and spend from shared accounts and financial services. We talk through major financial moves (investments/purchases) before either executes. I cannot imagine having my life this intimately entwined with someone else, but then carving out our finances as something to keep separate and negotiate over.

I suppose that all makes sense, and what to me seems like a simple "Look at x-ray, and tell me if you see a broken bone" operation may be more complicated than I am imagining. But I still have a hard to shake feeling that there has to be something better than "Start a whole new workflow with another doctor within the same system, beginning with an in person appointment".