I recently had a conversation about this with one of my professors (an MD JD himself who works on health policy, a very respected prof here) and I tend to agree with the argument he made.
1. In the fields where what the OP claims is generally true - primary care fields - doctors do not think they are compensated enough and patients think it is too expensive. In his words, "this is a market that will not clear unless taxpayers are willing to spend a lot of money" but it doesn't change the fact that people need those services, some more than others. As a result, expanding training and scope of practice for mid levels seems like a logical thing to do since docs are not willing to take enough of these jobs. Obviously, there are some questions here about whether this is safe, correct, etc.
I asked him if he was concerned that training and expertise differences between mid levels and MDs concerned him and he said there are certainly troublesome gaps but we would be outright lying to ourselves if we didn't admit there were not worse gaps in the current system where a huge subset of the population does not even have access to primary care services or cannot afford it. For most problems, a PA/NP following the cookbook will be just fine and problemstic cases can be referred.
2. The role of the physician is changing. There are going to be a lot more avenues for people to receive care in the future and few of them will require a physician to be directly involved or co-locate with the patient. Telemedicine, health monitoring technology at home, etc. Acute and complex care will most likely always be the domain of the physician but many services do not truly require a physician's eyes. Furthermore, docs will have a greater diversity of roles, sometimes simply as managers rather than the point of delivery of care.
It's hard to say how much of this is good and bad for physicians and for patients. Time will tell.
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Starting To Have Doubts About Medicine
