[the_d3f4ult]

I'm a medical sub-specialist. When I trained, my primary care mentors were simultaneously some of the smartest and most poorly compensated physicians in the system. I have to master a very narrow body of knowledge to function well. To make a good differential, a family medicine physician has to know a lot about everything. This skill saves the medical system tons of money by preventing unnecessary testing, lab work and specialist referrals. It also saves lives and dramatically increases patient quality of life. I can't emphasize enough how hard this is to do since, in the American system, you can be held liable for any missed diagnosis. You have to be sure that you're correct and it's much easier to just order everything and discharge the liability to a specialist.

Practicing primary care in this era is a nightmare. Like the article says - most clinics are run by PE or hospitals that push 'providers' to see a complex patient every 10 minutes while absorbing none of the liability for rushed, low-quality care. The compensation for these positions is now significantly less than most of the salaries that you see in the "Who's hiring?" threads on HN except with a tremendous amount of liability attached, a ton of customer service and a guarantee that your salary will go down relative to inflation.

The idea that NPs or PAs could just fill in the holes in our primary care system was always laughable to anyone who understands how medicine is actually practiced - to do the job well you need well trained, highly intelligent people. The punchline of the joke is that very few PAs/NPs ever intended to go into primary care and now the market is flooded with "Psych NPs" and "Derm NPs" pedaling Ritalin and botox.

Nothing will fix this problem short of a complete, ground-up rebuild of our healthcare system.