I'm actually expecting doctor's moat to break in our life time. We're already seeing the beginnings of it.
Essentially, physicians have been so bottlenecked for so long that a bunch of states has simply said "screw it" and started paving the way for mid-levels (NPs and PAs) to operate in certain roles physicians have previously covered. The physician lobbies seem unwilling to address this, so I expect that mid-levels will continue to move up the chain. They know the market is desperate for a solution and physician interest groups are completely unwilling to provide that.
Midlevels don’t necessarily hurt doctor compensation, because they are supervised by the doctor, who gets a cut for managing them in private practice. In hospitals it frees up doctor to do more high value procedures instead of lower value follow up visits in clinic.
IMO, a model where a doctor leads a group of mid-levels seems pretty much ideal. It's like the senior dev leading junior engineers.
Unfortunately, it seems AMA has been so resistant to any change that enough places are simply saying screw it to oversight and allowing mid-levels to practice independently (with limited scope). i
Essentially, physicians have been so bottlenecked for so long that a bunch of states has simply said "screw it" and started paving the way for mid-levels (NPs and PAs) to operate in certain roles physicians have previously covered. The physician lobbies seem unwilling to address this, so I expect that mid-levels will continue to move up the chain. They know the market is desperate for a solution and physician interest groups are completely unwilling to provide that.