Originally Posted by W222

The sad thing that I now realize is that this will likely occur in EVERY specialty, with a few rare exceptions. No longer will medicine be run by internists/hospitalists, it will be run by NPs/PAs with almost complete independence. The ICU will be run by midlevels with some input from the CC physician (I have witnessed this taking place). The surgical specialties will resist this the most but they are going to see their reimbursement drop as certain operations are considered "too costly" and "unnecessary" (ie. knee replacements in 85 yo ASA 4s).