Okay: then what is the alternative to the current road we are currently on? Do you have a rebuttal to the situation as I presented it earlier; namely, that if we just continue to do nothing then other forces will step in to try to meet a need that, by all accounts, must be met (unless you would like to argue that we should just leave underserved areas underserved) and those forces will include the expansion of rights of mid-level providers (a process already underway) which will eventually enter other, more competitive markets at a lower labor cost, crowding out physicians and driving the physician market up towards sub specialization or, in the long term, creating a two tiered system where only the very well insured and willing-to-pay-out-of-pocket see physicians and the rest don't or only see physician extenders for the majority of their care?
Personally, I don't think the current system is sustainable if the profession is to thrive. Survive it will but thrive? The current system does not provide for the healthcare need of the country, is needlessly expensive because of its focus on downstream, acute, and chronic care and unwillingness to expand the responsibility of the physician beyond the short horizon of an individual patient. Further, it does not have incentives to nor is it geared to (profitably) create incentives for the free exchange of patient information which is the backbone of and a necessary requirement for a healthcare system committed to the improvement of the standards of care. Physicians would thrive in a system that would commit itself to universal access, service, and the free exchange of patient information. That is the system that has a need for a healthcare provider trained in the scholarly approach. The system we have now, one based on individual transactions, that treats patient information as proprietary and as an asset, that is not universally accessible, that has a varied and uneven standard of care depending on geography and tradition, that has no incentives to simplify and streamline access to preventative and primary care, is wasteful, inhumane and immoral. This is a massive problem. That is why I think force is the only answer left us to try to move the system in a more productive direction. The problem of the underserved is the most pressing and basic problem to solve because we can't have all of the downstream benefits of a more efficient healthcare system committed to continuous improvement without universal access. If force gets us a quarter of the way there, I don't care how many residents leave as soon as possible (hell, I would imagine some of them would end up liking the lifestyle and stay anyways), as long as people are getting out there and doing what needs to be done.
I'll admit I have no idea what it would take for attendings to get to these places. That's a real problem, very difficult. I don't think infrastructure will make it out to these places before there are people there to use it. I really don't. I also have no idea how to make it so they would within the current economic ecosystem. I wish I knew how it was that other countries managed to do such a thing so that we could mimic their system. Maybe it just comes down to picking the right people in admissions.