I'm not an NP (but was going to school to be one) but just a regular nurse (my 2nd bachelor's). I work in a major teaching hospital in our state, affiliated with a local medical school and I can tell you that our NPs and PAs are used as permanent residents (that's our nickname that they agree with).
I think when most people decide (at least in my case anyway) to go to medical school, it isn't how many letters I'm going to have after my name (I already have more than 2) or how much money they are going to make (because we all know that the amount of time physicians put into their work, they are compensated, but if you compare with business, they should be making a TON more) or with whom they are competing for patients. My mother was going to residency when there was a big push and movement to increase the amount of nurse anesthetists instead of anesthesiologists because quite frankly it would be cheaper for the hospital (turns out, nurse anesthetists turn over all sick patients to MDs anyway). Now, it's the same thing for NP and PA movement into primary care. I think this one is more realistic than the former, but at the same time, the way I look at it - a physician is always a physician. Whether DO or MD, it's a different category of people, education and level of conceptual understanding.
I work in an ICU where NPs sometimes take call and our PAs do all the work the surgery MDs don't want to do and some of them are awesome (better than our docs) and some I wish weren't there at all, but I somehow just don't think that NPs and PAs can ever replace (even in sheer numbers) a physician. They ratios may be different but PAs have to have EVERYTHING co-signed by a physician in the end (since they are "an assistant" and NPs (at least in our case) most of the time consult with an MD anyway. In OB, NPs automatically turn over ALL critical or high-risk patients to an MD, so I think the fear that there may not be jobs for MDs or that their salaries will go down is slightly premature.
In addition, I am from another country and my husband parents and my parents both worked as MDs in various specialties in two different countries in Europe and there, there is social medicine - same as what Obama wants to pursue (actually a smaller less drastic approach). There doctors do not make $500K but they do make a lot more than anyone, except maybe for business (which is also true in this country). So, even if Obama does this "dreadful" plan of his that some of you had referred to, a physician will always remain a physician and salary or not, there are a million and one ways that a physician can make money besides working in a clinic "overtaken" by NPs and PAs.
I think we will all be fine.
If anything, if people choose not to apply to medical school because of his plan... it's more chances for me to get in.
