To clarify, I think mid-levels are an essential part of the healthcare system and help physicians do their jobs better. However, the job they were initially intended to do and which they are still trained to do is no longer the job many of them are doing. They're practicing outside of their scope with inadequate training and that's dangerous.
NP education is a problem. Online schools are expanding rapidly which is another dangerous trend as many of these graduates will have no real clinical experience when they start practicing. Something only the nursing board seems to allow as opposed to every other professional board which requires extensive clinical experience.
Depends on where you're at and what field you're talking about. The hospitals I rotated through in med school almost all hired internists themselves. They weren't contracting outside groups. So yea, administrators were responsible there. You're right that the amount of facetime is determined by docs. But when you're carrying 25 patients how much facetime can you realistically provide? If you spend 10 minutes with each patient that's over 4 hours at the bedside not counting time it takes to go from room to room and talk to other members of the team. Rounds would literally take 6 hours. Then you've got orders and notes for 25 patients and that's assuming no other complaints, questions, or problems arise. That's not a realistic schedule in any setting.
The administration may not directly determine facetime, but they often determine patient load based on how many docs they're willing to hire. Let's not pretend like this is all on us.
I find this post ironic for many reasons, partially because I grew up in that general area (though not a suburb as well-off as Winnetka). You're making several bad arguments here though. First, you're assuming that your cousin is a typical physician when he's in the highest paying field for all IM docs other than maybe interventional cards. It's easy to say "look how great they've got it!" when your reference point is making double that of the typical doc. You're also assuming all your attendings are financially well off just because their kids go to fancy schools. How do you know they're not still in significant debt or that they didn't have parents paying for their education? Again, not really proof of anything. Additionally, even the 90's and early 200's debt was nothing like it is today. Here's a chart from the AAMC graduating student survey that shows average debt at those times:
You'll notice that even back then the average debt was literally half of what it is today, and pay is NOT significantly higher. There are better charts out there, but this one fits the time frame you're referring to.
We also have very different circles of college friends then. Many of my friends made 6 figures straight out of college working in finance and accounting and a couple are now making physician pay. Even the ones who aren't though are financially as well off as most docs in the big picture. More on that below.
If the bolded is true than you are far outside the norm. When people are able to moonlight, they're making closer to 30k/yr on average. You're making $100k more than that. It's not fair at all to compare yourself to the "average" med school grad or resident. The average resident will graduate medical school with ~$225k in debt which will end up being $275k by the end of residency when they're 31 years old (average matriculant is now 24 and assuming 3 year residency). Not outrageous debt, but given that many don't want to keep living like a resident, want to start a family, AND have what will likely end up being $350k in debt repayment, it's a much bigger deal that some people make it out to be.
No, it's not insurmountable, but it's also not a "shrug, it'll all work out" kind of deal either.
Not completely wrong, but there are many jobs that pay 6 figures that require nowhere near the time or financial commitment that medical school does. Let's come back to the part from above and break the numbers down though. I know many people who made 6 figures straight out of UG and they took on a relatively small amount of debt (<25k). Let's run some numbers on 2 individuals who both retire at 65 and contribute 15% of their income annually to retirement (recommended amount) at a 5% interest rate:
An accountant will graduate from college with minimal debt and can start making 6 figures straight out of UG. Investing $15k/yr for year for 43 years (22-65) will end up with a retirement savings of $2.25 million, with 71% (1.6 mil) of that being money made through investments. Additionally, they can start their adult life far earlier, start a family sooner, purchase a house in their 20's, etc (many of my hs and college friends fit this profile).
A physician will finish residency at 31-32 and if they invest $30k/yr into retirement for 34 years they'll end up with $2.52 mil, with only 61% (1.5 mil) of that being made through investments. So actually less passive income than the accountant. That's also not accounting for the massive educational debt they'll be paying back. So they're getting a later start, taking on more debt, and their overall net worth isn't all that different. Let's also keep in mind that the accountant is probably working less hours and has a far better lifestyle than the physician until they are in their 40's and the docs have their debts paid off.
Now there's 2 major differences between medicine and most other fields. The first is simply job security. If you have an MD or DO degree, you'll pretty much always be able to have a job somewhere. Some other fields have great job security, but not like medicine. The other point is earning potential. As you pointed out, sub-specialists can make a lot of money. However, you said everything after acceptance is straightforward, I'd argue that to land a residency in one of the top fields (ortho, neurosurg, derm), it is far from straightforward and you have to be above and beyond to get there. Some people simply aren't capable of this.
So yea, physician is a solid gig. However, it's not the field it used to be and there are plenty of other options available for those wanting to be financially secure that don't involve 7-11 more years of education after college, have nice lifestyles, and are still strong financial options.
The problem is that massive numbers of NPs who aren't on that side of the fence. So many so that it's no longer a minority. It's a legitimate and serious problem.
I know of a few NP FB groups with thousands of members who would disagree with you. Google "Brain of a doctor, heart of a nurse" and get ready to feel depressed.
