I think it’s already happened or is happening in literally every field you mentioned.
Others mention aviation and that's an interesting correlate. The autopilots on the big jets today can and often do land the plane as well so the need for the pilot is negligible. You really could safely operate these aircraft with no pilot at all, but I think the public would balk at getting on a pilotless aircraft right now. There's also the simple fact that the pilot is one of the cheapest parts of operating a large aircraft. There are some interesting startups looking at using pilotless Very Light Jets for air-taxi services; if these gained traction and acceptance, then ultimately I could these spreading to commercial aviation at large. This actually sounds a lot like how midlevels have permeated the medical field!
So why would we want to spend the time and money to do a job that someone can do with 2 years of online courses? Or less? Hiring NPs and scribes and other support staff have actually been shown to improve physician happiness, likely because it offloads much of the crap work that we don’t want to do while simultaneous increasing revenue for the practice. The incredible numbers of new NPs coming out of school each year will only put more downward pressure on wages and allows physicians to pay less and less for these services.
How this will impact the profession as a whole remains to be seen, but I see the midlevels being ancillary players in a bigger story. Their push for independent practice dovetails with a major push from business to provide better, more convenient health services to their customers. The minute clinics and wal-mart primary care clinics and urgent care centers are all being staffed by midlevels and will certainly siphon away more and more of these generally lower acuity patients.
This is where it's interesting to me, because I personally think that if it were NPs clamoring for independent practice in order to hang out their own shingle across the street from the local family doc, none of us would care much because most patients would prefer to see the MD unless the midlevel could offer a lower cost or more convenient service. It's when we overlay the CorpMed aspect, the Sam's Choice NP clinic, that the threat changes and we see that the traditional MD practice model simply cannot compete with the low cost and convenience of these options. Again, I would cite the simple fact that none of us here avail ourselves of our own product when we or our family members get sick.
The midlevel debate is, to me, a red herring while the real threat to our current practice model lies in the rise of commercial medical care products that are more appealing to the average consumer than what we currently offer. All physicians, and primary care in particular, will need to offer a product people actually want to buy at a price they are willing to pay.
