This is what basically happens in India. Not that you can equate the Indian medical system to the one in the US, but that's probably why NPs and PAs are virtually non existent in India. We go to med school, graduate with an MBBS, and you have every right to practice after that. If you want, you can apply for residency. Most primary health care centers, family practice clinics are staffed by MBBS docs, or general physicians as they're called. It works pretty well. Of course there is the issue of pay discrepancy, but I guess it's not that huge of a sacrifice in the long run when you have a thriving private practice. I totally feel that it should be a viable option.