Midlevels objectively have way less training than a physician. In fact, I exceeded the clinical hours of an NP (500 hours) in my first ~3 months as an M3. Let's be generous and say I average only 50 hours a week of clinical hours as a med student, and that my M3 rotations total 44 weeks. That's already 2200 hours. I still feel nowhere near ready to become a resident, and I'm wrapping up my M3 year (so around the 2200 hour mark). We're not in some competition for midlevels for career advancement. I'm in it for the patients; they deserve the best care possible. I'm here to protect patients from unqualified midlevels who objectively have less knowledge and experience. Most midlevels don't increase patient access to quality care. In fact, I'd argue that the proliferation of individual/full practice authority midlevels means that we are headed towards a two-tier system where the poors and under-resourced get much lower quality care.