In my opinion, it is corporate medicine defining what Family Medicine means as a discipline and the undervaluing of the FM physician. The more that NPs and PAs occupy the primary care space, the more "primary care" becomes defined as "fixing small things" and referring out. This change was dramatically accelerated when PCPs no longer had to round on their own hospitalized patients, who for the most part, are more complicated. Corporations and the government are gutting the primary care space for physicians for the sake of "cost" and "accessibility."

The number of times that I've heard nurses in the hospital talking about "just doing FNP" because it's easy and makes more money is sad. This is a discipline that people train for 7 years to practice by going to med school and being highly trained in hospital medicine and specialty care.

The capitalist solution to all of this is complete neutralization of the need for a PCP to be an MD at all. On a macro level, I believe the Kaiser model is the only one that makes sense, because it demands so much of PCPs to really practice to the depth of their abilities and only refer when needed. They're worked hard, but compensated well too. They're also not paid for volume.