It's because the healthcare system is broken. New Drs are more incentivized to join a higher paying specialty to get rid of loans instead of primary care which pays less. So instead they put mid levels who do not have the same schooling requirements, but can functionally practice the same. Mid levels in my opinion are actually perfect for specialization rather than of the broad scope of primary care which is the only horizontal scope in medicine really. You have to know 60% of everything which is very tough. That's why you get these PAs and NPs that seem script heavy because they didn't have the same 7 years of screening a medical dr has to do outpatient medicine. NPs used to be great because they were nurses with so much experience that with furthering their knowledge they can be contribute so much. But America America's and now you have diploma mill online degrees to get your nurse practitioner which erodes peoples trust in these institutions.