Disclaimer: I'm still a medical student, take my biases into account when you read this.

It seems like mid level providers are being granted more and more autonomy each year. In fact, they have full practice authority in 20 states (no need to work under a physician). Knowing that, are the AMA et al truly strangling the supply side of healthcare? From the politico article you linked, it seems that the number of specialists we have is unnecessary, so that can't be it.

I'd like to think that most doctors aren't trying to out-compete mid-level providers, and that most doctors are trying to do right by their patients. Maybe that's naïve.

I also agree that the wages for physicians are too high, and that reform from the ground up (education costs, healthcare costs, and reimbursements) is desperately needed. However, to state that providers are the core problem is tremendously naive. The average salary of physicians, even at $250,000/yr, with 1 million physicians in the US is $250 billion/yr. In comparison, the revenue from the health insurance industry was around $1 trillion in 2017. The hospital industry made $970 billion in 2016. The pharmaceutical industry made $450 billion in 2016, I can only imagine that number went up. I can see how the insurance industry and hospital revenue would be tied in physician reimbursements somewhat, and obviously pharmaceutical payments, but the pharmaceutical industry shouldn't be impacted by physician salaries.

As a side note, very few doctors I've had the pleasure of knowing have any idea what their services cost patients. Proceduralists generally have a better idea.

For those of you interested, I'll try to explain what is needed in a residency program. Your program needs to provide you with the training necessary to be proficient at all aspects of that specialty by the end of your training. That means you need the patient volume, mentorship, and variety to meet that standard. It just so happens that it's very difficult to meet that standard unless you're at a larger institution. Community programs do exist, but today the vast majority of programs except for family medicine are at academic centers.

What that also means is that you can't train too many doctors in one place at one time. Especially in the case of surgical specialties - You need as many procedures as you can get in your residency, extra residents take those procedures away from you.

That isn't to say that more family medicine and primary-care track residencies aren't needed, they absolutely are. At the same time, without more Medicare funding for these residencies (per the politico article it takes around $150,000/yr to train a resident physician) hospitals aren't willing to take on the extra cost. A bill is hopefully making its way through the House to increase the funding for more residencies (15,000 new spots over 5 years).

Ultimately, I think the trend is going to be that more and more doctors will specialize, and mid level providers will be mostly nurse practitioner or physician assistants. Hopefully the data will continue to be positive in terms of outcomes, and prove that we just don't need the amount of training we thought we did for those providers.

P.S. While I'm not going into primary care, I loved my family medicine rotation in school. I felt like I had genuine impact on my patients, met some of the most down to earth doctors, and it was an active day with lots of variety.