I agree that ad hominem is of dubious utility; however, here I'd argue this is not an ad hominem in that I made no judgment of the poster, but rather pointed out he has frequently posted on this topic, calling for "investigation of medical cartels by the FTC" and claiming we are "overtrained", and that it is time to "end the Flexner tyranny".

They also heavily advocate for midlevel care as a replacement for physicians because we are "overtrained".

I'm yet to find a physician (especially somebody trained at Harvard/Stanford/etc plus a couple fellowships) who is actively practicing, and who hasn't told me with intellectual honesty that 80% of the patients they see present with trivial cases which could have been handled by a resident or a midlevel. They mostly put up with it because they get reimbursed a couple hundred $ for these trivial cases, which they shouldn't be.

Same for rads fighting over high RVU MRIs and CTs for 30 year olds without prior history. Half of those shouldn't have been ordered in the first place, the other 40% can probably be read by RAs.

That's why I think physicians are overtrained in the US for the type of work they de facto perform.

> There's almost no job where 80% of it couldn't be done by someone significantly junior. Especially when people are going to die if the person in the role can't handle the whole job, and there's no cost-effective way of presorting the work, it's not at all a sign of overtraining that 80%—or even 90%—of the work items could be done by someone far less skilled.

Nobody is going to die if nurses start prescribing acne creams and performing digital rectal exams. I'm talking about trivial routine care which is bulk of entire volume.

Emergency care where people die is a different story. Nobody should be reimbursed anything in emergency care. EM docs and midlevels should be on a salary like in Kaiser, with best outcomes at lowest costs being the only incentive.

> I'm yet to find a physician (especially somebody trained at Harvard/Stanford/etc plus a couple fellowships) who is actively practicing, and who hasn't told me with intellectual honesty that 80% of the patients they see present with trivial cases which could have been handled by a resident or a midlevel.

There's almost no job where 80% of it couldn't be done by someone significantly junior. Especially when people are going to die if the person in the role can't handle the whole job, and there's no cost-effective way of presorting the work, it's not at all a sign of overtraining that 80%—or even 90%—of the work items could be done by someone far less skilled.