> 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.