> We need more doctors and nurses, full stop. Anything that prevents that is what needs to be actioned against.

I agree we have a shortage, but to offer a counter-argument:

We shouldn't need a 100% full-blown doctor for everything doctors do today. We could also help address the shortage by splitting out some responsibilities that are restricted to just doctors among professionals that only have 80% (or 60%, or 50%) of the training / certifications of an MD.

We've already presumably been doing this in the US with physician assistants and nurse practitioners. It hasn't solved it, but the problem would undoubtedly be many times worse without them.

Great call out, I agree. NPs [1] are the NCOs (non commissioned officers) of the medical field. Where applicable, level up folks with the desire and aptitude from RN->NP. This specific pain point is a talent pipeline health and structure challenge. MD feelings around this are going to be something to consider, to note when preparing for the opposition [2].

[1] https://en.wikipedia.org/wiki/Nurse_practitioner

[2] https://www.ama-assn.org/practice-management/scope-practice/...

If you said "Where applicable, level up folks with the desire and aptitude from IT support->senior engineer. This specific pain point is a talent pipeline health and structure challenge. SWE feelings around this are going to be something to consider, to note when preparing for the opposition" people would go wait, maybe the occasional fresh bootcamp grad or ITsupport technician has the potential to do strong work or manage a team, but in general their education has not prepared them. Of course if you ask a doctor "could the RN or NP run this floor" there's a conflict of interest when they tell you "no", but they're also correct.

Having a nurse is probably better than no medical care at all, so a tiered system where poor people get nurses without realizing they're worse than doctors would have that advantage, but the right overhaul imo would be reducing the years of schooling required to become a real doctor (undergrad, med school, residency, maybe fellowship, finally attending). If doctors skipped undergrad and cut out some med school or fellowship requirements, they'd start working earlier and could afford to choose specialties that pay less. As well as expanding residency slots and moving insurance compensation to family medicine and pediatrics.

edit - here's a good example, https://old.reddit.com/r/medicine/comments/1f6m5i9/its_scary... the good news is they'd agree with you that midlevels do have a role, the problem with scope creep is defining what that role is, and the assumption that the training is 80% or even 50% there