This country really faces a dilemma in its attitude towards healthcare. Patients keep getting sicker, fatter, more complex, and more demanding, while doctors keep losing ground to managed care, Medicare, and Medicaid. Most of us are too busy and too in debt to make much of a stand.
Physicians are facing pressure from many different directions and it really amazes me. I don't know how we got to be such as target, but we have. It is interesting that people have not put together the facts that healthcare costs keep going up, but doctors' incomes slowly decline.
Mid-level providers are making their inroads just like drug-eluting stents. It will be interesting to see if they make the difference, both in terms of quality and cost savings that people think they will over the long-term. I think mid-level providers serve an important role in healthcare, but I rarely hear an overhead page for "Mid-level provider to the ICU stat." Or when somebody has cancer, do you hear, "I have this terrible cancer growing in my brain, I better call the nurse practitioner." The question is not whether four years of medical school and another 3 to 9 years of additional training make a difference, but whether or not America values that training.
As far as the future value of an MD degree, medical students and residents need to take a carefully look at the market and talk to many people about different specialties. Unless you have low student debt, I really don't see how you can make it in this country as a primary care doctor. The cost of living is just through the roof here.
At the same time, other specialties have their issues. I keep hearing people at my hospital talking about outsourcing radiology and even sending patients to India for elective total joints. The problem is that India has a booming population and are there enough doctors in India to handle extra volume from the US? With the falling dollar, is it still economically advantageous to send patients overseas?
Pick a good specialty like heme/onc, orthopedics, general surgery, pediatric anesthesia, gastroenterology, or invasive cardiology. They are good bets to retain the value of your MD degree. Also, take on as little debt as possible and think about business issues. Strongly consider the fact that you will change jobs within 2 years of finishing training, so use that time to pay off debt, not accumulate huge mortgages and trinkets.