It must be financially very difficult for a primary care MD with limited income 

to raise family and deal with his student loan. Indeed it is obvious why we are seeing

the trend, i.e. increasing shortage of the primary care MDs.

As a matter of fact, a close friend of mine, whose son is one of them and has four children,

has been supporting his son's family financially for years.

As a consequence, we are seeing more and more of physician assistants and nurse practitioners 

in doctors' offices, hospitals and ERs. My wife saw her gynecologist once or twice, then 

settled with a PA. Now she likes PA better because the PA is readily available and spend more time

with her.

When I was practicing, I often liked PAs better than interns and residents because PAs follow

my instructions better than the young doctors in training.

The writer who is a ophthalmologist, I believe, may be missing the point.

We are not or should not be replacing primary care MDs with PAs or NPs.

We only need to make sure PAs and NPs are working under the supervision of MDs

including primary care MDs and all the specialists such as gynecologists, cardiologists,

anesthesiologists, ophthalmologists, etc.