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The cynical take was that "learn to code" was a deliberate push to oversaturate the technology worker market in order to break the power and unity of a dissident and growing political-economic block. Tech workers were getting too big for their britches, too expensive, and too socially/politically powerful. But now that there's 100 people applying instantly on linked in for every single tech job, and laid-off mid-level devs are taking 5 (even 6!) digit pay cuts just to get back to work (which also completely shuts out fresh grads even more since they are now competing with people who actually have experience)? Not so much.
The rise of a competitor to the PMC successfully quashed. But we see as well the power of all those gatekeeping institutions in other professions. Why was tech so easy to flood with workers as opposed to something like medicine? Because there's no big regulatory credential bottleneck.
Even if AI rapidly reaches the point where it could begin replacing doctors - it won't, because of the massive regulatory, legal, and credentialing edifice. That is, even if it becomes true that any guy of moderate intellect with just a bit of training and a fine-tuned LLM could statistically match the average primary care physician, that still can't happen. He can't be your PCP, because he doesn't have an MD. And as we all know, you need an MD to be a doctor and do doctor things. That's just the way things work. Which is great for doctors, not so good for everyone else.
Rideshare apps completely slaughtered traditional cabs and cabbies, especially the racket of medallions. Sucks to be some poor cabbie who saved up for years to get his own medallion only to have his entire investment torpedoed. But, it was ultimately a good thing and made car service infinitely more accessible and cheaper for everyone else.
What I'm saying is we need to break the hold of the MD over medicine. This will absolutely suck for doctors who already have their MD, who will see their wages drop tremendously as they are forced to compete with people who didn't take on six-figure debt and invest the better part of a decade getting an MD. It will, however, dramatically reduce healthcare costs and increase healthcare accessibility. I'm not saying you get rid of credentialing entirely - but there's no reason that every single doctor needs to do a whole ass MD where they take tons of classes and rotations on specialties they will never use. There's certainly a use for such well-rounded physicians, but it's frankly absurdly wasteful to have someone with 10+ years of higher education spending all of their time doing rote carpal tunnel releases that someone could learn to do in a few weeks. We're already seeing this emerge inefficiently and chaotically with the rise of the nurse practitioner solely because of the dire need, but what really needs to happen is a massive, widespread and deliberate reduction in the legal privileges of the MD in terms of "only an MD can legally do this."
It's worth noting that one of the main reasons for this transition is the sheer depth of poor quality service and outright fraud associated with the old yellow cab model. It truly was unbelievably brazen and hard to convey if you didn't live through it.
Now back to my regularly scheduled defense of doctorhood.
There's a range, everything from pretty much parity (MD, DO, MBBS) to obviously inferior but often not in a way that patients notice (NP, PA, Psychology Prescribing), to actually quite dangerous (Chiropractors, Naturopaths, Alternative Medicine providers - some of these have full or mostly full rights in some settings/states).
You see all kinds of tensions associated with these options and I know plenty of doctors who have lost out on jobs to one of the others, but in terms of improving care well... we have evidence it makes it worse, and we have evidence that it saves no money or even costs money (example: unnecessary testing).
Many of physician job responsibilities extend outside of direct clinical work and you can't replace them adequately with the others (they make better administrators, managers, and executives). Others also can't fulfill the educator roles or research roles.
Most doctors do some form of teaching and research and essentially all of them have done both at some points in their career.
That kinda stuff doesn't track well on research into these matters but is important. Likewise physicians pick up the slack in the way the the others (especially nurses) do not.
We've been running a natural experiment for awhile now and having growing evidence of that gap.
You also have to consider that if you box someone into say total knees from the beginning then they have to do that 100% of the time they can't switch to another specialty to avoid burnout or other things like that. It's very common for surgeons to switch around and extend the longevity of their careers by doing that sort of stuff.
What'd they do, not tell you the price and then make up one that didn't make sense after services were rendered? Hard to believe that people wouldn't love that...
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