I'm sorry but it's hard to follow your post it's so full of emotion.
It seems you want PA and NP to be MD's, why? They are not.
I'm very confused why you propose that lower tier care givers take the place of higher tiered ones?
PA is not MD, thats what I said, that should be clear, you want to say because some PA's practice without the checks and balances they are supposed to have ( there are good reasons for this ) that makes them the same as a MD, they are not, as I said if you want to be a MD then go to Medical school.
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I know for a fact that rural people dont care! doctor!
they are happy to get care in some areas they are lucky to see someone with a stethoscope, DOCTOR
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Have you ever lived in the South? I hear this everyday, "They are a PA they are not a real Doctor" I think my experience is valid since I practice for a long time too, I respect the NP's and PA's I have worked with, in fact before medical school I was going to go to NP program but I was talked out of it by 2 NP's I know, they told me to go the extra mile and get the MD. I'm glad I did.
OK one last thing to make this clear......... I think Nursing (I'm an RN) Nurse Practitioner, Physician Assistant and so forth are great and worthy and needed jobs, we need these people and as a MD I will continue to respect and work with them, I ask the nurses now about the Patient and what they think.
Do not come on here and tell me I should be a NP or PA cause it's better, or its easier or what ever, these jobs have both good and bad with them and the people going to the Caribbean want to be MD's, Physicians at that level, not a PA, if they did then they would do that.