I need to clarify. Not every doctor can ditch their liscense obviously. But inherent in this arguement assumes PA/NP's will have ability to practice completely independantly as it is already in many states. If they are able to practice completely independantly they do not need any MD oversight to care for the full spectrum of patient needs. Doing cash-pay is limited to derm, PCP,psych and neuro (and plastics obviously). The specialities that are doing it now can easily drop their liscense if they have a NP that can work completely independantly from a clinical standpoint and simply hire them to do all the prescribing, ordering etc.
Not all states are there yet with NP's being independant but as they continue their take-over, they will need independance to perform the role that is being carved out for them by the new system so by the time talks of tying doctors to taking a single system would happen, I forsee every state allowing NP/PA to do their own thing.
I think the worst hit are gen surgeons. They already make no money and obviously cant do a cash practice. Ortho, urology, neurosurg already make 450k plus and will probably be trimmed to 300k plus which still is a great salary, even they would likely attest once they actually think about it.
So yes it sucks but those making 300k now will continue to do so. Those making 150k will likely continue to do so and ironically those making 120k such as many PCP's will probably make more because reimbursement rates are improving for many of them.
Bottom line is medicine will look VERY different but it will have the full span of options as it does now for consumers.