The NPs take care of all the easy stuff. That includes basic acute care, chronic management when things are stable, etc. but there are a ton of patients who have really complex crap, have lots of comorbidities, are at risk for drug reactions, are unstable, etc. Those folks generally need to see the doc who spent 4 years of medical school on top of 3 years of residency.

His compensation should go up, not down, as the complexity of what he takes care of increases. The problem is that you can’t see 22 of those people a day. It just completely burns you out and each visit takes far too long. So they need to space those out with the easy stuff.

But back to your question of reimbursement. All of doctors reimbursement is tied to a CMS billing system that is essentially the same for every doc. So one specialty doesn’t lose reimbursement vs another. If one decreases, they all decrease. This is at least true for outpatient medicine (not including surgeries and heavy procedure based clinics).