It's much more complicated, but more importantly, the quantity of information itself has increased. In fact, medicine is the only field in existence where the entire "body of knowledge" doubles in 5 year increments. Think about that... every five years everything there is to know about medicines doubles, and that rate is only increasing. So the question is, is it even possible for a provider to grasp all of that information, even at a superficial level in 8 years? 12 years? 20 years? Or, as the system seems to be dictating, does it make more sense to train more intensely, in narrower scopes of practice. Honestly, why does the med student who KNOWS they want to be a hand surgeon spend all of that time learning which antibodies can cross the placental barrier? Is it good to know? In an ideal world absolutely, but pragmatically, it's antiquated. We need to refine the system and this is where "midlevels" come in. As previously mentioned many med programs are experimenting with this concept as it becomes increasingly clear that the current model is woefully inept at producing providers in the numbers we need. It's about thinking progressively and not getting entrenched in a dogmatic model of education that we are painfully outgrowing.