I would add one more small edit to your list of two. When one speaks of a remedy for the disparity between primary care and specialist salaries, EVERYONE except the specialist assumes that the only way to accomplish this is to reduce the specialists income, hopeful that a zero-sum game is in effect and this money will then flow to the primary care physician. This was, of course, the canard used to sell the RBRVS system to organized medicine (and we’ve seen how THAT worked).

Who doesn’t feel that their contribution is under-appreciated. I am an ophthalmologist. My core procedures have been ravaged by our third-party payer system, going from an unsupportably high price, through a reasonable market “trading zone”, and now far below what is a realistic representation of the expense, skill, and risk acceptance involved in these procedures. This phenomenon is due simply to the frequency and success of this particular part of my world. Must we continue to de-value and demonize specialty medicine and specialists? Must we continue to allow people outside of medicine to use a divide and conquer strategy, moving like so many sheep dirrected by wolves? Why can we not simply work to enhance the prestige and income of the primary care physician AND the specialist, or better yet leave that up to the individual physician and patient?

The primary care physician is indeed under-paid and under-appreciated, but she is neither of these because the specialist is over-paid.