An article that can be found here suggests that my prediction that not too far down the road primary care will be delivered mainly by "mid level" practitioners may not be on target. It seems that fewer PAs are opting for primary care mirroring a trend in med students to shun primary care. Low pay, shrinking prestige ,cost of education and low level of job satisfaction are factors said to push docs away from primary care and the same factors may have a similar effect on PAs .
Thanks to KevinMD for calling attention to the article referenced above.
Maybe "mid levels" will be replaced by something like PA assistants (PAAs) or NPAs ( nurse practitioner assistants). The third party payer spin doctors will need a better name than "lower levels" to refer to them, however.