"When the only tool you know how to use is a hammer, everything starts to look like a nail"

How increasing specialization is another factor driving up health care costs:

Changing the way medical school works could also help alleviate the problem, Frey said. Currently, the number of slots available for different specializations is not based on society`s needs. The high number of specialists, in turn, creates more demand for expensive services.

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“If they do choose the lower-paying field, they are also faced with a grueling work schedule that involves seeing dozens of patients, diagnosing and treating potentially hundreds of different conditions and struggling to coordinate patients` care with other doctors, he said, and much of that work is underpaid or completely unpaid.”
Gee, I feel the same way as an underpaid subspecialist.
The issue is largely an issue of value-added by any given physician, standard of care, and the overhead costs/specialized skills required to add that value.
Primary care docs think this whole phenomenon just pertains to them. Trust me, it occurs within specialities as well.
Just as most primary care docs have given up OB, etc., most specialists have narrowed their scope of practice. This actually is more efficient and produces higher quality care than a “jack of all trades” approach. But does every back ache need an MRI? Clearly not. In this case the primary care doc can serve as the “brake” from the overtesting a specialist might order.
Then there is the choice of subspeciality. Would you rather be a spine surgeon, or specialize in Medicare hips? Are you a pediatric ophthalmologist, or a retinal specialist? Your income will vary by multiples. And none of their services can be provided by a primary care physician.
To me, family practice nowadays is mostly about simple episodic care, letting the common problems that cure themselves do just that without the million dollar workup, and triage/screening for serious disease. The issue is whether primary care is attractive compared to the more involved and comprehensive role general practioners had in the past.
What do you do for your own health? I see a family practice doc to draw screening labs, get routine vaccinations, and periodic physical examination. For everything else I see a specialist. I think this is most efficient and provides highest quality care.

"When the only tool you know how to use is a hammer, everything starts to look like a nail"

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