It is amusing to be considered part of the old guard now
Admittedly, I have not been on a job hunt in > 5 years (and maybe that gap in time blinds me) but many of the issues you've mentioned were issues back then.
"Back in my day":
- good jobs were still hard to find. We were taught even as residents that the best jobs are found by word of mouth. Because they don't need to be otherwise advertised.
- I was taught to view salaried positions (particularly high salaried positions) with caution. The fairest setup in an employer / employee situation is ultimately one based off of productivity with a salary perhaps to buy time for both sides to get to know each other. I can't speak to whether or not salaries have stagnated but I have noticed that when we interview graduating residents ; they keep floating higher and higher salary numbers that are simply not realistic when compared against their anticipated productivity.
- good partnership opportunities were still rare, I can see this one being more pronounced with the proliferation of PE but not sure what mid-levels have to do with this
- how "good" you were, particularly in a private practice environment, focused more on how productive you were as opposed to the quality of care rendered. This has always been the case in private practice.
In the end, I do not think we are disagreeing. I do think expanding midlevel practice authority is a mistake. I do think it will hurt the field (and in particular, patients) in the long run. I think it will hurt medicine in general in the long run. But as you said, this is a problem almost every other field faces. Where we may differ is that I do not think the damage to dermatology specifically is as catastrophic as others make it out to be. I certainly do not think it will make applying for a dermatology residency less competitive.
Having previously worked for a PE-owned group, I can also say that while the group obviously makes more money off the mid level than a physician, a well-qualified physician (particularly one willing to oversee midlevels) is also worth its weight in gold to the practice. Our strongest recruitment pitches were geared towards these physicians. Perhaps location played a role but I also found we had very well-educated patients. The patients themselves had a very good handle on what they would allow the midlevel to see and what they insisted the physician would see. I supervised 4 midlevels and when it came down to complex medical derm, excisions, Mohs (obviously), and cosmetics, most patients ended up insisting on seeing me. I'd like to think being a well-trained dermatologist made a difference. But the point is, even if my state allowed for independent midlevel practice, even a ruthlessly number focused PE-owned group couldn't have simply replaced me with a midlevel. There will always be a place for good physicians.