It's not enough tiers, though, because (at least in my experience and the sense I get from other people) the specialists still have only mastered the 20% of iss

It's not enough tiers, though, because (at least in my experience and the sense I get from other people) the specialists still have only mastered the 20% of issues that account for 80% of cases. I'd love to see two more Pareto levels, at least. Like, an "advanced practice specialist" could cover the next 4% of things to pick up 16% more of the cases. And maybe one last tier that covers 0.8% of things that account for 3.2% of cases. Granted, this still leaves 75.2% of the entire list of bizarre possible things that could go wrong hard to diagnose and treat, and that will be hard for the 0.8% of patients where something insanely weird is happening, but with a bit of humility about what it's even possible for our scientific knowledge to cover about "all the possible things that could ever go wrong," and in recognition that we'll essentially always just be doing the best we can to help people and we may not be able to help everyone, those seem like decent target numbers to me.