I wish there was an answer to all this.
There is: we call it a fellowship.
Believe me, I am totally sympathetic to what you say, and don't mean to sound glib about it. My fellow sub-specialists would shoot me for this, but the primary care providers should be the ones who get paid more, not us. Besides the higher fee schedule, we get another added benefit of extra years of training: namely, the ability to say "you will have to talk to your primary about that". That simplifies our job tremendously and sometimes I think it is worth way more than the money.
