What does that look like in a more intensive hospital setting? I've seen the shift to midlevels happening in primary care, but I'm not sure how that translates to inpatient settings - I'm vaguely aware that there are rules around when a PA/NP must consult an MD before making a decision, and I feel like they would encounter those situations way more for an inpatient.

Many states now have unsupervised, independent practice for PAs and NPs from the first day they are issued a license. There is variation by state, however, and some still require physician oversight. The amount and quality of that oversight also varies considerably.