"Where Are All the Doctors?"
This is a guest post from commenter Helen:
I do have an issue. Where are all of the doctors? It seems that wherever I go there are Physician's Assistants, and the medical facilities seem to want us to think that they are doctors. What I mean by this is there is never any mention that they are not a doctor that they are a PA. They said "Deb will be in to see you soon". Deb walks in and introduces herself as Deb and never tells anyone what her title is. Many times when making an appointment we patients are never told that the PA will be seeing us. I have gone to several appointments and was never told that the professional that would be attending to my medical needs was a PA. I am a stay at home mom and my family is fully insured through my husbands employer. We are not medicaid or anything like that.
I seems to me that an appropriate use for the PA's would be for routine issues like Strep testing, pregnancy testing, UTI's, stitching patients after the Doc has seen them, diagnosing earaches all under the direct supervision of an MD. I live in Nebraska and the PA's are seeing the lions share of the patients. Many times with no physician anywhere in the building. I had to take one of my infant twins to the pediatrician for a puzzling symptom. A PA came in (without telling us her proper title). I knew something was different about her from the other physicians in the practice. There wasn't the expert presence that I usually felt with the other doctors. She did procedures and ordered expensive tests that were way off base. I came home and looked her up and I saw that she was a PA. Later I went back and saw our physician and she looked at the symptoms and gave a very reasonable explanation about what was going on. Those tests that the PA ordered were not even close to being necessary. She also left the main cause untreated.
Why are PA's running the show? Where are all of the doctors? Why are we as consumers and patients being conditioned to accept a PA as a doctor? I am in a mom's group, and most of the moms think PA's are pretty much the same as doctors. Many think the PA's are as competent and knowledgeable as doctors. Then why don't we just call the PA's doctors? When my daughter cut her finger the doc saw her and the PA came in and did the stitching. That seems like an appropriate use of a PA. There are PA's in offices where the are no medical doctors in attendance. Aren't PA's supposed to be working under direct supervision of a physician? (I know the was no doctor there because I asked).
I am not a medical professional. I am a consumer and I am at the mercy of the medical community. They tell me what they want, I have to see who they want, and often I am given no information about the type of care I am going to receive.
Helen
UPDATE: a report of more midlevel infiltration in the fields of Dentistry, Radiology, and EMS (courtesy of DocV)
I do have an issue. Where are all of the doctors? It seems that wherever I go there are Physician's Assistants, and the medical facilities seem to want us to think that they are doctors. What I mean by this is there is never any mention that they are not a doctor that they are a PA. They said "Deb will be in to see you soon". Deb walks in and introduces herself as Deb and never tells anyone what her title is. Many times when making an appointment we patients are never told that the PA will be seeing us. I have gone to several appointments and was never told that the professional that would be attending to my medical needs was a PA. I am a stay at home mom and my family is fully insured through my husbands employer. We are not medicaid or anything like that.
I seems to me that an appropriate use for the PA's would be for routine issues like Strep testing, pregnancy testing, UTI's, stitching patients after the Doc has seen them, diagnosing earaches all under the direct supervision of an MD. I live in Nebraska and the PA's are seeing the lions share of the patients. Many times with no physician anywhere in the building. I had to take one of my infant twins to the pediatrician for a puzzling symptom. A PA came in (without telling us her proper title). I knew something was different about her from the other physicians in the practice. There wasn't the expert presence that I usually felt with the other doctors. She did procedures and ordered expensive tests that were way off base. I came home and looked her up and I saw that she was a PA. Later I went back and saw our physician and she looked at the symptoms and gave a very reasonable explanation about what was going on. Those tests that the PA ordered were not even close to being necessary. She also left the main cause untreated.
Why are PA's running the show? Where are all of the doctors? Why are we as consumers and patients being conditioned to accept a PA as a doctor? I am in a mom's group, and most of the moms think PA's are pretty much the same as doctors. Many think the PA's are as competent and knowledgeable as doctors. Then why don't we just call the PA's doctors? When my daughter cut her finger the doc saw her and the PA came in and did the stitching. That seems like an appropriate use of a PA. There are PA's in offices where the are no medical doctors in attendance. Aren't PA's supposed to be working under direct supervision of a physician? (I know the was no doctor there because I asked).
I am not a medical professional. I am a consumer and I am at the mercy of the medical community. They tell me what they want, I have to see who they want, and often I am given no information about the type of care I am going to receive.
Helen
UPDATE: a report of more midlevel infiltration in the fields of Dentistry, Radiology, and EMS (courtesy of DocV)
Labels: health care crisis, physician assistants
posted by scalpel at 10:02 AM
29 Comments:
I've never seen a PA, but I almost always see a nurse practitioner (I can usually get in quicker, and the most serious thing I've ever come down with is a UTI, nothing an NP can't handle with one hand tied behind her back).
I am ALWAYS told by the clinic that it is a nurse practitioner when I make the appointment though. I think NPs and PAs are a great resource, but I agree that there needs to be full disclosure and there should at LEAST be a doctor in the building!
Where are all the docs?
Great question! And the simple answer is that there is a shortage of them as well as every other health care provider/practitioner/medicine man etc...
I'm a PA and in our office we go out of our way to explain who and what I am... I introduce myself as a Physician Assistant (no letters, no acronyms: too confusing for most folks). I don't call myself "doc" and I don't let anyone else call me that. I wear a name tag that is in full view of the public I treat, I have poster in my exam room that explains what a PA is. My MA and front office staff are great about helping folks to know what I do and how I can help. I have mini-pamphlets all over the office explaining how PA's are educated and how we fit into the healthcare system and team. I do this because it is necessary ethically and for true informed consent.
It saddens and frustrates me to hear comments like Scalpel's post. Not every PA or NP is out to pull the wool over the eyes of pts or third party payers. We don't have the same education that docs have: that's why we need their supervision. But we're not inept either. A big part of my job is being able to recognize when I have reached my limits. I have been well-trained in that regard. I regularly communicate with my supervising physician. I wouldn't have it any other way!
I know that I won't be able to convince Scalpel of the utility of mid-levels or that it is actually safe to have them around but I hope that he will take the time to better understand how things really work in a more comprehensive manner rather than the narrow, tunnel-visioned approach that has been displayed by his last few posts.
Sorry, buddy... I agree with many things that you say but your opinion on midlevels is way off base.
I think it's an interesting and worthy discussion, and I appreciate the tone of those who have participated; I've only had to delete one comment. Obviously I'm presenting a viewpoint that is going to upset a bunch of folks, but that's what I do here sometimes. Don't take it personally...I'm not a policy-maker, just a harmless shit-disturber.
I've learned a lot from this interaction, and I'm eager to learn more.
Helen:
For someone who isn't a "medical professional" you certainly have quite a bit of knowledge about how tests are billed, etc. Let's not decorate your opinion for the holiday season, shall we?
I do agree that an introduction of a provider should include there professional title. As a patient, you do have the right to say that you wish not to be seen by a PA. However, I encourage you to investigate the profession rather than past judgment on the industry. Before going to PA school, do you realize that I worked as a Paramedic for 10 years? Do you know that I have Doctor's who are 3 years out of residency coming to me for case questions?
As a whole, you should base your decision on the quality care that you receive whether is be an MD, DO, PA or NP. The health care system is in crisis and you should applaud a country that does something about it.
I don't usually comment, but I do want to get in on this conversation. I started infertility treatments in February of this year. I went in for a routine annual and saw the NP at that time. I just wanted to ask a few questions about what would be involved with treatments and I felt that the NP would be just fine for that. She was amazing. She came in and explained exactly what an NP does and then ordered the basic fertility blood workup. She then referred me to a physician who speacilizes in infertility at the same office. During my treatments, I would have to go in on certain days at certain times and the doctor was not always available. I saw the NP at those times. She did a wonderful job and I am grateful that I was seen by her. She eventually was the one who did my routine IUI that resulted in my pregnancy.
I understand that seeing someone who isn't competent such as the PA that you seem to be referring to is frustrating. But, on the other hand, I had an excellent experience with my NP and I will see her for my routine annuals as long as I live in this city. The doctor I was being seen by was great, but I really loved the NP.
I guess my point is that not all PA's or NP's or whatever else they like to call themselves are incompetent. Please don't judge all of them based on your bad experience. Which, I would like to point out, good advice for the "real" doctors, too. Just because I saw a doctor who was very unprofesional and had a lazy eye once (not that that really had anything to do with his competency), doesn't give me the right to judge all the other doctors out there based on him.
PAs commonly practice in rural areas without the physical presence of a physician. A physician may stop by the office once or a few times per week and is available by phone if necessary.
I recently worked with a largely incompetent NP in a clinic setting. For example, he misdiagnosed a major cardiac problem in an elderly, diabetic, obese, African American female as exercise-induced asthma. He didn't know what tests to order, so he generally ordered them all. He spent 1-2.5 hours with each patient agonizing over his assessment & plan (he was just so often unsure) and balked when a patient wanted to bring up more than one health issue. I resented having to pay to shadow him (I'm a medical student, and the clinic doctor was gone that day).
NPs like him unfortunately give competent ones a bad reputation. I wouldn't allow anyone like him to touch me or my family even to suture a wound. On the other hand, I've seen an NP for nearly every gynecology visit. Two out of three were fine -- the second one prompted me to consult the doctor, who was bewildered by the NP's gross misdiagnosis of an endocrine problem when I was in fact perfectly healthy.
Obviously schooling alone doesn't bring competence, so it seems that each NP & PA must prove him/herself to be a competent individual.
There are the good, the bad and the just plain ugly in every profession; and at every level of that profession. I'm just thankful to live in a country where we have a choice. Sure, there's distance involved for we rural folks - but you still have a choice.
Medicine is not the only place the mid-level practitioner is infiltrating in to;
http://www.healthjobsnationwide.com/news.php?articleID=12
It's happening in dentistry and EMS
From the perspective of a pre-hospital provider, I definitely agree that some proof of competence is important. I agree with Emily and medicine girl that it's up to the provider to prove that they know what they're doing. Recently, in fact, (and I talked about it while commenting on a recent post in this blog) my wife had a negative experience with a PA that we had to deal with.
It happens.
On the other hand, there are some really, really good mid-level providers out there. One of our hospitals up here has a well-regarded cardiac facility, and there are PA's and NP's in the practice who are top notch. Bear in mind that they work hand-in-hand with the cardiologists who run the practice. Because of this very little gets by these people, and if I needed to be taken care of by them, I'd trust them in a minute to do so.
I do have to comment about some of the mid-level providers I deal with, though, regarding their view of us pre-hospital folks. In all of the time I've worked as a Paramedic (coming up on 5 years on top of 10 as an EMT) I've gotten more grief from PA's and NP's about what I can do in the field compared to what they can do in practice. I think one of the things that needs to be made clear is that as a Paramedic I have protocols, including standing orders and on-line direction, that I have to follow. And I have to know what I am doing - it is not as simple as "one purple box and one brown box" anymore, and it hasn't been like that for a long time. And, for those of you who've never been in the back of an ambulance when the shit is hitting the fan, it's an experience you've got to try at least once to see where we Medics and EMT's come from...
Now I realize that we don't get trained up at the level of an NP or a PA, but we get trained thoroughly and well - well enough, in fact, that I believe there are things I can handle better than a mid-level provider, at least in an emergency setting. And we always have the ear of the doc, no matter what. So much so, in fact, that I work under a doc's license in the exact same way a PA does. And overall, I have more latitude with which to do my job.
My $0.02.
Just my take on things:
In my OB/GYN's office, I have seen the PA 9 times out of 10 and I actually prefer her over my doctor. Usually, I am simply going in for a routine annual, and she has more time to answer questions, etc. I don't hog her time--I like to get out of there as fast as I can but, if I need it, I like to know it's there.
Every office I've ever been a patient in, as well as every clinical setting in which I've worked, the PA's have "PA-C" displayed clearly and prominently on either their name tag, their scrubs, their lab coat or a combination of the three. As health care workers are all strongly encouraged to (i.e. we are supposed to) introduce ourselves by name and title to alleviate the confusion that comes with the clinical setting ("Hi, I am Suzy Q and I will be your nurse today" "Hi, I am Jim and I will be the tech working with Suzy Q") but in the real world, unfortunately, sometimes that does not happen.
It is my understanding that, legally, a physician has to oversee a physician's assistant, to put it in simple terms. I can't imagine how a practice can allow PA's to work without physician's in the building (maybe someone can explain it to me) and I do not think this is the norm. Maybe in other states it is different that it is here in Michigan, however. Depending on the size of the practice, there are typically a couple of PA's and NP's working under the physicians. And, for example, in the case of my PA mentioned above, they should defer things to the physician when appropriate. I saw my PA for an issue a while back and she evaluated it, ordered the appropriate tests and said that if it wasn't resolved in two weeks I needed to follow up with the physician. (It resolved.)
I am currently an undergrad looking at both PA school and med school and I am finding that, in some cases, the requirements for PA school are more...competitive? shall we say? than med school. There are some schools that I will never get into because, though I have many years experience in the field, I am not a medical professional i.e. an RN or paramedic. However, my GPA is great and, for all intents and purposes, I am a great candidate. So I can probably get into medical school. Anyway, I am just saying PA's go through some strict training and know their stuff. I hope that one bad experience with one PA, just like a bad experience with a physician, doesn't taint your view of the profession overall.
A PA diagnosed my Lyme Disease. I had no symptoms that were commonly indicative of Lyme and I never even remembered being bit by a tick. I went in to see why I was so fatigued. I was having headaches and I honestly just thought maybe it was stress induced and due to my menstrual cycle. The PA decided to run a few tests and lo and behold I had Lyme. Kudos to her for being a competent PA. She saved me from a debilitating disease. She also introduced herself as a PA, as did the PA who stitched up my 5 year olds eyebrow in the ER. Again a competent professional.
Instead of whining about not getting to see a Doctor, why don't you give these professionals some kudos for being just that, professionals. I don't think they should be the end all, but I do believe they have their place. I'm a military spouse and vet who has spent 10 years dealing with the military healthcare system. I'm grateful in being able to at least get in to be seen within a day or two. Until you've had to wait 2 weeks to be seen by a doctor to get an antibiotic for an infection, I'll take the PA who can see me today.
Shoot PAs take down the Internal Mammary, harvest the Saphenous Vein, only thing I see the Physician do is sew the Anastomoses...
The PAs in my doctor's office when we lived in Colorado was A-1! Personable, caring, instructive -- Great! However, the PA in my current Tennessee residence is a nightmare. She did not introduce herself at all and did not even mention that she is a PA. She was judgemental, abrupt and rude. She ordered a prescription and did not explain why she was changing my meds and did not want to discuss the medication at all. She did not want to renew my prescription for Ambien, because "we don't want any teenagers to get ahold of that because of the possibility of rape..." I'm 60 years old, a female, we have no relatives or friends in this town who would have access to our meds in our house -- I'm hardly likely to go out and rape someone and my disabled husband is even less likely to do so. Needless to say I've changed to a doctor 30 miles away and even though it takes nearly an hour to get there, I'm very happy that I've changed.
There are excellenct people, good people, and terrible people in health care...you just have to try them and decide for yourself. I have worked in the healthcare field for many years and thought I had seen it all, and now I'm wondering if I should have complained about the PA who treated me so rudely. I guess I'm the cowardly type -- I just changed doctors without saying a word to anyone at this local clinic...
Classof65
Merry Christmas Scalpel :)
Different states have different laws defining what is required supervision of a PA. Most say that if a physician is not in the building, they have to be available by telephone for consultation. This is an important option as there are many rural clinics staffed by just a PA or NP with their supervising physician 60-100 miles away at a larger clinic. Those clinics are staffed by PAs or NPs because there just simply aren't enough doctors that want to work in a rural setting like that. There are areas that if it was required for a PA or NP to have a doctor in the building... there would simply be no clinic there and the people in those rural areas would have to drive 100 miles for routine exams or for bronchitis. Does that seem fair? If you took all the PA's and NP's out of the picture, think how long it would take to get an appointment with a physician.
PA's are trained to know their limits and when they need to refer to a physician. If some PA's don't know their limits, that is their personal issue, not the profession as a whole.
Also, I'm sorry the poster has a problem with her clinic not disclosing if a person is not a physician. But where I work, my name tag clearly says Physician Assistant at the bottom and when I walk into a room I introduce myself saying something like, "Hello, my name is Jane, I'm a physician assistant." I don't try to make people think I'm a physician because I'm not.
Before you make assumptions or judge the PA profession as a whole, how about education yourself about the education and training it takes to be a PA. Here is one place to start: http://www.aapa.org/geninfo1.html
Most doctors are great obviously, but, really, the problem of incompetent physicians is more far-reaching and has a greater likelihood of being detrimental to patients since there is no one double-checking their work.
When you combine an ineffective physician with hands-off administrators who do not do anything when the doc is missing obvious diagnoses or letting patients sit in the rack for hours unseen, and you get me, who feels the need to make up for the docs' crappiness.
On that note, MERRY CHRISTMAS! Time to fire up the Guitar Hero!!!
I walk into a room I introduce myself saying something like, "Hello, my name is Jane, I'm a physician assistant." I don't try to make people think I'm a physician because I'm not.
Good for you, but that's not how it's done everywhere.
Before you make assumptions or judge the PA profession as a whole
You're in no position to judge what patients elsewhere see.
I saw a PA in a hospital who was introduced to me BY THE STAFF as "Dr. Smith." How would I possibly know she was a PA and not a doctor?
She was competent as far as I could tell. She diagnosed me without an exam or any tests of any kind, though she had the advantage of reading my PCP's report first.
I will not be seeing her again. Number one, she doesn't listen to me. She may not need the information I'm trying to convey, but what happens if I have something to tell that makes a difference? Her input channel is exceedingly small.
And number two, she berated me for my HBP. I have white coat hypertension. How is jumping all over me about my HBP going to help?
My PCP is an actual MD. He listens to what I have to say, and when he's talking, I listen to him without interrupting him in order to get the most from what he is saying. He is very calm and gentle. At my last appointment for the first time since I have been seeing him, my blood pressure was actually normal. I was able to relax for once.
I don't give a rats behind whether a medical professional is an MD or a PA. What I care about is competence and ability to resolve my problems. I haven't experienced incompetence in a PA (limited experience with them), but I have seen it in doctors and nurses. But I think my experiences are a poor basis for making a judgment about this issue.
These antecdotal stories like the one above are not particularly relevant to the discussion at hand. There are good doctors and bad ones, there are good PAs/NPs and bad ones. The question is not whether we can haul out more examples of incompetence in PAs than not, it is a question of under what circumstances, GENERALLY SPEAKING, a PA should be allowed to work.
Do you know that I have Doctor's who are 3 years out of residency coming to me for case questions?
Thanks for the laugh!
I have a Ph.D. in computer science. It is not uncommon for any of the Ph.D.'s in computer science that I know (and I know a lot of them) to ask other people, even those with no formal training or even a college degree, for information about how a particular program or piece of hardware works. Being a doctor doesn't mean you know everything.
You are way too puffed up with your own self-importance. Get over yourself. The fact that a doctor asks you something simply says that you know a fact that he doesn't know. It doesn't imply ANYTHING about your overall competence, nor does it suggest to me that you somehow are just as good as an MD at what you do.
Our PA's introduce themselves as "Hi, I'm Jack Smith, one of the physician assistants".
"Do you know that I have Doctor's who are 3 years out of residency coming to me for case questions?"
Big deal, everyone asks everyone questions. Get over yourself.
PAs and NPs are not a bad thing if you're informed and they're competent. As a patient of a multi-physician practice that employs these midlevels and has had encounters with all three types of practitioners, I think a lot of their utility depends on several important factors: (1)the practice's policy on the availability of physicians; (2) the experience of these practitioners and whether or not they're smart enough to know when they're getting in over their heads clinically; (3) the nature of the patient's problem(s), i.e., the simpler stuff like URIs and uncomplicated UTIs or something like a routine exam (which any competent midlevel could handle) vs. a patient with 3 chronic problems and some kind of acute pain that could have a differential dx a page long (which I'd certainly hope they'd be able to see a doc for).
If the midlevels weren't available, I think a great number of people would be unable to see any sort of healthcare provider on a regular basis, which would be bad for patients in general. The system has its flaws, to be sure, but unless we suddenly get an influx of new docs, we'll have to use these "physician extenders" to the best of our ability to help our obviously busted system
I don't know. I am not an expert, but phrases like 'mid level infiltration' make mid-level care providers sound like cockroaches. Like they're sneaky spies that only come out in the dark to take a dump in your favorite cereal box.
I have seen turf wars between physical therapists and massage therapists mediated by my state medical board (largely against the massage therapists). The negative language here, reminds me of those divisive politics.
From what I understand, in an ideal clinic, PAs should make life easier and more profitable for doctors while providing quality care to patients. If that is not happening, the solution is not to disparage the entire PA profession but revisit the business and care model.
Swapping anecdotal stories takes the issue to a petty level, which really doesn't help anyone or create solutions. It just furthers the divide. If there is an issue with mid-levels, it starts long before any of us have a bad run-in with them; with the training, with the medical economic model, with the medical industry as a whole etc...
M
I think it depends on who it is. I have seen great DRs, PAs, NPs. I have seen really awful ones as well. I admit I only see PAs and NPs as a last resort if the dr is not available. I feel I pay for a dr's service, I should get all that I pay for with that. My pcp has a PA that just does urgent care stuff. Strep throat, treatment of migraines, flus, stuff like that. I had a raging case of strep that came on all of a sudden and was aggressive when my pcp was on maternity leave, the PA treated it and I got better. I didn't have an issue with seeing her for that. Dh had a migraine two weeks ago that was not responding to imitrex IM. So called the dr's office and they said bring him in and the PA would see him. She saw him during LUNCH. Gave him shots of toradol and compazine and he was much better. Honestly when I get my steroid shot in my bad knee, the PA does a better job than my ortho.
Where it matters most, I see a doc. I am currently 8 mos pregnant with a very high risk pregnancy. I only see my ob and have demanded that from the beginning (he is a solo doc in practice with 2 cnm and 1 np). You are supposed to see the CNM or NP for the first visit. I started with him from the beginning and glad I did as I was diagnosed with very low progesterone at 4 weeks pregnant. I was switched to my ob at 9 weeks with my second child. After two preeclamptic pregnancies, one 2nd trimester MC, an early MC, I was sticking with my ob. Before all of this with my second child, if I called the ob's office with a question, they would have "someone" answer it in the office. Now if I call the office and my ob is not there, they page him. I don't know if that is because I am very high risk (had doppler study that indicated compromised bloodflow to the placenta at 18 weeks and bad ob history) or what. It sures does make me feel better that he is on top of everything. My pcp is on top of everything to with me. I think it just depends. I will say that PAs, NPs, and CNMs are for low risk people in low risk situations. They are NOT for high risk people.
I grew up in a very geographically isolated area. If you were injured, the nearest ED was 70 miles away. If you were injured critically, the BEST ED was 200 miles away. When I was growing up (not that long ago) helicopters were not an available mode of transport.
I have seen great progress in our area with NPs and PAs in the local EDs. The ED that was previously forced to close down that is within 20 miles is now staffed.
A lot of "emergencies" that occur within rural areas can be treated locally. If there is staff available. The staff knowing when the "big guns" are needed, and when to transfer is essential.
I firmly believe, from my experience in rural communities, that many rural EDs would go unstaffed and be forced to close were it not for NPs and PAs.
The good ones know when something is out of their reach and know when to send it on to a better facility. Doctors at a rural facility know the same.
Between taking my mother to appointments, my children and myself I have seen alot of NPs and PAs in the last 7-8 years.
Not once have any of them not identified them self as being a PA or NP. This has not all been at the same office either. It has happened at my own doctors, my children's doctors and my mothers so I really can't imagine it being widespread that these people are deliberately misrepresenting themselves. The issue might be more with others misrepresenting the actual facts.
I also went to an appointment with my friend and she introduced me to her NP as a Doctor. The NP immediately corrected her by saying "I am not a doctor, I am a NP." It was my friend who insisted this wasn't true. She said. "I don't care what you call yourself but to me you are my doctor." So right there is a patient who refuses to see things realistically.
I have had a couple of experiences similar to Helen's. I had made appointments to see Dr. Jones and when I showed up for said appointments, Dr. Jones was a no-show and someone else (a PA, I found out later) saw me; I was never informed - when I made the apppointments or when I went to the office - that Dr. Jones would not be avaialbe.
Interestingly, it does not seem like my private health insurance company was charged a dicounted rate because I did not see an MD.
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Yep, the insurer writes the checks, but guess what? They write it out of MY money. So what we've got here... it's MY body, MY health, MY insurance, MY co-pay... I think maybe I've got good reason to know who is treating me. In my state, I can look up license suspensions, I can even pull up dr. ratings. So I ask for the full name of the doc, look 'em up, make sure they're in my ins. network and haven't been disciplined in my state or any other state. And if a PA/NP is foisted on me w/o disclosure, see ya. I've got good insurance and if you don't have enough respect to tell me who's treating me, how do I know you'll have enough respect to tell me other critical info about my care?
OTOH, I am perfectly happy to have my oil changed at the quick-stop but use the dealership for major repairs. A handyman built my fence, a GC remodeled my bathroom. Some work is well-suited to lesser-trained professionals, and I am happy to see an NP/PA for minor, routine services. But I certainly expect a discount. If I'm not benefitting from full med school/internship training, I don't expect to PAY for it.
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