Would be interested to see that article source. Sounds like very much the exception rather than the rule - if true at all.
You know you can also search your doc or NP etc and see their educational bio.
2 Likes
Iāve found that if I see the PA or NP I get in sooner. My last gynecologist visit was the first time I saw the NP instead of the Dr. it was a month out for the NP and 6 months out for the gynecologist. My primary is a MD but if Iām feeling the need to see someone for something respiratory I go to urgent care where they have a mix of NP and PAs.
My last dermatologist changed to a membership practice and my new dermatology practice I see a PA unless I need a procedure. Same with the urologist, PA for routine and MD if I need further evaluation.
My daughter has a good friend who wanted to be a PA. She tried for several years to get into a PA program but ultimately decided to get her RN. She got the RN from the local community college at a great price. She is working in an ER and getting her Masters.
1 Like
My ādoctorāsā office doesnāt even have a doctor. They had one until last Christmas but she left and they just have NPs now. My official doctor for insurance purposes is at another office and Iāve never met him and probably never will as that office is about 10 miles away and I never go near there.
i went to the office today and she referred me to a specialist, which I knew she would. At the dermatologist I see a NP and if she needs help sheāll talk to a doc who may or may not see me (I have seen 3 docs at their offices).
At retinologist office, always see a retinologist. At podiatrist, I did see a doctor and donāt know if they have NP/PA.
I see several PAās regularly and appreciate being able to get in quicker and have been happy with the outcomes.
I think perhaps older generations, like my friendās mom, are not used to the PA/NP trend and are less trusting of someone who is not an MD. My mother-in-law is that same way. In fact, as a snowbird herself, she has a roster of doctors in two states and pits them against each other in their diagnoses of her relatively minor ailments 
2 Likes
I find this very interesting. It seems on this thread if the PA or NP spends time that is what makes them good. The training is vastly different. From a medical standpoint just spend sometime talking to both and you will see the difference of their education. The whole PA training is interesting to me. Letās face it itās out of need. Usually they specialize and have a very narrow focus and that is fine. But they arenāt doctorās. At some point there has to be a decision to be made. Will they make that decision or bring in the doctor to help? This to me is the problem. Too many think they are doctors and really just donāt have the experience or background. I have some experience with this. For anything āimportant āI will wait for the doctor. I can go to CVS and have an NP treat me for pink eye.
Also just because a PA assists in surgery just doesnāt mean anything. I used to be a residency director. They are being used in many way the way we would use a resident. Many doctors that have their own ORs could just train a staff member if needed.
I had a PA in a dermatologist office tell me there is little difference between his training and knowledge than that of the MD he worked for. Being a doctor, we had a conversation that wasnāt pleasant for him. Nice guy but sorry. You arenāt board certified in dermatology and cancer treatment regardless if you worked for 5 yearās in this space. This to me is the issue. Blurring the lines. Can you treat my skin tags. Sure.
My attitude is if I am being charged for a level 4/5 visit, I would rather get the most experienced person.
I get it. It can be a convenience, they spend more time, they are nice, etc but it doesnāt substitute training/knowledge.
What I see is lots of doctorās office are just not efficient. I also have experience with this. If they would be more efficient they would have more time with their patientās and be able to see more patients in their alloted times..
8 Likes
Bloomberg News ran a 5 part series called The Miseducation of Americaās Nurse Practitioners about the issues surrounding inadequately trained NPs in healthcare.
Apologies in advance because thereās a paywall.
4 Likes
I have a MD as PCP. Sheās a Canadian who attended a Caribbean med school, but completed a US FM residency. She is part of a large multi-specialty practice owned by a hospital system. (PCPās office is at a satellite site in an office building near my house, not at the hospital.) She listens well, rarely or never seems rushed or dismissive, and is responsive to emailed questions/concerns sent thru the practiceās portal.
I have an in-house physician (as in, I live with an EM physician) for simple illnesses and injuries that require minor medical care. (Infected cat bite, superficial abscess that needs to be drained, ear infection, pink eye, sutures for a deep or jagged cut, sprained joints) For more serious stuff, I either go to my PCP who can usually see me within 3-4 days (PCPās NP will see me the same or next day) or go to the actual ER.
I used to go to an optometrist for eye care, but since Iāve moved (and needed cataract surgery) I now see an ophthalmologist annually. Her practice is insanely busy and she is always, always runs late. As much as 60-70 minutes starting around 9:30-10 am. I just plan for it now.
And I will reaffirm what @Knowsstuff says about the PA/NP" āassistingā in surgery. That doesnāt mean anything special. Both my daughters āassistedā with surgery when they were first year med students and didnāt actually know anything yet.
4 Likes
My PCP is an MDā¦sole person in her practice.
My derm is a DO who has four PAs in her practice just at the office I go to (she has another office similarly staffed). These PAs are fine, and call the doctor in for anything they have a question about. Iām fine with this!
She has a second MD, but that person specializes in things like Botox.
Like peopleās kids applying to colleges, in the land of healthcare thereās many flavors of ice cream. If you prefer an MD, go seen an MD. If you prefer a DO, go see a DO. If you donāt mind a PA or NP, go see one of them.
If you happen to live in an area where thereās a wide range of options to choose from, then go for it! Have your favorite flavor of ice cream.
If you live in an area where seeing a particular category of provider is more challenging (i.e., several monthsā wait to get an appointment), then you might not have all 31 flavors of ice cream to choose from unfortunately.
I donāt have a medical degree. I very much respect people who do. But even though I donāt have a medical degree, I, too, have some experience in the realm of healthcare because Iām a consumer of it.
Iāve had bad care provided by MDs, DOs, and PAs alike. In terms of bedside manner, generally speaking in my own personal experience, the MDs have been way worse at this. The nonsense some of them have said to me sometimes is pretty bad. Not being listened to, treating me rudely, literally having one foot out the door while Iām trying to ask a question about my condition, being told that itās all in my head (guess what? That provider was totally wrong), the list goes on and on.
One time, my daughter had pneumonia and was getting worse. Took her to our regular pediatricianās office and they had us see a different MD than we normally did. That MD diagnosed her with Gianotti-Crosti Syndrome. told to go home and give her Tylenol, thatās it. Meanwhile 24 hr later, my kid now is way worse than before and my mom gut is telling me that something is really wrong. took kid to urgent care. They did chest x-ray. Pneumonia.
And that pediatricianās office decided to switch my daughter to that MD for regular ongoing care. That MD was dismissive and rude. We switched to a different providerās office entirely.
Other daughter had her tonsils out when she was in elementary school. About a year ago, took daughter to a local urgent care. Was seen by a PA. Asked PA to do a rapid flu & COVID test to rule those out, given kidās symptoms. That PA was not the sharpest tool in the shed, said that because daughter had no tonsils, it wasnāt possible for her to get influenza, COVID, or even a sinus infection. Guess what? She had a sinus infection. That PA was an idiot.
If I had listened to this one rude MD years ago who told me āMaybe itās all in your head,ā then I NEVER would have been diagnosed with the rare genetic condition that I have. I chose to find a better provider elsewhere, somebody who listens to their patients, and figured out what was going on with me.
If you donāt like PAs or NPs, then donāt go to them for care.
Regardless of the provider, if the PA, NP, MD, or DO is rude, doesnāt listen to the patient, and has already decided my diagnosis before Iāve even opened my mouth, then Iām taking my business elsewhere.
2 Likes
More rambling on this topicā¦
1 specialist I see is an MD. Heās one of the best providers Iāve ever had. Ever.
the PCP I see is a DO in Internal Medicine. Iāve had MDs before for a PCP and those PCP MDs Iāve had before donāt listen. This DO has more of a āwhole person/whole patientā perspective. Heās awesome. Actually reads the info sent to him from specialistās office, discusses it w/me in the next appt.
I go to a cancer center regularly for the past 6 yr thanks to breast cancer. Have annual check ups there with an MD oncologist whoās amazing. Great bedside manner, good listener, etc. Thanks to the ATM gene mutation I received at birth, I get to have annual MRIs now to check my pancreas. In fact, Iām having one tomorrow. Follow up appointment is with a PA in the GI dept of the cancer center. That PA reviews the radiology results with the āinterventional gastroenterologistā MD who did my more invasive GI screening 2 yr ago. Both of them are great. I see the PA a couple of days after the MRI. The PA is awesome. The MD she works with is awesome. They communicate with each other. Itās totally fine.
Are all MDs great? No.
are all DOs great? No.
Are all PAs great? No.
Are all NPs great? No.
Just like any other profession. Some are good at their job. Some are just ok. Some are buttheads. Some are just not on the A game and happen to have a bad day on the day that YOU happen to see them.
</end babbling> 
4 Likes
I find this thread a little sad as an MD pediatric subspecialist. I totally understand liking an NP/PA and feeling like they are better listeners, more available and pleasant. But the idea that there are any who have equal knowledge or experience to MD/DOs is absolutely false. Training is so vastly different, and some of the benefits of these fields (being able to switch specialties on a whim) makes the difference in ability immense. I always wait to see the MD/DO and when I donāt I always regret the choice.
7 Likes
This is completely true and Iāve seen it. My clinic used to employ a NP who essentially had never worked as a nurse. She was a disaster clinically, despite being intelligent and having graduated from a prestigious NP program (and post-bacc nursing program before that.)
She was replaced by an NP who had graduated from a non-prestigious regional public nursing program, worked as an ICU nurse for a number of years, and then went back and got her NP (also from a no-name public school.) She was outstanding. So valuable to our clinic.
5 Likes
I donāt know that any (many?) of us are claiming that NP/PA are just as knowledgeable? I worked in a residency program for 25 years - MD training is extensive and at times brutal (those overnight shifts!)
I think there is a time and place for these roles and should be seen as a āvalue addā to the patients and the clinical staff of a clinic/office. Not a substitute. But a more broad menu for patients under the right circumstances.
6 Likes
I would love to see my PCP, a DO, every time. Itās no longer possible. If there is something wrong with me that I suspect needs to be addressed, I will hold out for the DO. Considering that annual exams are pretty much nothing burgers anymore, I am fine with a PA for that. Same with my med checks - I have been on thyroid for 50 years, so I can interpret my results now & would go to an endocrinologist if I thought something was wrong.
My urologist is an MD, and I have never seen anyone but him for my appointments. I see a PA for my skin checks, but if I want to see the dermatologist, I can book an appointment with him.
Recently, I learned about an amazing PCP in my area who intrigued me. Sheās not taking new patients. My Hās PCP has taken a different job with the hospital system - he canāt get a new PCP anywhere near us until they hire a new PCP for that practice. Heāll see a PA until that time. Itās not necessarily a āchoiceā anymore whether to see an MD/DO or a PA/NP. Thatās a bigger issue.
3 Likes
My PCP is Harvard-trained, smart, but very directive. I need care that is collaborative since I am pretty well-informed. I much prefer my NP and havenāt seen my Primary care doctor much at all- since she insisted on a CT with contrast for a minor gas pain (I did oral contrast after checking with nephrology, and still had a bad reaction). My NP helps me avoid medical harm since he listens and knows my sensitivities and health conditions well. He also does what I ask for because he trusts me.
1 Like
Iām well informed too. But I survived an aneurysm which a triage nurse at an ER, NP and the senior NP at an urgent care facility diagnosed as the āwhen you hear hoofbeats think horses not zebrasā problem, not what the board certified ENT correctly diagnosed even without a physical exam, and booked the OR and anesthesiologist even before the confirming test/diagnostic results.
Sometimes all the ālisteningā in the world (they listen to us, we listen to them) is not a substitute for actual medical knowledge and surgical training. Iāll happily have the NP at my PCPās practice diagnose my strep throat and prescribe the Z-pak which Iāve safely taken before, but anything new- Iām exerting my āold lady privilegeā and seeing a physician.
9 Likes
As was said elsewhere in the thread, often patients have little choice in the matter. YES, I like all the providers, APRNs and MDs/DOs. We often have to book with whom we can see, especially if issue is time sensitive. I recognize that the APRNs have way less training than the MDs/DOs, but we canāt necessarily wait weeks/months for an available appointment if the problem is now and the doctor is booked for weeks/months.
The APRN was able to see H when the DO had no openings. Itās not ideal but Hās issues couldnāt wait and we needed them addressed asap. The APRNs has been great about getting H referrals to specialists who could see him, though there bookings months out
My lung doc will squeeze me in whenever he can because weāve been together for nearly a decade now, but heās often out of state, earning more money so he can afford to live here in HI with our low reimbursements.
The patients often have VERY LITTLE choiceāsee the available soon or wait weeks/months to see the MD/DO. If one can wait, fine. Otherwise, one tends to try to be seen asap with whomever is available.
1 Like
Hmm. This is making me rethink one of my medical relationships, where I sort of donāt trust the MD specialist (heās newish and young) and do respect his NP. Fortunately Iāve already had an initial appointment with someone I saw for a second opinion who I liked and respected a lot, so I may just switch my care to them
1 Like
Also it used to SOP for medical equipment sales people to scrub into the OR and āassistā during surgeries, especially for orthopedic devices. (In some case, it was actually the salesperson inserting the device into the patient, not the surgeon. Thankfully the FDA has cracked down on that and device salespersons must now stay out of the OR.)
So āassistingā in surgery doesnāt mean much.
**
I agree that there are good and bad MDs, DOs, PAs, and NPs, but if I have something new or unusual going on, I want a board certified physician with at least 7 years post residency/fellowship practice experience. (The 7 years was suggested by my previous PCP who was dept chair at a very large hospital system. He said 7 years is the beginning of the āsweet spotāāin practice long enough to see everything weird, rare or odd in person, but not long enough to be burnt out and jaded.)
My daughter who is the EM doc is an exceptional diagnostician. Sheās the one at her department who recognizes all the truly rare, weird stuff patients come in with. Sheās so good that when she calls cardiology or neurosurgery to come in for her patient, they donāt question her; they just come in. But sheās also very direct (Umā¦ terse? plain-spoken?) and doesnāt suffer fools easily. Or at all.
7 Likes
The /residency forum on Reddit has a lot to say about NPs, especially the on-line programs that admit students without previous nursing experience. Very interesting reading. My husband and daughter have some serious medical issues and weāve had some not-so-good NP experiences. Ditto for my mom with dementia.
Iām sure there are very good NPs, but I think they need a lot of experience before being in the position. Maybe good for ear infection, yeast infection, run of the mill stuff. I donāt think an 18 month on-line program is a substitute for MD training, yet, in our experience, their visits are billed at the same rates as a MD visit. That annoys me.
I understand many find NPs to have more time, be more attentive, or really like them and I definitely get the quicker appointment time preference. For our needs, weāre hoping to stay with MDs.
2 Likes