I needed a dermatologist. There were only 2 anywhere nearby who would take my insurance. When I called the doctor's office, they asked if I wanted to see a doctor, or a doctor's assistant. I said doctor.

The office was extremely busy, but the doctor did a good job, and my incision healed normally.

I treated my incision with vitamin E, just poke a hole in a capsule, and squeeze onto a cotton swab, and apply to site. This procedure was not per doctor's instructions, but the results are very good.

No surprise that PA's and NP's are on the rise.

He had a 3.8 undergrad Gpa and a 29 mcat score and only got into med school from a waitlist. He applied to 20 schools and was only accepted by one. Not enough slots for those who want to be doctors. Many more schools are being opened but with student loan rates going up it will be hard for all but the rich to go to med school. In addition schools admit foreign students and us students are shut out. Things need to change

I didn't save the link - but it was about the increasing number of fake diplomas for degrees in just about everything but medicine & law were at the top.

Five years ago my PA saved my life by aggressively following up on a mild symptom I complained of. She found cancer, and a week later I was in surgery (I'm currently "officially" cured, 5 yrs out). My Gyn Doc. took over my care and said that I must see a physician from then on.

I see a Nurse Practitioner Ph.D. in family med. for routine things. I developed pneumonia about two months after my CA surgery 5 years ago which was followed closely by meningitis (fer da Christ, as we say). She stepped back immediately when this happened and my regular MD took over. Once I was fully recovered, I began to see my NP again.

This is at two different clinics, but both handle medical situations very similarly. If it's routine, you need not see a Doc. I happen to agree with this and it helps keep costs down. Remember that the Docs and the PA's/NP'S are not the ones profiting from the high cost. It's the insurance companies and the suppliers.

It started about fifteen or twenty years ago.

I've never had a problem with a PA, though
it does appear to be a money scam sometimes.

Not as a care provider but in technical support. NP's and PA's have been around for most of that time. From my experience, the nursing staff, NP's and PA's have a much greater effect on positive outcome treating a problem than the physician.
I don't want to denigrate the ability of physicians but they are trained to to think in a certain way and most don't learn how to observe and evaluate what works and what doesn't.
The first critical factor is face time. If for no other reason than financial, NP's and PA's will always have a better grasp of the facts and for that reason I trust them more.

This happened to me once, and it turned out that I had MRSA.

but after what just happened to that college student in GA, it could very well be MRSA as you say!

My late father served as an "apprenticeship" in a practice when he started out before branching off onto his own. A physician with a busy practice has to split his/her time not just with time in the office (or offices) but also make hospital rounds. PAs take care of the "routine" cases and also provide back-up when things get busy. They also gain valuable experience working in a successful practice that they can take on their own. In the "good old days", another term for them were "Internist".

as an "Internist". An Internist is a M.D. who specializes in internal medicine, one of the most rigorous specializations.

...pardon in the specific use of words...caffine hasn't kicked in yet.

The idea arose out of greed, not necessity. MD's took their cue from the Armed Forces where many patients are seen by medical practitioners less than M.D.'s and discovered that by shifting a portion of their practice to lower-paid PA's the income of the practice rose proportionally. As this caught on, more and more are now doing this, even at such great teaching hospitals as the University of Michigan. And there's a deliberate attempt to fool the public with the professional 'dress' standards now being used. It used to be that you could identify the doctor by his/her white lab coat. Now, PA's and Nurse Practitioners routinely don it as well, so often you don't know WHO you're seeing unless you ask. With the additional problem that Nurse Practitioners are now getting 'doctorate' degrees in some health care field, which entitles them to identify themselves to the patient as "Doctor". It's a bad idea which is only going to get worse.

and yes, it makes the bottom line look a lot better.

However, I already knew my diagnosis going into the medical office. What I would be concerned about is whether the NP or PA has the skills of a diagnostician. Will they pick up on something if I making a glancing comment about an issue?

Yes, it's good that PAs and NPs help control medical costs, but I also question whether saving a few dollars is worth risking either my overall financial situation, my health or my life due to an overlooked problem that a physician may have noticed. All of that comes with the additional education and residency training that the PAs and NPs didn't obtain.

One other note is that prescriptions cannot be filled under the name of a NP (I don't know about PA's). If you are going to a medical office that operates more like a clinic, then it becomes easy to forget the name of the physician which could cause problems down the road (like at ERs or traffic stops by the police).

perfectly qualified to treat most patient complaints. In some instances, you might not get seen at all by a health professional if it weren't for PA's and Nurse Practitioners lightening the load on busy doctors.

Sorry your friend got screwed over by her "insurance". It's annoying, not being able to see the doctor you want to see.

P.S. In full disclosure, I have a close friend who is a PA. She would roll her eyes at your statement about the internet. People find stuff randomly on the internet and come in with all sorts of kooky ideas and notions about their treatment. Sometimes the internet doesn't really have the best answer.

At first I was a bit offended (NP are a bit like PAs where they can diagnose and make prescriptions) because I felt I should be able to see a real doctor.

After 12 years I'd rather see her. She knows me best and takes good care of me. Heck she even offered to stop by my house on Saturday to check up on me (I had an intense bladder/kidney infection and she happened to be in the neighborhood).

BUT..........

I think when it comes to serious matters that at some point a doctor should interview. PAs and NPs are excellent for doctor visits with routine stuff but thanks to a different NP I almost ended up with my appendix being removed unneccessary.

Back in 2004 (I remember because this happened before a DU gathering at the GOP convention in NYC), I was having severe abdominal pains. My regular NP was actually no longer at the practice where I first started (back then I wasn't 100% sold on her) so when I came in with pains another one saw me and said she thought it was Appendicitis. I had all the tests done and none of them actually proved I had appendicitis but she had me admitted to the hospital. It wasn't until 2 hours before the surgery that a doctor finally saw my records and realized my problems had nothing to do with my appendix but a bout of Colitis - something that could be cleared by a dosage of anti-biotics. Fortunately the surgury was cancelled (and I made DU gathering but couldn't drink). I looked at what that NP did and the first test for appendicitis is to press in the area of the appendix. IF there is pain after the pressure is released then it's the appendix. I never had that PLUS my white blood cell count was not aligned with what was normal for appendicitis. THing is if she had a doctor intervene early on it would have saved me alot of hassle and expenses.

So I think PA/NP are an excellent and affordable way to provide healthcare but they need to add a bit of regulation that ensures doctors are involved when the issue escalates to something serious.

I think we are going to see more and more of this in the future. Im ok with it as long as they dont go to far like having receptionists doing operations..