My medical group is mostly PAs too. I've been pleased with them.

I choose to see a Nurse Practitioner (CNP) for my GYN appointments; the only time I saw an MD in that practice was when I needed surgery. I love my CNP!

OTOH, the only time I saw a CNP in my Internist's office, she misdiagnosed me and said MRIs give the patient just as much radiation as CT scans. That is totally false.

And when I visited an urgent-care center this year, the PA (who looked about 18) looked at the blisters on my swollen eyelid and asked me if I wanted an antibiotic. I didn't, and that was that. The next day an eye doctor confirmed my suspicion that I had shingles.

If I had a choice I'd prefer to see a physician - unless I was merely getting a flu shot or some other routine care. Although I know the medical offices I visit have CNP's and/or PA's I have yet to be seen by one. I'm sure that will become the norm since that's one of the side effects of our current health care delivery system.

The only experience I had with a CNP was so poor that I called the office and spoke with one of the senior physicians in the practice. My DD had a swollen lymph node and the first appt. she could get at her Ob/Gyn office was with the CNP who failed to check her other side to see if she had bilateral swollen nodes and who then prescribed an antibiotic. She also failed to ask some pertinent questions which would have provided an explanation for the node.

The office we originally started with here did that he went to work at the emergency room at the hospital and was getting in other doctors and PA. When they finally told us the truth that he was not coming back we terminated immediately. I found another clinic that some of my neighbors had been going to for a while and I researched the doctors there and found one that could handle my many and varied conditions. I absolutely would not continue with seeing anyone other than my doctor. I have a team of specialist that have to work together and know what is going on with me. My new doctor who is an Internal medicine specialist, as the previous one was, said she had been hearing a lot of things about the office I terminated from and it wasn't good. We have been extremely pleased with our current doctor, I really like all my team now and they are all communicating well.

I am extremely pro active in my health care, and with my many conditions it's essential. I pay to see a doctor I expected to see a doctor. If not I will definitely move on to a more responsible physician.

There are few private medical practices in my area now. Doctors have all joined one of three competing hospital conglomerates. They have wrapped up MD's in all specialties, clinics, diagnostic services, home health care, even hospice. These are 'tight little islands of referrals' that make money on you from cradle to grave. (I expect undertaking is on the list to be acquired next.)

When my husband was very sick a while ago, they wanted him to see the CNP. I said no, he really needs to see a doctor. I feel that is my right since I'm paying the doctor cost. If they want to lower my copay, then fine I'll see the CNP.

PS - the prevalence and growth of large group practices as chisue mentions have come about because 1)administrative costs and hassle of dealing with insurance companies are expensive for a small practice, and 2) most docs just want to deal with patients and don't want to spend time doing the things required of any small business owner.

Over the years, I have been to several docs for a couple of matters who are part of clinics at two of our nearby medical schools. The experience of walking into a large reception area teeming with the unwashed public sometimes can make one feel like they've walked into a free clinic for homeless people. It's worth it though, because once behind closed doors with the docs and their residents, you know your being seen by the best.

It's just the changing face of health care.

I actually love the huge group practices. My favorite was the Lahey Clinic back in Boston. It's so convenient to get referrals in the same building. If I need lab work or an xray I just head downstairs. I don't have to worry about each doctor taking my insurance, and the appointments are all managed centrally. All the doctors have all the results from each other without me having to call around.

For my personal experience out here in California, I mostly see doctors. I had a doctor perform an annual test for me, but had a nurse practitioner do the re-check 6 months later. I'm okay with that.

I've found a place I really like for my general medicine. It's a small group facility but it's treated as a walk-in clinic so you don't need appointments. I've never waited more than 5 minutes to be seen, which is much faster than any other doctor where I've actually had an appointment.

Well put, SnidelyWhiplash. I couldn't agree more! I always request a physician. That's what I'm paying for.

Redcurls....It does raise a red flag if dr's. start leaving an established practice.

In the practice I go to the only time you might see a PA or CNP is if it's a sick visit and you need to see someone right away or you are just getting a shot like the Shingles vaccine. If I schedule a physical or a follow up it is always with my dr.

I recently had to see a hemotologist. I saw him a few times, but now that the situation is resolved and I am in "monitor mode" I now see the CNP. She is very thorough and takes her time with me.

Fortunately, I live in a large metro area so it's easy for me to find someone else if I'm not happy. Try looking for a new practice...you can read reviews online.

My wife is a Nurse Practitioner, a Gerontologist (could that be why I married her, to take care of this old man?). She has years and years of specialized training to work with elders.

There is a different sort of mental analysis that occurs in a NP (or PA) brain other than an physician. A physician is concerned with the end result and that's about it. However, the NP or PA is concerned about the trip to the end result. I believe that is why the nurse brain differs a bit from the physician brain.

This conclusion came as a result of working for several years in a nursing home (I am not a health-care provider, but an office type). I saw the way the docs made their rounds and I saw the way the NPs made their rounds. A lot of difference in their approach.

I go to a large (430+ providers) clinic in town. Once, when my physician was not available for a non-critical appointment, I asked for an NP or PA. I was told that she did not believe in them and that I would just have to wait. I was steamed! I went to convenient care and paid a higher co-pay! A nurse practitioner took care of the situation!

40 years ago, things were different. Large clinics did not exist as they do today. NPs and PAs were a small number of providers. I would go to a 'mid-level' provider anytime. That person would listen to what I have to say. If necessary, a physician could get involved (that has happened to me with my hearing issues), but I like the approach that comes with someone other than a physician.

Jim, I'm sure your wife is a caring and capable professional. I didn't mean to suggest anything personal about those who have followed less traditional paths to their positions in health care. Fundamentally, a nurse practioner is a nurse. Nurses provide nursing care and other expanded things that have evolved over time, including specialties like nurse anesthetists.

But don't lose sight of this truism - only a medical doctor is a medical doctor. They're not perfect, they have flaws and problems in general in the same proportion as others in our community do. Other providers have less education and training, had to meet less stringent requirements to enter the programs they took, had to demonstrate less expertise to receive their licenses, and as a result have limits on what they're allowed to do.

When I have a medical question or issue, I want it to be assessed and diagnosed by a medical doctor. That's a non-negotiable for me and for many others too.

I agree, Snidely. My daughter is in college to be a doctor. When she was shadowing PAs in the doctor's offices, several of them said to her "Just go be a PA. It's less schooling with good pay." So no thanks. That comment is exactly why my husband and I steered her away from being a PA.

With that being said, though, there is an NP in the pediatric office I take my children to, and she's been there for years, started out as a nurse, and I do like her. I think she's very knowledgeable. However, if it's not for a simple sick visit, I still make appointments with the physician. The PA there saw my son once and misdiagnosed him. Luckily it wasn't anything major, but of course that didn't help how I felt about PAs or NPs.

In my work, I see all of them getting sued, so it happens to the best of them. :) But I do feel that you have to be diligent about your healthcare and advocate for yourself, do research, and go to who you feel comfortable with. Like any occupation, you have exceptional workers and not-so-exceptional workers. It's no different in the medical field, but this isn't an occupation where I particularly want an "average" person caring for me. After all, my life is depending on it.

Good luck finding someone you feel comfortable with. Talk to friends and co-workers, etc., check reviews like someone mentioned, and hopefully you'll reach a decision you can live with! ;-)

P.S. I'm currently trying to find a dentist since mine retired, and it's a nightmare. haha Try and find one that sterilizes the instruments appropriately today! I have a friend that's a hygienist and tells me stories along those lines. Ugh. There's always ways they shortcut things so it costs them less. :-(

I find it interesting that states have different rules about NP and PA certification.
For instance, in New Mexico a NP has prescriptive authority, including those heavy duty drugs. No medical doctor supervision.
In Illinois, same thing with prescriptions; however, a medical doctor must be supervising.
In many states NPs and PAs are not allowed to write any prescription. Go figure.

No offense taken as to my wife. She has a master's degree in nursing, besides her BSN. And, beyond that she had several years working at a teaching hospital in Chicago before she felt qualified to do what she did before retiring two years ago. She even mentored some family practice residents as they were learning about working with elders.

When I was a working person, part of my job at the nursing home was to screen nursing students for shadowing nurses within our facility. I met a couple of folks who immigrated from the Philippines where they had been medical doctors. However, they would have had to start from scratch to get their US license to practice as medical doctors. However, they could take a 2 year registered nurse program (not a BSN) and care for folks in a different way. Both of them were pleased with their decisions.

I guess the poor people who live in my community have to do with the lowly nurse anesthetist. Luckily I haven't killed anyone in over 22 years of giving anesthesia, including the morbidly obese 2 pack a day smoker I safely anesthetized for a general anesthetic today. Phew!

My doctor left the clinic to be on the staff at the hospital so now I see a P.A. Who I like so far. My husband was in his fifties when a P.A. Found that he only had. One kidney! And this was from asking about a rash on husbands chin! No doctor through the years had discovered that.

Sleeper, do you do the same work as an anesthesiologist? I was under the impression they are the only ones who can give anesthesia but I guess I'm wrong! Are there only certain types you can give, or are you under the supervision of an anesthesiologist? Do patients generally know who is administering it?

I hope I'm not offending you - I'm genuinely curious as I thought that anesthesia is always administered by a doctor given the risks. I didn't realize it's also a nursing field.

It is my understanding the these professionals always have a doctor over seeing their decisions. There must be at least ONE doctor at your clinic.
A friend is an RN heading back, two years to get his NP. Going to him for 99%of what ails us, well I see no problem. On the flip side I know a gal who has her four year degree in psychology going back now, two years for her PA. I am not so eager to have her come near me for a common cold. It would be helpful if we could know the route said person took to their title. I want someone with more than 18 months of medical education, thank you very much.

Chi, no offense taken. Yes, I can do everything an anesthesiologist does. The state that I live in is an "opt out" state, meaning that no physician supervision is required. But even if supervision was required it is usually the surgeon which is really a joke. I don't know many surgeons who can give an anesthetic. But, we don't do bigger cases where I work. Just things like gall bladders, hernias, cataracts, colonoscopies, appendectomies, c-sections. Anything complex or really sick patients get sent elsewhere. I have cancelled cases because I don't feel comfortable with the situation. Every patient needs to be cleared for surgery by a primary care provider. I know that we have lost patients who don't feel comfortable with a CRNA administering their anesthesia, and it is no secret that we are nurses. I always introduce myself as a nurse anesthetist.

My son has wanted to be an MD since he was 2. Lately, he's changed it to a PhD. I actually think that's a better idea. He'd rather research than see patients, but honestly, I doubt he'd get the chance anyhow! I love my nurse practitioners, and only see the MDs when there is a problem. So few MDs nowadays. What's it gonna be like in another score of years?

Rob - your son may have made a smart decision -

My niece is in her first year of a surgical residency and is already $250,000 in debt from loans to cover her tuition and living expenses while in medical school. When she finishes her training she plans on enrolling in one of the programs that reduce or forgive your debt in exchange for practicing for a specific number of years in a designated area that needs surgeons.

A surgeon? She'll never be replaced. That one is way too specialized and takes way too much training not to be an MD position. She's gonna be ok. Glad to hear she's willing to help that area that needs her. Maybe she'll even fall in love and stay. Thank you niece!

I need a new primary care MD and a new dentist. It's no use asking for referrals from people who have always enjoyed good health -- or good teeth! We've rocked along with our present (barely adequate) MD and our (convenient) dentist since 2000.

The MD failed to admit me to hospital last month when he saw me a day and a half before I was in the ER at 4 a.m., resulting in a four day stay. ER docs rushed to improve my oxygen uptake and stabilize my erratic heart. I had not *suddenly* become seriously ill. I was ''whooping' when I saw him -- same as when I got to the ER.

My DDS has now twice failed to adjust for bite. I have a cracked root on one lower molar (pounded by the new bridge above it). A thrown crown he just reset fractured a day later. ("Oh, you'll need a new crown! $$$$)

Is there a shortage of MD's? We only took this one because it was so hard to find anyone taking new Medicare patients in 2000. We saw right away that he was marginal, but the group practice (since absorbed by a hospital group) was efficient -- and we were younger, with few ills! Our prior, excellent doctors retired.

The last time I had to find a new MD (because my employer changed insurance companies), my health insurance company assigned one to me. At first I was pleased with his down-to-earth manner and obvious intelligence, but then certain things started making me feel uncomfortable, and I found someone else. Shortly thereafter he was arrested and convicted on drug charges. I'm just sayin', Chi . . . ;-)

Rob - my niece wanted to specialize in pediatric facial reconstructive surgery. She had worked part time in a plastic surgeon's office all during college and knew exactly how difficult and emotionally draining that specialty could be. However she has had to revamp her goal because she simply cannot afford to extend her training after her general surgical residency is complete. She is is paid while in training but the average salary for a resident is between 42,000 and 62,000 depending on how many years of training you've completed.

She would rather not practice in a medically deprived area - but she'll never be able to pay off her loans otherwise.

Most residents can get by on the $50K +/- . You can't buy a house and ski in Vail on that money, but on the other hand, they don't have much spare time.

If your niece is already doing general surgery, the extra years for another residency and fellowships (2-4?) won't add that much to her debt. She can well afford it if that's where her heart is pushing. Money is a small factor but there's also a passion element to these decisions too. Few of these training slots go unfilled, so others find them economically feasible to pursue.

The real cost of added training is spending a few more years at a resident's salary instead of starting to practice. Not the added debt, that's relatively minor.