The one and two physician primary care office, you may have had when you were younger, has succumbed to history. With the advent of managed care, and the consolidation of the health insurance industry, federal government and the health insurance industry has become The Master. Smaller medical practices ran to the local hospital, crying “Save us! Save us!”. The smaller hospitals approached the larger hospitals for safety, and larger hospital systems were formed as an antidote to the health insurance industry’s depredations.

When you combine MANAGED CARE DOMINANCE over the last thirty (30) years with a KNOWN PHYSICIAN SHORTAGE for the past thirty (30) years, you have the resulting crisis that primary care medicine has become today.

A traditional primary care office now requires a minimum of four providers in an office to cover expenses. The higher the operating expenses are, and the more expensive a geographic location is, the more providers a primary care office requires, and the more patients per day an office must see. Insurance driven medicine is paid by the visit or procedure.

ALL medical office staff people are important to the quality of your experience as a patient. The front desk, administrative staff, nurses, technicians, and providers are all important. But it is the Providers who have monthly production quotas and budgets to achieve.

Physicians, Physician Assistants, and Nurse Practitioners all have advanced degrees, and are all known as “Providers”. But they do not all have the same extensive training, responsibilities, obligations, and legal liabilities that physicians have.

You can see, a Physician Assistant (PA) graduates with 12% the clinical hours training of a primary care physician, and a Nurse Practitioner (NP) graduates with 3% to 9% of the clinical hours training that a primary care physician has.

As the population in an area grows or as a population ages, the more primary medical care will be needed. At some traditional primary care offices, PAs and NPs perform upwards to 80% of all medical visits. Many of those are without any direct physician supervision or follow up.

Ask yourself, “Are you putting yourself at risk, by NOT having an experienced family physician?”

What type of supervison of PAs and NPs are actually being done?

The regulations regarding midlevel practitioners or advanced practitioners are vague:
North Carolina statutes require mid-level providers to have physician supervision, as do the NC Medical Board and the NC Board of Nursing... BUT ...

• The supervising physician does not have to be onsite
• The mandatory Collaborative Agreement or Supervisory Agreement are typically, very loosely defined using terminology such as:
• "... must establish minimum standards of consultation ..."
• "... must be appropriate to the skills of the supervising physician as well as the mid-level practitioner's level of competence ..."
• "... physician to provide the legally required supervision of the PA or NP ..."

Based on your personal experience, do you feel like your concerns have been listened to, and that you have received the proper medical care you need?

Do you feel like you are on too many medications, or have had too many specialty consults on your medical condition without any real answers?

If so, continue reading!