a specialty (ENT) and I used to have NPs that worked for me. I felt like they were well trained, and they could always come to me with any questions, but I tried to see all new patient consults myself, and have the NPs see follow-ups. I don't think it is right for a patient to be sent to a specialist, and be seen by the mid-level and not see the doctor, but unfortunately I see this happen all the time in numerous specialties. Now, I no longer have any mid-levels that work for me.

I often work with mid-levels in the operating room (CRNAs) and some of them have been outstanding - like you pointed out - those were mainly ones I worked with 10 years ago. I would not hesitate to have those excellent ones work on me or my family. But, some of the ones I have worked with the past few years, are scary, to be honest. These can be life & death decisions, with that need quick decisions. I have been left trying to guide the freaking out CRNA through airway emergencies. I blame the staff anesthesiologists who often are nowhere around, and don't seem to want to help train them.

And then there are multiple patients each day who come see me, referred by PAs and NPs. There has been a definite trend over the past 10 years of ridiculous referrals, and questionable patient management.

What really bothers me is the volume of patients that come to see me with real problems, and in reviewing their history, they will have been seen multiple times by NPs or PAs and NEVER once seen by a physician, despite numerous visits to a medical clinic. I end up being the first, and only doctor they have seen and am left dealing with many medical issues that should not be managed by an ENT specialist.