Has the quality of mid-level providers gone way down in the past 15 years? This is based off a patient that was just referred to the ER for a ridiculous reason by an NP working an urgent care clinic. Due to HIPPA concerns I won't give specifics but suffice to say I have seen a lot of ridiculous ER referrals in my part-time ER work but this may be the worst.

Funny thing is just last night I got to wondering if the quality has gone way downhill or as I learn more the disparity is more apparent. When I was a med student/resident I felt like the PAs/NPs we worked with were pretty decent. Not really harming patients. The last 5 years or so I feel like most of my interactions with them are largely the "what the heck" variety. This may have started when we lost the one mid-level in our clinic who had been in the clinic 20+ years. Since then it's been a carousel of 5 different hires to replace her. Unfortunately all of them with less than 5 years experience. I have been shocked at the basic questions I get asked on a daily basis. Shocked because if these are the questions they're asking how can they effectively treat anyone with more complicated questions. As I look back I feel the ER referrals by NPs have gotten more silly over about the same time frame. I know there are good and bad providers in any field but I feel like in general the quality has gone downhill with the mid-levels that I've interacted with.

Just curious what those who have been in medicine longer have noticed.