In the first years of my career, NPs were more common. I generally found them to be better qualified. PAs seem to come out of school poorly trained- they seem to have very little confidence in their experience and decision making.

I do think the volume of PAs over the past few years has led to lower quality applicants and graduates. There are only so many places to get good clinical training. Many PAs end up just shadowing other providers because they don’t have a place that will/can let them provide supervised patient care. They get separated from the mental process of evaluating patients and having to make decisions - and in the training process going through that process in detail with a supervisor.

I have been to various urgent care conferences and I am often struck with the varied level of care that is provided in different parts of the country. Some urgent care clinics function close to an ER. Urgent care clinics in Utah are far from it. I get very frustrated with my colleagues, physicians and PAs, that send their patients to the ER at the slightest sign of difficulty. Many providers are just unwilling to try - listen a little longer, deal with a screaming child, find out what the patient wants. PAs are very often the worst about this because of a lack of training.

Intermountain recently changed the way they pay their urgent care physicians - we are now paid by the hour, instead of by the number of patients seen. I’m okay with this change for various reasons, but this will lead to even more referrals to the ER.