I felt at first they collectively were very good. It does seem to be slipping. As an ER doc I often am shaking my head at what is sent to me from the urgent care and from the independent NP/PA offices.

That said I have one or two of our local primaries that often I’m wondering what they were thinking.

I think it is multi factorial, one is that the newer grads are of a mindset of how do I maximize my time value of my career. Meaning I can go to school for 2 years and bam I have a degree and can do basically the same thing. For some people they don’t realize that “earning” a degree is very different from being an actual provider.

I also think that on Both sides of it docs and the mid level that you will find excellent and poor providers largely based on their desire to learn, treat patients and truly diagnose and evaluate. So in many ways it comes down to the individual.

I think others have a great point that those in higher education are really just trying to make a buck and crank out graduates. Many don’t have good training experiences. This it’s hard to truly develop as a provider.

But overall I have increasingly become less and less impressed with the mid levels. I would personally rarely if ever go to see one or truly trust their opinion on a difficult case. I largely take their phone calls and then start de novo on my evaluation.

But, each day I’m just becoming more and more of a cranky old ER doc 😊😊