Are paid for what you know. If you simply refer to the MDs who actually know then in many ways you simply just add another cog in the wheel and more cost is incurred. To me that is a bad outcome.

I think for a lot of primary care and pediatrics etc they are pretty good and can fill in and help in many ways. So as far as outcomes including morbidity and mortality maybe there isn’t a huge drop off. But in knowledge and expertise my experience has been it is a dangerous and significant decrease.

Again I’m becoming a old grumpy ER doc. 😊