QUESTION

The last time I made an appointment to see my doctor, I was seen instead by a nurse practitioner. Shouldn’t I have been told beforehand?

ANSWER

It can definitely be a rude surprise when you think you’ve made an appointment with a doctor only to find that you’ve instead been assigned to a “midlevel provider,” the catchall term for nurse practitioners (NPs) and physician assistants (PAs). While there is nothing illegal about a medical practice changing the provider you see, it’s poor communication on the scheduler’s part not to let you know ahead of time. There are a few reasons why you may have been assigned to the NP instead of the doctor. It’s possible that the doctor was absent that day (doctors get sick, too!) or had an overbooked schedule or a patient with an emergency, among other reasons. From the practice’s point of view, you’re still seeing a professional. From your point of view, you aren’t seeing the professional you had expected to see. But getting upset with the doctor or his/her staff won’t improve the situation—or your health. Instead, next time you make a routine appointment, be sure to tell the scheduler who you want to see and confirm that this particular provider will be available. Then ask the scheduler to let you know ahead of time if a change needs to be made in the provider you will see so that you can make alternative plans if you prefer. If the doctor’s office isn’t respectful of your requests, then it may be time to find a medical practice that is. Note: If you need an appointment quickly because you have an acute illness or injury, you may not have much choice in the provider you’ll see. Policies vary depending on the medical practice. In terms of the quality of care you’ll receive, that provided by an NP or PA has been shown to be equal to (or sometimes better than) what you’d receive from a medical doctor if it’s a routine visit or your diagnosis is a basic and acute problem such as the flu or a rash. Both NPs and PAs are well-trained to handle such health problems. NPs are nurses who have earned a higher-level nursing degree (such as a master’s or PhD), while PAs have earned a master’s-level degree, which includes a clinical rotation, typically following a science-based bachelor’s degree such as biology or chemistry. Both NPs and PAs also may work under the supervision of or in collaboration with a designated physician, depending on the laws of the state where they are practicing. However, it’s best to tap a doctor’s expanded expertise if you’re experiencing unusual symptoms or have a chronic condition that needs constant monitoring and you’re not being seen by a specialist. It’s worth noting that many people prefer to see an NP or PA instead of a doctor for a variety of reasons. For example…

  • Better availability. You may have to wait longer to schedule an appointment to see the doctor. Midlevel providers often have more availability.
  • Extra time to ask questions. Because of the way insurance reimbursement works, mid-level providers can spend more time with you than doctors can. Having the extra time to ask questions is a definite benefit.
  • Lower medical costs. If you are going in for a checkup or following up on some tests, then you won’t need to pay the higher fees charged by doctors—especially if the cost is coming out of your pocket. Note: You can ask about the difference in cost when you schedule the appointment.
In today’s health-care world, it’s up to us to manage appointments and our expectations. We can no longer rely on the health-care system to do this for us!