Is it wrong to ask for the Physician instead of the Physician's Assistant

[Led Zep]

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I went to a dermatologist about 6 months ago. I had previously been to this dermatologist a few times except this time I had some new concerns. When I went into the office I was seen entirely by the PA, she prescribed some meds, and I left. The meds she prescribed didn't work, so I went to my primary physician who gave me a different med which worked really well (he also expressed concern why the other med was initially prescribed)

So now I need to return to the dermatologist. When I make an appointment is it wrong for me to ask to be seen by the physician rather than the PA. I mean in all honesty he is the one who did the extended training via residency and would better be able to diagnose me. Am I wrong?

Understand I have complete respect for PAs and their rights as well and this is not meant to offend anyone but I feel when it comes to SPECIALIZED treatment (like dermatology, urology, ENT, etc.) the physician is IMO better able to make the call because they have had more training and experience.

What do you guys think?

Again not trying to start a flame war, just want some honest input. (Maybe venting a little which I apologize for)

 

[CodeBlu]

I went to a dermatologist about 6 months ago. I had previously been to this dermatologist a few times except this time I had some new concerns. When I went into the office I was seen entirely by the PA, she prescribed some meds, and I left. The meds she prescribed didn't work, so I went to my primary physician who gave me a different med which worked really well (he also expressed concern why the other med was initially prescribed)

So now I need to return to the dermatologist. When I make an appointment is it wrong for me to ask to be seen by the physician rather than the PA. I mean in all honesty he is the one who did the extended training via residency and would better be able to diagnose me. Am I wrong?

Understand I have complete respect for PAs and their rights as well and this is not meant to offend anyone but I feel when it comes to SPECIALIZED treatment (like dermatology, urology, ENT, etc.) the physician is IMO better able to make the call because they have had more training and experience.

What do you guys think?

Again not trying to start a flame war, just want some honest input. (Maybe venting a little which I apologize for)

Totally ask for the dermatologist. No offense to PAs, but I'd rather be seen by a Nurse Practitioner, instead of a PA. If you're paying this dermatologist, you should definitely be getting what you paid for... that is the care of a dermatologist.

Edit: I should probably add, that I know a few PAs, and they're wonderful. But their clinical experience is limited, especially if they are younger. They learn most if not all of the basic science that MD/DO students learn, but the clinical stuff is a lot more limited. Think of it this way... which MD/DO do you want to see? The one who hasn't completed a residency program in the field of which your problem lies... or the one who is moonlighting with no residency training... see what sticks, maybe? Nooo thanks!

 

[gmcguitar4]

agreed. and if there is a problem.. there are plenty of other dermatologists out there.

 

[V5RED]

If you are paying for a service, than you have the right to request how it be done.

They have the right to refuse to do things your way(ie not having the physician see you him/herself), but in that case you have the right to take your money elsewhere.

 

[ppfizenm]

If you aren't happy with a doctor you always have the right to ask for another. Even in a teaching hospital you have the right to ask for an attending over a resident.

 

[FrkyBgStok]

generally isn't a problem, but in my area, if you ask for an appointment, they will set you up in a week or so and you will see a PA or NP. If you specifically ask for the physician, you may be waiting close to 2 months. So clearly you wouldn't be the only one asking for the physician.

and this is my area and for the established dermatologists (not the ones that just moved to town out of residency).

 

[NickNaylor]

If you aren't happy with a doctor you always have the right to ask for another. Even in a teaching hospital you have the right to ask for an attending over a resident.

I'm sure you have the right to ask, but I doubt that the hospital or clinic must comply with the request. It's likely the same deal here. If you don't like it and the clinic refuses to oblige you, go to another clinic.

 

[ToldYouSo]

Totally ask for the dermatologist. No offense to PAs, but I'd rather be seen by a Nurse Practitioner, instead of a PA. If you're paying this dermatologist, you should definitely be getting what you paid for... that is the care of a dermatologist.

Edit: I should probably add, that I know a few PAs, and they're wonderful. But their clinical experience is limited, especially if they are younger. They learn most if not all of the basic science that MD/DO students learn, but the clinical stuff is a lot more limited. Think of it this way... which MD/DO do you want to see? The one who hasn't completed a residency program in the field of which your problem lies... or the one who is moonlighting with no residency training... see what sticks, maybe? Nooo thanks!

I'm surprised, I'd totally ask for the PA before an NP, especially considering the amount of clinical training hours and education is basic science exceeds any nursing program.

 

[S6MD]

inb4 emedpa

 

[ppfizenm]

I'm sure you have the right to ask, but I doubt that the hospital or clinic must comply with the request. It's likely the same deal here. If you don't like it and the clinic refuses to oblige you, go to another clinic.

They do have to comply that is, at least in level one trauma centers in New Jersey if the patients are knowledgeable enough to ask.

 

[Musclemass]

Totally ask for the dermatologist. No offense to PAs, but I'd rather be seen by a Nurse Practitioner, instead of a PA. If you're paying this dermatologist, you should definitely be getting what you paid for... that is the care of a dermatologist.

It's unlikely that the charge to see a PA or NP is the same as the charge to see the dermatologist. If you see someone with lesser qualifications, wouldn't you think the charge is less?

Unless you're thinking about cases where someone with insurance has a co-pay cost, in which case, you're really not "paying to see the dermatologist", you're the paying to be seen. The insurance plan pays the difference. Yes?

But back to OP, if it matters to you (and it probably should), get an appointment with whomever you wish to treat you. Go elsewhere if you're not given the choice.

 

[TriagePreMed]

I'm surprised, I'd totally ask for the PA before an NP, especially considering the amount of clinical training hours and education is basic science exceeds any nursing program.

I completely agree. PA>NP.

 

[willen101383]

I completely agree. PA>NP.

Agree +infinity.

I cant really figure out how to explain my reasoning without offending anyone however. Either way a midlevel is a midlevel. I am almost done with my first trimester of m2 year and have completed all the systems except neurology and GU and could NEVER imagine myself treating patients essentially on my own yet.

 

[Morsetlis]

Totally ask for the dermatologist. No offense to PAs, but I'd rather be seen by a Nurse Practitioner, instead of a PA. If you're paying this dermatologist, you should definitely be getting what you paid for... that is the care of a dermatologist.

Edit: I should probably add, that I know a few PAs, and they're wonderful. But their clinical experience is limited, especially if they are younger. They learn most if not all of the basic science that MD/DO students learn, but the clinical stuff is a lot more limited. Think of it this way... which MD/DO do you want to see? The one who hasn't completed a residency program in the field of which your problem lies... or the one who is moonlighting with no residency training... see what sticks, maybe? Nooo thanks!

I think they actually learn more clinical procedures and physical diagnosis rather than basic sciences. That's why PA's are ill-equipped to understand zebras, let alone catch one.

emedpa isn't here yet 😉

 

[Bacchus]

It's unlikely that the charge to see a PA or NP is the same as the charge to see the dermatologist. If you see someone with lesser qualifications, wouldn't you think the charge is less?

Unless you're thinking about cases where someone with insurance has a co-pay cost, in which case, you're really not "paying to see the dermatologist", you're the paying to be seen. The insurance plan pays the difference. Yes?

But back to OP, if it matters to you (and it probably should), get an appointment with whomever you wish to treat you. Go elsewhere if you're not given the choice.

You don't bill based on your degree. You bill on ICD-9 codes. I don't know honestly if a physician billing get's more or if its the same. Just making a guess and defer to my higherups.

 

[chrissyxf]

You don't bill based on your degree. You bill on ICD-9 codes. I don't know honestly if a physician billing get's more or if its the same. Just making a guess and defer to my higherups.

PAs and NPs bill at 85% of the physician rate, at least for insurance companies. I'm not sure how self-pay works.

 

[IlDestriero]

If you aren't happy with a doctor you always have the right to ask for another. Even in a teaching hospital you have the right to ask for an attending over a resident.

Occasionally a patient will make special requests. If they ask for no CRNAs, they would get a resident or fellow. If they say no trainees, they are reminded that it's a teaching institution, if we can we would try to give them a CRNA. The problem is that they usually make these requests immediately prior to surgery. Generally the surgeon says, take it or leave it. I have seen VVIPs have faculty only accommodations. You can get anything you want when your a large donor. If they can be done at an ASC, it's experienced faculty only all the time.

 

[ppfizenm]

Occasionally a patient will make special requests. If they ask for no CRNAs, they would get a resident or fellow. If they say no trainees, they are reminded that it's a teaching institution, if we can we would try to give them a CRNA. The problem is that they usually make these requests immediately prior to surgery. Generally the surgeon says, take it or leave it. I have seen VVIPs have faculty only accommodations. You can get anything you want when your a large donor. If they can be done at an ASC, it's experienced faculty only all the time.

My experience is limited to the ER but if the patient knew enough to ask for an attending (and few did), thin spread as they were, they got the attending or at the least a more experienced resident. In most cases this was only when procedures were being done and I had the feeling the patients who asked had bad experiences with first year residents before.

 

[mmmcdowe]

Occasionally a patient will make special requests. If they ask for no CRNAs, they would get a resident or fellow. If they say no trainees, they are reminded that it's a teaching institution, if we can we would try to give them a CRNA. The problem is that they usually make these requests immediately prior to surgery. Generally the surgeon says, take it or leave it. I have seen VVIPs have faculty only accommodations. You can get anything you want when your a large donor. If they can be done at an ASC, it's experienced faculty only all the time.

Seriously. I was with the chair of a department once and he had to stop seeing his patients three times in an afternoon in order to placate the nonsensical medical fears of a donor and his family/friends because he was about to drop a few million.

 

[primadonna22274]

Absolutely ask to see the doc. Understand the wait time will be longer, and this is a big reason specialty PAs have been brought in. Now one treatment plan that didn't work is no reason to write off that PA entirely--but if you don't let her know it didn't work she can't learn from that.
And for the record, PAs get 2-4 times the clinical training hours in their avg 27-month program that NPs get in theirs. PAs get abbreviated basic sciences and the full spectrum of medicine/pathophys/pharm...and enhanced procedural/clinical skill training that MD/DO students may not get until residency, because it is presumed that most PAs won't do a residency. I predict sweeping changes to this whole scheme of medical education in the next 15 yr...stay tuned. For the most part though, PAs are very well trained for what they are designed to do--act ad physician extenders.
Lisa PA-C, OMS1

 

[NewYorker9]

there's no reason why you can't ask to see the the physician

 

[plauto]

It is perfectly normal to ask to see an MD/DO over an NP or PA. Just do so when you make your appointment. Many patients call asking to see the MD/DO.