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Haha, yes sounds very different. I've practiced in the rural midwest and dense coastal cities with shockingly poor access for the majority of specialties (unless you were wealthy). This would not be common in either.I can accept there are big regional differences here, especially between resource-poor areas and areas with large AMCs. I think of the number of patients I personally have who appear to be seeing a cardiologist for HTN on 1-2 anti-hypertensives with no major complications or nephrology three times per year for extremely stable Stage 1 CKD and have to conclude we work in areas with very different follow-up cultures.