In recent years, the medical landscape has seen significant changes, not all of them favorable. One of the most noticeable shifts is the increasing reliance on physician extenders—such as nurse practitioners (NPs) and physician assistants (PAs)—to handle a substantial portion of patient care. While this model works well for a broad segment of the population, it doesn’t suit everyone’s needs. As a physician myself, I understand the importance of efficient health care delivery. However, I have reservations about seeing a physician extender exclusively, especially when I have more medical training and experience.
When I contact a medical office to schedule an appointment, I often have to inquire directly whether I will see a doctor or an extender. Despite identifying myself as a fellow physician, I am frequently met with resistance. Many offices adhere strictly to their policies, which often prioritize extenders over doctors for initial consultations. This “take it or leave it” attitude is disheartening and, frankly, unprofessional. The lack of accommodation for a colleague requesting to see a doctor undermines the mutual respect that should exist within the medical community.
Reflecting on my childhood, I remember the courtesy extended to my family when visiting my physician-uncle’s colleagues. As a doctor’s niece, I was always warmly welcomed. Fellow doctors would go out of their way to ensure we felt at home, recognizing the shared bond within the medical fraternity. My family was never charged a penny. This sense of camaraderie and respect continued into my professional career until about a decade ago. The transformation since then has been stark, and the once prevalent doctor-to-doctor courtesy seems to have all but vanished. I am not talking about waving payments.
Today’s experiences often starkly contrast those earlier memories. Recently, I was labeled as “rude” by a receptionist for insisting on an appointment with the actual doctor rather than an extender. She even questioned my credentials, suggesting that a “real doctor” would follow their office protocols. This incident highlighted a disturbing trend: the erosion of basic peer-to-peer respect among physicians. It’s troubling to think that an APRN or PA, not a licensed physician, is positioned as the gatekeeper for further visits or surgical decisions.
This shift in practice not only undermines patient confidence but also reflects poorly on our profession. Physician extenders play a vital role in health care, yet the system must recognize and respect the preferences and expertise of fellow doctors. Mutual respect and courtesy should be non-negotiable, fostering an environment where collaboration and professionalism are paramount. As we navigate these changes, it’s crucial to remember and revive the foundational principles of respect and support within our medical community.
Maria Ramirez Hubbard is a behavioral and cognitive neurologist.
