To be clear, there are plenty of doctors. The issue is you can't practice at all in the U.S. without at least some residency training. Most states require 2 years to even get a license. However, with competition from overseas the number of applicants to residency programs is increasing every year without an increase in slots. So there are many many people who graduate and can't do anythign with the degree, they just end up floundering for a year doing something else and reapplying to residency or eventually giving up. People are so desperate to get into any program at all they are even willing to work for free these days.
The fucking AMA is useless, instead of fighting to allow unmatched MD's to practice in some capacity they publish all of these BS statements about how they're fighting midlevel 'creep' while doing fuck all. It's infuriating.
I have an uncle who's a doctor. When I was a little kid he would criticize/mock my dad for being in a union trade and the whole 'call the hall' thing. About ten years ago my uncle was like...yeah we probably need some kind of union at this point.
The medical industry is totally out of hand in the US. It's driven almost exclusively by finance types and that's terrible for patients. It's also at all levels of medical care as far as I can tell. Assisted living homes, hospitals, urgent care: good luck because whatever your age and wherever you are, even if the provider means well they may not have the time or the tools to do the job properly. I know someone who worked at an assisted living home in 2020 and the operating system on their computers was comically old - Windows XP or something. They also had a bad old phone system and during COVID their administrator kept getting dropped from calls with the Health Dept. The owner would not update anything because he wanted to extract every last cent from the business. They had all these horror stories during lockdown.
I've had two experiences with NPs. One who basically misrepresented themselves as a doctor; they were employed at a location owned by a medical group. A law office called me and asked me if I want to be part of a lawsuit about that. The group that owns the office where that person worked has a track record of hiring people from far away and basically seems to pressure them to misrepresent themselves as doctors. In this case, they hired someone from across the country and that person probably couldn't afford to move back right away or something like that. That's the person who saw me. They seemed kind of dumb so I just didn't take their recommendation; during the consultation I said, "This is the opposite of what the last doctor I saw at NYU Medical Center said can you give me a reason I should take the opposite advice now" and they just hemmed and hawed. But almost everyone who worked there was a new hire from 2000+ miles away, or a travel nurse. So in that case, at least to me, the providers seemed like some combo of desperate and naive and trapped. I almost feel bad for them, but not really because of all the malpractice that seems to have been happening at that location.
At the risk of being flamed, I've also had a good experience with an NP. This person is in private practice, in an office with one other provider, also an NP. I needed an appointment; their clinic could see me quickly and accepted my insurance. Their practice is honest in their advertising that it's a clinic run by NPs. They are transparent about their training and what universities they attended - decent state universities, and when you walk in to the exam room the diplomas are on the wall. They're not hiding anything, basically. I made the appointment because I have a history of anemia; I was feeling tired in that recognizable anemia way. I figured they could order bloodwork and read my iron level as well as anyone else. The NP actually sat with me and explained all the values in the lab work when it was back which was nice. The appointment didn't feel rushed like most do these days.
If you need to see someone, provided it's a sane NP who knows their limits, they're not all bad. But I'd be careful about like, how are they talking about themselves in the way they describe the clinic/practice. If you're pretty sure you have an ear infection and just need some amoxicillin: an NP can be fine. Like chiropractors it seems there's a big range - there's normalish ones who even a doctor will tell you to see for certain back issues, and then there's crazy ones who think they have all the answers but it's mostly woo. NPs seem kind of like that.
The scary thing is thinking about who giant hospital chains or urgent care chains might hire to keep costs down. It won't be the experienced NPs who are smart enough to know their limits and run their own practices competently. It's going to be people who are really green or who fit the Dunning Kruger Effect.
