To answer Q's question, the situation is really really complex, and it varies state to state. If we are talking about Florida, I would tell you that you should have no trouble seeing a licensed doctor anywhere in this state. If you are having an issue, maybe we should look at why you can't get in. Could it be that: 1. The doctor is having to deal with more and more paperwork and has less time to see patients 2. There are fewer and fewer practicing physicians because more are retiring or opting out of this mess 3. We are reimbursing them so low that they'd rather sit at home or see less patients and pay "extenders" (PAs/NPs) to do their heavy lifting. I can tell you all 3 affect me. I'm relatively young, but I would quit tomorrow if I could. The paperwork is just simply ridiculous and it's getting worse. Electronic medical records have made things worse. Patients are so ungrateful nowadays and they generate absolutely no rapport with you. They simply go to whoever's cheapest or on their insurance plan. If Obama gave my 3,000 patients tomorrow the choice of (1) seeing the worst doctor in the state for free or (2) paying $50 a visit to see me, 2,900 would choose the free doc. I believe this is what Michi was referring to above. People are inherently not suited to judging their own health. It takes an objective, learned person to differentiate pathology from simple inconveniences. I'll post later, but IMO, NPs and PAs have definite roles, but aside from the most obvious areas of need (Mississippi Delta, etc.) they should always be supervised or under the tutelage of an experienced MD.