The Doctor Won’t See You Now—Should You Worry?

Physician associates, physician assistants, and nurse practitioners are playing an ever-increasing role in healthcare. The people in these roles are valued colleagues, fill a clear need, and often provide high-quality care. All that said, I am sometimes troubled that the role these colleagues have not been well considered. Dr. Bobby Dubois presents a thoughtful consideration of the topic and offers advice for patients.

Adam Cifu

If you’ve ever taken time off work to see “the doctor” and instead been greeted by a nurse practitioner or a physician associate/assistant, you’re not alone. I hear this from patients and friends all the time, and it raises real questions: Is this a bait-and-switch? Is your care worse—or just different? Most importantly: what should you do to get the right care at the right time?

Here’s my straight take, grounded in the evidence and my life in health care: for routine, protocol-driven issues, outcomes with nurse practitioners (NPs) and physician associates/assistants (PAs) are generally comparable to physician care. Where I have concern is with complexity, diagnostic uncertainty, or when you’re simply not improving—those are moments to see the physician or confirm same-day physician oversight.

Why the rise in NPs and PAs

Access is tight. In large U.S. metro areas, the average wait to see a physician is now about 31 days, up sharply since 2004, with some specialties and cities waiting far longer (AMN Healthcare’s 2025 survey). Demand is rising with an aging population and more chronic conditions, while the physician pipeline isn’t keeping pace. Recent perspectives in the New England Journal of Medicine outline the workforce crunch and the limited levers to fix it quickly—either reduce demand, increase supply, or both (NEJM).

To close the gap, health systems are leaning on NPs and PAs. In Medicare data, the share of visits delivered by NPs and PAs roughly doubled from 2013 to 2019—from about 14% to 26%—and a sizable share of patients had at least one NP/PA visit in 2019 (BMJ/summary and PubMed abstract).

The training of NPs, PAs, and doctors

Training pathways are different, and it’s okay to acknowledge that. Physicians complete medical school plus 3–7 years of residency with broad rotations and roughly 10,000+ hours of supervised clinical care. NPs typically complete a master’s or DNP (many are online courses, not in-person education) with just a few hundred supervised hours and (in many states) can practice independently; PAs complete a master’s with ~2,000 supervised hours and collaborate with physicians. The headline: physicians are extensively trained for broad differential diagnosis and complex, multi-morbidity care; NPs and PAs expand access and are highly effective in protocol-driven domains. If you’re curious about the evidence debates, this AJMC overview is a fair starting point (AJMC review).

How good is the care?

For many common conditions, yes. A longstanding Cochrane review finds that nurse-led primary care delivers similar clinical outcomes to doctor-led care, with some signals of slightly better blood-pressure control and high patient satisfaction (Cochrane). In diabetes, a 2023 study showed comparable quality and cost for patients under NP-led vs physician-led primary care, with no differences in recommended care or diabetes-related hospitalizations (PubMed). And when it comes to counseling—like helping people quit smoking—NPs and PAs often spend more time and may be uniquely positioned to deliver that support (AJMC brief).

PAs specifically? A new BMJ rapid review concluded PAs practice safely and effectively across settings, with consistent findings for quality and safety (BMJ).

None of this means nurse practitioners or physician’s assistant are interchangeable with physicians. It means for routine, protocolized issues—hypertension follow-ups, cholesterol management, stable diabetes checks, minor infections—NPs and PAs can be an excellent, timely choice.

When I would insist on seeing the physician

Complexity is where physician depth matters. If your symptoms are new, confusing, or not improving—think persistent headaches, lingering back pain, unexplained fatigue or mood change—ask to see the doctor or confirm that your NP/PA visit includes same-day physician review. If you juggle multiple chronic conditions or many medications, or if there’s a real possibility of a serious alternative diagnosis (e.g., “heartburn” vs. cardiac disease), push for the physician appointment. That’s not disrespectful; it’s good stewardship of your health.

How to navigate your next appointment (and get better care)

I want you to feel empowered—not blindsided. Here’s how to make the system work for you:

• Ask upfront who you’ll see. When booking, say: “Is this with the physician, NP, or PA? If it’s NP/PA, how does physician oversight work?” You deserve transparency.

• Use NP/PA access strategically. For routine follow-ups or minor acute issues, take the earlier NP/PA slot and keep momentum on your health plan.

• Escalate wisely. If a problem is new, unclear, or not improving, request a physician visit—or at minimum, documented same-day physician review.

• Don’t “wait and see” too long. If you’re not better within the expected window, call back and ask for reassessment. Waiting weeks can turn a simple issue into a bigger one.

• Bring your data. Home blood pressure logs, glucose trends, med lists, and timelines help any clinician deliver better care—fast.

The bigger picture

We’re living longer with more complex health needs, and the workforce realities aren’t changing overnight. That makes team-based care essential. The good news is that you can leverage the strengths of each clinician on the team: NPs and PAs often provide faster access, more counseling time, and excellent protocol-driven care; physicians bring deep training for complex diagnosis and multi-condition management. Used wisely, this is not a bait-and-switch—it’s a way to keep you moving forward.

Dr. Bobby Dubois is a physician and scientist with 180 peer-reviewed publications on evidence-based medicine, appropriateness of care, and the value of health care interventions. He is also an Ironman Triathlete, and wellness/longevity/health podcaster and writer. To hear more health thoughts, listen to his podcast: Live Long and Well With Dr. Bobby.