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The problem I see is that these jobs already exist (e.g. paralegals, nurse practitioners, dental hygienists), but are baked into the total practice. My primary care physician costs the same whether I see him or the nurse practitioner, and they are performing the same tasks, so why am I wasting my doctor's time for rudimentary work and simultaneously paying much more for an NP when I don't need to?

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My brother and I started a "member/concierge" primary care network for uninsured/under-insured patients. Members pay $20/month (individuals) or $15/month (business plans) and the patients can set appointments to see an ARNP/PA for $10 copay or the MD for $25 copay. Most primary practices can't take this issue into consideration because your copay is set by your insurance policy.

Interestingly, if you see a nurse practitioner in-office while a physician is not present in the office (I don't think they need to stop in), insurance companies (maybe only Medicare, can't remember) only have to pay 85% of the bill charged by the doctor's office.

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