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> I think we need multiple grades of doctor.

Don't we have that already?

Doctor / Physician

Physician Assistant

Nurse Practitioner

Registered Nurse

Nursing Aid / Nurse Assistant

You can't book an appointment with most of these directly, and not all of them can write prescriptions legally. For instance, I can't just book an appointment with a nurse to take a look at a cut to see if it needs stitches. The nurse might be the one to actually do the work, but I can't cut out the middleman legally.

> You can't book an appointment with most of these directly, and not all of them can write prescriptions legally.

You can with many nurse practitioners (and maybe physician assistants, but I've had no experience with them) at places like minute clinic (http://www.cvs.com/minuteclinic/).

I've gone to a similar place that's in my office for some minor routine things, and it's been cheaper and easier to schedule than a proper doctor visit.

Nurse practitioners are special in that they can do roughly 80-90% of what doctors can do, including writing prescriptions. In some cases they can act as specialists, such as handling mental health needs that your standard GP wouldn't handle.

They certainly do have an important role to play, but we need a lower level medical professional that can accept appointments and perhaps write a limited set of prescriptions and handle treatment of basic ailments.

One shouldn't need a masters for the 'oil change' of medicine, just as one needn't be a registered engineer to change an air filter.

PAs fill much of that role. Yes, they do require physician supervision, but at many practices you can make appointments directly with them, never seeing an MD.

The last time I needed a basic physical, I saw the PA. She ordered blood-work and reviewed the results with me. I'm sure one of the physicians signed off on everything, but as far as I know, she did the work.

Likewise, the last time I had the flu, I made an appointment with one of the PAs. She did everything, with the physician just signing off on the prescription at the end.

Post-surgery, my follow-ups were with PAs or NPs, not the physician. He did drop in to say "Hi." but that was about it.

> You can't book an appointment with most of these directly, and not all of them can write prescriptions legally.

So I think that varies from state to state.

[Anecdote warning] When I was in grad school, at least, I was able to directly book appointments at the student health center with PAs, MDs and DOs (perhaps a university-run health center is different, somehow?). I also don't recall ever facing difficulty having a prescription written.

My understanding is that a PAs can't open their own practice, but that several PAs can function more or less independently under the supervision of one MD/DO principal.

Nurse practitioners are doctors. None of the others listed can legally diagnose illnesses or prescribe treatment. That's the point. If nurses could open up their own practice and prescribe meds, that would be more like what the OP is proposing.

PAs have prescribing power

Nurse practitioners might have a doctorate in nursing, but calling them doctors is extremely misleading. They function is a very similar capacity to PAs, although PAs often have more capabilities.

All of the levels mentioned here have their places, but calling any of them "doctors" who don't have an MBBS, MD, DO, or equivalent physician-level degree is inappropriate.

They do not require a doctorate in nursing -- it's a masters degree. ("MSN-NP")

Yeah, hence the "might"; some programs are doctorate degrees

Yes, but all those professions require the oversight of a MD. A doctor, or group of doctors who deeply care about profits. I'm not knocking profits. I know it's all about money. It's just when you can't increase competition, you have no control over prices. The amount of time, and political BS, a doctor has to go through just to get through medical school is rediculious. Then there's the residency--that's the apprentiship. When they get out--know wonder they want a lot of money for what they went through.

I don't have a simple answer, but I would like to see more government built medical schools; increasing the supply.

I would further like to see most drugs available over the counter, with the exception of antibiotics, and very strong pain killers.

I would like to see a society, where a patient who is on a long term medication, only has to see a doctor once a year, or if the patient needs a higher dose. (Right now most patients only need to see a doctor once a year, in order to get refills, but very few doctors are willing to authorize a year's worth of refills. They want to bill for those office visits. I understand it in some situations. In other situations, I don't understand dragging in patients, especially those patients with lousy insurance, or no insurance.)

I don't have a simple answer. I'm on medications--I can't just stop. I've felt hostage to the system for too many years.

I am greatful to the Health Care Act though. I know, you guys all hate it. Yes, it has faults, the Insurance/Pharmaceutical companies took advantage of, but let's see what the system looks like when the next Republician president vetoes it?

   I'm guessing that a similar situation exists with
   doctors; physicals, vaccines, and a handful of common
   diseases (like colds) probably make up a sizable
   percentage of visits. There's a market for someone who
   can just handle these cases and pass them off to the
   higher grade doctor when the need arises.

Those are called GPs up in Canada. They do more than just deal with colds, but the system is set up so you first go through a GP and then are referred up.

In the US we have general practitioners. They are full blown doctors with all of the 8 years of training that that entails.

What I'm proposing is an intermediate step between doctors and nurses (or perhaps buffing up the powers of higher level nurses so they could operate standalone) so that one doesn't always need to make an appointment with someone with 8 years of specialized training to be stuck with a tetanus booster shot.

GP := General Practitioner.

As a patient I don't want this to happen. I'm ok with nurses administering the shot, but by having an MD giving his approval first (or a "Super nurse"). At what point do you draw the line and say "this is enough knowledge, get to work"? What happens when things go wrong? How do you make sure things won't go wrong? It's not like in a lot of technological settings where if the system doesn't boot you can just buy a new one (caricature). You're dealing with the life and quality of life of a human being. Stakes are different.

> What I'm proposing is an intermediate step between doctors and nurses (or perhaps buffing up the powers of higher level nurses so they could operate standalone)

We have categories matching that description in the US now, most notably Physician Assistants [0] and Nurse Practitioners [1].

[0] https://en.wikipedia.org/wiki/Physician_assistant

[1] https://en.wikipedia.org/wiki/Nurse_practitioner

This is a good point. Sometimes the market has already approximated grades-of-doctors - for example, it's possible to spend a lot of time and money with a podiatrist, and still end up not solving stance/arch/ankle problems with your feet. But a competent ski bootfitter will do a better job of sorting you out, for less money and without waiting rooms, for most non-surgical issues.

I think we need multiple grades of doctor.

Isn't that where nurses come in?

It's pretty much impossible to just book an appointment with a nurse right now in the US.

I booked an appointment with a doctor for basic allergies (Houston), and ended up seeing some version of nurse instead. It worked well, and I didn't have to wait weeks and weeks for the appointment.

Then I think I see a pretty simple fix...

Legally, many levels of nurses can't write prescriptions. They also can't take appointments directly--I'm not sure if that's a legal requirement also--even if the work entailed would have been entirely done by them.

Dentistry has true to introduce an assistant level which can do basic dentistry, but so far as I recall this movement has only been successful I Minnesota? New Hampshire wants to try it out too, but generally dentists fear the profession will suffer from a perception of "dentistry light" and impact their business.

I can't imagine letting anyone take a drill to my teeth but the most skilled DMD I can afford to pay. I'm surprised others don't feel that way (but hey, whatever floats your boat).