So, how do you make sure that only garden variety patients see the medical assistant, while seriously sick ones or those who have only telltale signs of a 1-10k illness see the real doctor? If those rare ones don't get to the doc they die.
so, because even the best make mistakes, that's a good reason to let under-trained (relative to an MD) people with even less skill make mistakes? Not following your logic here.
In my case, my doctor felt that because colorectal cancer (at the time) was relatively unusual for my age demo, that he didn't really need to consider it. Instead of doing an actual DRE, or a fecal occult blood test, he simply dismissed it out of hand (pun intended) as internal hemorrhoids. A year later, I was having a full resection, chemo, radiation treatment, and a permanent colostomy. Thanks!
For what is worth, a physician assistant can diagnose quickly (and they can be assisted with a ML/rule-based diagnosis system that is trained on something like "Pocket Medicine: The Massachusetts General Hospital", which is what most doctors in training use as a handbook) and escalate the difficult ones to the specialist doctors.