Comment by mindslight

> What do you think you need an MD for, in your primary care visit, that an NP can’t do?

I guess not much at this point where PCPs don't seem to do much beyond use rubrics, prescribe, and refer. Which is why I used the word enshittification - it's part of a continual gradual march down in quality/services to a captive customer base. Basically the opposite environment of innovation aiming to serve customers.

> How much time, in a day, do you think doctors are spending on “insurance”,

I'd say at least half their time, if not much more. They certainly aren't scheduling these 10-15 minute appointments back to back all day. By "insurance" I am of course including all of the extra documentation and runaround they have to do simply to satisfy the third party beancounters' demands. I'd say this even includes a good number of patient visits themselves.

https://www.astralcodexten.com/p/what-your-doctor-spends-80-...

https://siderea.dreamwidth.org/1182366.html

Observations in my personal experience line up with this:

- Number of signs at my primary care office about their procedures for providing/processing referrals, like this is the majority of their work

- The numerous questionnaires every office makes you fill out ahead of every appointment, that they themselves never actually read

- Experience with a not-terribly-large specialist office who employed an entire full time "nurse navigator" whose job it was to help doctors prepare documentation for "prior approvals"

- The multiple times I've seen a doctor personally step in to grease the system for something way way below their pay grade, because it was the only way to provide appropriate health care

I'm sure I'm forgetting plenty too. Frankly I don't know how one could step into any moderately sized medical provider and not perceive the entrenched corporate government tentacles in every facet.