Like you, I would prefer to see a physician right away. Having to see a nurse does strike me as a waste of my time. (I'm a nurse myself.) But I recognize that costs have to be reduced. What I think would appeal to me would be a set up where there are always doctors on the premises to whom a NP can refer a patient for immediate attention, when the problem is appropriate for that referral.

The Urgent Care clinic that I recently went to did not have a physician on the premises, though there were plenty of docs just down the hall in the ER that is housed in the same building. These nurses did a poor job of evaluating me and sent me out misdiagnosed. I wanted to believe them because I didn't feel like sitting in the ER. That showed me the pitfall of having NPs screening acute situations with no direct access to physician back up.

Six years ago, I went to a different Urgent Care clinic that did have MDs on the premises. I went there with a similar complaint. At that place, I was triaged to be seen by a physician and got the appropriate eval and diagnosis.

I guess my main problem is that I can't see having NPs working without pretty close collaboration with MDs.

Serious problems usually require some sort of imaging to diagnose. In the old style independent doctors office, there often was not equipment available to do x-rays. So you'ld still have to make a trip somewhere else for the image, then return to the doc for a reading. Family Practice clinics IMO should be big enough, with multiple providers, to make it worth the cost of having imaging capabilities right there. That does seem to be the trend.

Rural areas do pose a whole other set of complications in setting up a network. Having competition does seem to push quality up, and you get that in an urban setting.