if you're going to see a physician assistant or a nurse practitioner

You should change your mind if there's no attending physician at that place.  I'm not here to stir up fear, but in this past week there's been a missed diagnosis of cancer, overly liberal administration of antibiotics (including the less-than-optimal kind and for way too long), wrong dosing, and minimal following of guidelines at best.

There's a lot of ego around here, especially with the NPs who talk down to the residents and medical students, when the NP then gets criticized for not having a thorough enough history and physical exam, as well as a "very superficial" assessment and plan.

I feel like an NP is more of a "physician extender" than a physician replacement, same goes for PAs. Doctors go to medical school to study from Cecil's, develop a strong foundation in physiology, pathophysiology, pharmacology, side-effects, nuances in the physical exam, and then they go onto do residency and maybe fellowship where they're in charge of using their minds to take care of the sickest patients.  Not to mention they have to take the USMLE Step 1, 2, 3 and take board certifications in their specialty.

I feel like the NPs are at the level of a third year medical student, and the PAs more along the knowledge and skill level of a 4th year medical student.  Their physical exams and histories are all done with checklists (so a high school kid could do it), and there's little to no thought about a differential diagnosis.

I haven't had an NP or PA been able to tell me what the latest guidelines are on management of  X or Y, and I never hear them explain why they're recommending a certain dose, why they chose that antibiotic, and why they chose to treat for that amount of time.  It's just "because that's how it is," or "why don't you google it?"

I'm sure there are great NPs/PAs out there, and I would really like to work with them.  This environment is just too much for me, really.  Too much for me because it's all "voodoo medicine," where people don't prescribe this or that because of one isolated incident, or because they heard a scary legend at a party.

Evidence-based practice is what needs to be going on here, no "oh I heard this can cause Stevens-Johnson syndrome" or "I've just seen this work better."

Just to add, there doesn't need to be just an attending physician there, but someone who is really good and thorough and passionate about patient outcomes.

Nurses are trained to do, doctors are trained to think.

If a nurse wants a million letters after his/her name and wants to practice medicine, they should go to medical school.

I feel bad for all the patients who have been the victim of medical mistakes because of mid levels. I'm not saying midlevels are the worst or that doctors are perfect (because many make many mistakes), but I just can't trust someone to take care of me if they haven't gone through medical school and residency.