Pain Management centers using Physician Assistants and Nurse Practitioners instead of MD's

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Regular Member

Date Joined Feb 2008
Total Posts : 255
   Posted 7/22/2011 4:35 AM (GMT -6)   
I've noticed over the last couple of years in North Carolina that when going to see my pain doctor at a dedicated pain facility I wind up seeing their physician assistant or nurse practitioner instead of the MD. For me this has been my biggest problem is dealing with these pseudo-doc's who can write prescriptions under the supervision of an MD. Some of these PA's or NP's are good but the majority of them practice medicine out of the book which is the wort type of medicine there is. I am an individual not a statistic in a book. This is where I've had most of my problems because these guy's or girl's like to quote everything out of the book regarding pain meds. This is when I had my last confrontation with a PA who stated that the 90mg's of methadone is equal to 360mg's of morphine and by taking more I can have a cardiac arrhythmia leading to a heart attack. When I mentioned I was on 180mg's before coming to that doctor he stated they were a pill mill and did not know what they were doing... So from now on I will make sure I am seen by an actual doctor that is able to look at the patient and not a book for treating me. In 12month's I was seen by the MD 1 time and the other 11 months by a PA. Sorry for ranting..Thanks Randy
AVASCULAR-NECROSIS (AVN) in 6 joints. HIPS,KNEE'S andSHOULDERS-Replaced 1 shoulder. replacing left hip 9/8/11 then left shoulder.
MED'S-Methadone 30mg's TID and OXYCODONE 15MG 1 TAB QID.

Veteran Member

Date Joined Jul 2009
Total Posts : 2042
   Posted 7/22/2011 8:09 AM (GMT -6)   
In many/most pain management practices all that the PA's and NP's are allowed to really do is make sure everything is OK during followup visits. If there is a problem then they are usually instructed to bring in the doctor. Their hands are often tied by both the law and the rules put in place by the doctor they work for and/or the clinic they are at.

Odds are that just butting heads with the PA's is not going to get you anywhere, nor will it get you anywhere to ask them for changes in your treatment plan. If you are feeling that your plan needs to be adjusted then this is what you need to be bringing to the attention of the PA's and ask them to bring the doctor in on this.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Veteran Member

Date Joined Mar 2011
Total Posts : 816
   Posted 7/22/2011 9:21 AM (GMT -6)   
I do agree with Jim, I have been going to the same pm doc for almost 2 years now, I have seen the doctor, maybe (including surgery) 6 times, the rest of the time I have seen his pa, who is a wonderful young lady who has never lectured me about meds, who I can talk to, she knows me by name, I as strange as that my seem to say that, many others I have seen over the years, almost always had to ask me, or say "and you are?".
My pm doctor has many, many patients, he has three offices in 3 different hospitals, he is sometimes doing rounds any of the three hospitals where he treats patients, where his patients who have had surgery.
I feel blessed that his pa, can see me, write my scripts and send me on my way.  If I have a problem she thinks she cant handle, the next appt. I would have would be with the pm doc. himself. 
For the first time since my gp left his practive in 2006, I feel at home.  I have been thru hell and back, finding this pm doctor and the staff who work so hard for us, is a blessing I will treasure always, when I found them during the first visit, I actually cryed, and I dont cry.
Hope you find an office like this one.  All of us should be treated with the respect given anyone who has a chronic disease.
Take care of yourself, I am not familiar with N.C. at all, but I hope you find what you need to get the help you deserve.
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

Veteran Member

Date Joined May 2011
Total Posts : 636
   Posted 7/22/2011 11:43 AM (GMT -6)   
In the PM practice, I go to, I am scheduled with the dr every 3 months, the other months with the NP. I have however called and rescheduled with the dr on occasion when something has come up that I know she will need to refer to the dr. I may need to wait a few weeks and pick up scripts in the mean time. I have also told the dr occasionally that I wanted to follow up with him verses the NP and they have always been good with my requests as long as there is a reason.

I did call my insurance provider at one point and they told me I had a right as the patient to been seen by the physician verses the NP or PA if I wanted to. Now, I am not sure what would happen if I said no more NP for me, I dont want to rock the boat. I am happy with how I am treated at this point by the entire office.

No-relief, have you asked for your next appointment to be with the dr? Maybe a call to an advocate with your insurance provider may help. Mine has some sort of special call center for chronic illness issues. These nurses help you with understanding procedures, medication questions, patient rights, etc... They have often checked on me after a surgery or major procedure. I know they are also there to protect the insurance company and to keep costs down, so they are not only looking out for your best interests, but theirs as well. They may be able to help with suggestion or more effective treatments, verses years upon years of doing the same things because the NP or PA is just doing things by the book and following the protocol.

Sorry, I was bit all over the place. It is over 100 degrees here, the heat index was 115 at 10am this morning, my brain is fried,lol.

Big hugs,
DX: CRPS/RSD full body, Fibro, CP, DDD, DJD, OSA, Syringomyelia, Arachnoiditis, failed fusion. Fusions C5-6, L5-S1, hardware removal and removal of scar tissue. SCS trial successful awaiting placement.
MEDS:To many to mention, changes every week it seems.

Veteran Member

Date Joined Jul 2008
Total Posts : 1560
   Posted 7/22/2011 6:31 PM (GMT -6)   
I too see my doc's PA every other month with NP on those alternate months. So basically I see the PA one month and the NP the next. I've never, in the 4 years I have been with this doctor, seen the Doc. I know he is there, because when my PA has questions about my treatments she goes to Doc to get answers. Now, that said I realize it is frustrating to see a PA instead of the doctor that has the practice. However, I rather like this practice and realize that my doctors have many, many patience to see.

I would not worry too much about seeing a PA, you have to realize that they are probably seeing hundreds of patient and she/he is most likely talking to the doc regarding your treatment.


I live to "Tame My Pain!"
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