[jrnichols]

"My cousin did not need to see a doctor or a nurse practitioner to get an x-ray. I’m not sure I’ve ever seen that happen in the U.S."

I've had a few internet discussions with this particular doctor before and what I've learned is that she's used to things in California because what she describes above is definitely something that I've seen and experienced in the US. Kid fell off bike. We went to ER. Doc & tech met us in triage. Went right back to x-ray. We were in and out of the ER with imaging taken care of in less than 90 minutes.

Also, being punted to urgent care isn't always a good thing. This is how Kaiser missed a damaged disc in my lower spine. They had a habit of turfing me to urgent care and brushing it off as sciatica. It was when I moved to Texas that a Baylor ER did an MRI, revealing the true source of the problem, and was shocked that in all the years before, nobody had ever done that.

Health care systems aren't identical in every state, as I've found out the hard way.

"The nursing triage was wonderful and actually doing nursing" This might be another reason things are so expensive. Not every single aspect of emergency department care needs a full blown RN to take care of it. But when attempts by other levels of provider (LVN, LPN, EMT-Paramedic) are made, nursing unions come in like a hawk and lobby to crush whatever efforts are being made. It's frustrating to see happen.

[apathy]

This simply shows the power of a union. If physicians operated more effectively there would be no NPs prescribing.

It cuts both ways. I do not begrudge nurses their income, they sure as hell earn it for the most part. Put an investment banker in a nurse's job at County and see how long they last, then tell me it costs too much.

[jrnichols]

and it shows what happens when you lack a union too. :/ Us folks in EMS run into this often. There's IAFF which we can join, but they actively seem to hate any private EMS at all. Yet fire departments don't want to do the stuff that us in private EMS do. so we're kind of caught in between.

Texas recently made some legislative changes that will allow facilities to utilize paramedic level providers to their full scope in an emergency room setting, though. that's a huge plus.

[apathy]

Go Texas! (First time I've ever said THAT in my life...)

[jrnichols]

Not everything here is perfect but there are a lot of things that I like. Good example in my line of work is that it's a "delegated practice" state, like South Carolina. This means that different EMS services can use their own medical director instead of how it was in California where the county had one that all of the providers had to use. This allows a lot more flexibility and for more progressive pre-hospital protocols.

It's been a pretty good system.