[namelessoracle]

What you are talking about is ideal state. My experience is literally its always "here's the referal" if i talk about anything specific and the standard host of anti biotics and standard z pac style medicines dont clear it up. Always.

Now my view might be biased because i have been given Kaiser as my provider and i know they have incentives in their system that arent the norm. But its always a specialist referral. Ear problems that the anti biotic didnt solve? ENT referral! (the ENT laughed and said the general medicine doctor made the problem actively worse with the multiple types of anti biotics proscribed sense it was a fungal infection in the ears). Skin issue? Here's the dermatologist referral! Shortness of breath after working out? Here's the pulmonology referal if you want it. Your knee hurts? Here's the rheumatology referral.

I am legit curious what medical service the doctor would provide. You mention "multi-systemic disorders that most mid-level practitioners would never recognize" do you have an example of that?