Using a physician's assistant or family nurse practictioner for an annual exam

I haven't been happy with my primary care physician regarding my last few physicals. It seems like I've been getting short-changed when I go. He did do blood work the last time along with a urine test, but other than that, he did very little. Heart, lungs and that was pretty much it. No genital exam and no prostate exam, despite the fact that I'm 48 years old. I guess some physicians opt to bypass the rectal/prostate exam until you hit 50, but I can't understand the lack of a testicle exam. I think pcp's get pressed for time and basically eliminate certain parts of an annual routine exam. I've been considering going to a physician's assistant or a family nurse practitioner. He has a FNP that works under him, but she won't do physicals on males, which is absolutely ridiculous in my opinion. He does the males and she does the females.

Anyone else feel the same way about their physical/PCP?

It's not necessarily the doctor, welcome to the brave new world of managed care. If you want your genitals examined, go to a urologist. If you want your skin examined, see a dermatologist.

So in other words, see a specialist depending on what you want examined. Wow...

Bottom line: find a new doctor.

If your current doctor's office has a FNP there, the "family" part of that tells me that your doctor probably specializes in family practice. Find an internist instead -- you'll likely get a more thorough exam (or at least have a chance at a more thorough exam). And I've seen plenty of NP for full physicals -- so the fact that your doctor's office won't allow the FNP to do your physical is another strike against them. Go elsewhere.

I like your idea about using a physician's assistant or nurse practitioner for physicals. Hopefully he would be more thorough and I have always thought it would add to the embarrassment having a less qualified examiner. I think it would be thrilling to have someone less qualified than a doctor give me orders during the exam and see my genitals and anus.

I've been looking at internists and might consider that option. He has been my family physician for years, but I was very disappointed in my last exam. He had me undress and put on a gown, but I was wondering what the point was. I could have removed my shirt and it would have accomplished the same thing, since all he did was listen to my heart and lungs. The internist office that I'm considering has 4 physicians and 4 nurse practitioners. 2 doctors are female, 2 are male. The nurse practitioners are all female. I have never heard of a nurse practitioner refusing to perform an annual physical on a male if they are female until I questioned the FNP that works for my family physician. I was embarrassed and shocked at the same time. I have to believe that this internist office will allow a female nurse practitioner to perform an annual physical and hopefully, I'll get a full exam---genital and prostate exam included.

I think it depends upon the physician, not the specialty. Both physician assistants and nurse practitioners know how to and should perform complete physicals on either sex.

I have an appt for a annual physical exam on January 14, 2014 with a Family Nurse Practitioner, so we'll see how it goes. It's with a different provider--a female internist with 4 female Family Nurse Practitioners---should be interesting.

You need to find a new provider. Many mid levels spend more time with a patient than an MD does. Many don't do a prostate exam until age 50 unless you have presenting problems. male/female-the choice is yours.

Had an NP for mine. She seemed thorough enough.

You need to find a new provider. Many mid levels spend more time with a patient than an MD does. Many don't do a prostate exam until age 50 unless you have presenting problems. male/female-the choice is yours.

I've already found a new provider. The physician is a female internist, but according to the new patient form, I'm seeing one of her female nurse practitioners. I wasn't satisfied at all with my last physical with our family doctor. He's too rushed and his female nurse practitioner won't do male physicals. Damndest thing I've ever heard of. That's when I said good-bye. I'll still use him for routine sickness, etc, but plan on using the internist for annual physicals now.

My current primary care doctor is an internal medicine/endocrinology specialist. I get a very thorough physical every year. Due to a scheduling mishap one year it was handled by one of the clinic's PA's. He was just as thorough. I would imagine he follows specific guidelines for administering physicals.

I second the suggestion to find a new physician. Our family doctors give my husband a physical every year, and he always does a testicular exam. My husband is 36, so there's no reason you shouldn't have one at 48.

I have felt the same way, in the sense of the exam being lacking................but I haven't figured out a way to discover if a MD, NP, PA will be thorough. How do you ask a question like that, when you can't typically even speak to them other than through their nurse?

So much has to do with who's paying. I'm on Medicare. In the name of cost control, they don't pay for a real physical. My primary doctor checks heart, lungs and vitals, also orders lab work. To prostate and genital exam, I have to go to the urologist. For a skin exam, the dermatologist. For an EKG, the cardiologist.... It goes on and on, specialist after specialist. You can see how this controls costs, can't you?

While I find nurse practitioners and physician assistants to be more caring and less rushed, the financial considerations are exactly the same.

@ J9999

You can always schedule a consult to meet with the provider to talk to them before scheduling an appointment for a physical etc. You may have to pay for it out of your own pocket. Your insurance may have an allowence for it of some sort. If you have a healthcare option at work where you can reserve part of your paycheck for out of pocket medical expenses, you could use that to cover those costs. You can also check with the office to see if they have more than one set block of time for a physical or physical time slots for longer times. Be aware most providers charge accordingly in most cases for longer than 'normal' scheduled appointments.

My NP blows away the doctor that she works for. Everything is very through and most important of all.......she cares. The doc himself is always acting distracted and has the charisma of hobo ejaculate.

Andie knows everything, just ask her.

I think that they are all good you just need to find some one you like.

I went through somewhat the same thing. Not being satisfied with the "attention to detail". So I went looking for someone who cared more and took their time. Don't know where you're located but if it's in GA let me know and I can give you some ideas.

My urologist (male) has transitioned me over to his nurse practitioner (male). While I like the NP, I'm not happy with this happening without my choice or consent. I prefer to make all decisions regarding my heath care, ESPECIALLY the choice of provider. I've always avoided group practices because, outside of emergency situations, I want a single provider. I've been in situations where I've seen different doctors in a practice who have different therapeutic philosophy. I refuse to be a pawn in medical chess games or power struggles.

This has little to do with the new world of "managed care" . That world has been present in the US for over 30 years ! This has everything to do with your doctor not wanting to touch your junk. Males are prone to hernias, and cancers of both the prostate and colon at relatively early ages. Rectal exams should begin at age 40- NOT 50. Colonoscopies begin at age 50.

Your doctor is guilty of malpractice and you should report your experience him on www.HealthGrades.com as well as Yelp.com.

PeaceMale, to what post are you responding?

@Jds - the OP indicates that his doctor does not do prostate exams despite hs age . You also replied that this is due to the "new world of managed care". So i guess i am replying to the both of you .

I had an advanced practice nurse last time for mine. She seemed very thorough.

@Jds - the OP indicates that his doctor does not do prostate exams despite hs age . You also replied that this is due to the "new world of managed care". So i guess i am replying to the both of you .

It's true, depending on your insurance. I'm on Medicare. They manage costs by limiting what they pay for. My PCP won't get paid for a routine prostate exam more than once a year. In fact, they have a choice of doing a DRE or PSA, not both. To get my prostate evaluated, I have to go to the urologist where it's a normal part of most visits, especially when you've been diagnosed with BPH. Same "cost controls" with many common preventative exams. You go to specialists to save money. No wonder our government is broke - and broken.

Nurse practitioners have become very popular with OB-GYN's. Most patients are more comfortable with another female doing a routine pelvic, pap smear and breast check. The more complicated patients see the physician, but make no mistake, it's all about cost control. N.P.'s and P.A.'s make much less money than M.D.'s and D.O.'s . They can well handle the routine stuff and free-up the physician's time to deal with more unusual conditions. When Obamacare takes full effect, you may never see a physician.

In Ohio, there is a battle over prescribing privileges. N.P.'s can Rx anything but controlled substances, since they report to the State Nursing Board. The State Medical board supervises P.A.'s and won't let them Rx anything, without a physician's approval.

My last two exams have been with a urologist and my new family doctor. The urologist had his PA do the exam. She was one of the foxiest women I have ever seen. She did the most thorough exam of my gentials I have ever had. After the exam, she checked to see if I could get an erection. That was no problem on my part. My new family doctor is also a female. The first thing she checked was my testicles and penis (along with my my prostate).

My last two exams have been with a urologist and my new family doctor. The urologist had his PA do the exam. She was one of the foxiest women I have ever seen. She did the most thorough exam of my gentials I have ever had. After the exam, she checked to see if I could get an erection. That was no problem on my part. My new family doctor is also a female. The first thing she checked was my testicles and penis (along with my my prostate).

Rather unbelievable.

I think my Doctors office has a nurse practitioner, but I've never seen her. Since I really like and trust my Doctor I would really rather have her examine me as opposed to the nurse practitioner.