1)Notion all providers are the same (except for pay). There is no tirage. Primary care/family practice NPs and PAs are expected to see and manage the most medically complex patients that come through the doors (patients with multiple chronic comorbidities...AIDS, CHF, renal and liver failure) while the internal med physicians are getting paid more than twice as much and may be seeing someone with a history of asthma as a child and no other medical issues.
2) Not NP/PA friendly. As a "midlevel" you will see more patients than the physicians and more complex patients than the physicians (who have no other medical director responsibilities) and get paid less than half. You have to have 10 charts reviewed for punctuation per month while physicians have no peer review at all.
3)This more applies to the correctional health in general... Almost every patient you will ever see wil ask you for narcotics, benzos, extra mattresses, personal shoes,...You will see more patients who abuse prescription drugs on the outside than who abuse illegal drugs, and they feel entitled to get them in prison so they can be quite argumentative when you say no.
