Agreed. Nurse practitioners are a great addition to the medical field. They can handle most common problems and are well-trained enough to know when to refer you to someone higher up the chain. All the nurses in our school system are NPs now. This pretty much guarantees good, basic healthcare to all of the kids in the school district. They can all get their annual physical from the school NP and if a kid comes in to see the nurse and has, for instance, strep throat, the nurse do the strep test and write out a prescription for antibiotics and the parents, who may not have insurance, don't have to pay to take their kid to the doctor (granted, they still have to pay for the medication, but this is still a huge cost-saving service for a lot of uninsured families).

That sounds fantastic. I had a slight ear-infection the other day and couldn't be bothered going to the doctors for a antibiotics prescription. Even if it is free/cheap (Australia). Being able to skip the doctor part would be great.

Also - We've used the "Nurse on Call" call-centre a couple of times. It's been a good experience. Reassurance if it's not a big deal, and a referral to a doctor (or an auto dial to an ambulance) if it is.

> I'm hard pressed to name a single business in which consumers have been well served by call centers.

I can't speak for everybody, but I'm a big fan of the fact that my bank-experience is a credit card, an online app with digital signature features and a distant, streamlined call center. I can get someone on the line in seconds, 10 (I think) hours a day, 6 days a week. They can fix 80% of my problems immediately, and escalate the rest, in those cases they typically return my call in <24 hours. My favourite: No faux "we have a special, personal relationship, part of the community"-crap. My previous bank was 20 minutes away and was only open when I was at work. I had to take time off from work to do what I do in three minutes on the phone today.

I have the same opinion of my mortgage holder, except when I get on the phone with them, whereupon I have exactly the opposite of your experience: long wait times, incompetant first-tier support, a total lack of continuity across multiple calls, and inconsistent answers to questions. Fortunately, all I stand to lose from a major snafu with my mortgage is my house.

"I'm hard pressed to name a single business in which consumers have been well served by call centers."

And certainly not in health support. A doctor/nurse needs to look for clues by looking at patient present physically. His expressions, general health, walk, any marks on his skins etc etc. Sometimes a patient will not tell something really important to his doctor because he (patient) might think it irrelevant.

> I'm hard pressed to name a single business in which consumers have been well served by call centers.

Most of the time that I get on the phone to a big corporation I end up talking to someone in a call center.

There are certainly exceptions (phone company!), but I usually get adequate service. It's fairly common to get very agreeable, friendly, competent service.

We had a dial-a-nurse line in a town I used to live in. We used it several times, it was a very nice resource, and when we moved I missed having it. (That was about 10 years ago--I believe it is shut down now, FWIW.)

I get unbelievably bad phone service from:

* The phone company (for instance, my DSL goes down for 2 days because three tiers of tech support can't reset a DSLAM port without doing a truck roll first)

* My bank (for instance, it takes 1.5 hours in a grocery store parking lot to clear a bogus fraud alert on my debit card)

* My mortgage (for instance, it takes 3 30+ minute calls to successfully confirm receipt of a screwed up mortgage paymetn)

* FedEx (for instance, FedEx can't explain the difference between Freight and Standard shipping, doesn't know that they can't schedule a Freight pickup, and delays a shipment for a day)

* Airlines (for instance, it takes 30+ minutes to confirm that no support tier at Air Canada can fix screwed up seat assignments that take 4 minutes for a gate agent to fix afterwards)

* Taxi dispatches (for instance, I book a car a couple hours in advance, call multiple times to confirm, and find out 15 minutes after my deadline that no order was ever taken)

I'm being serious: I can't come up with an example where phone support involved a call center for me where I've had a good --- or even acceptable --- experience. Call centers are uniformly terrible. I'm convinced this is so because call centers have no incentive to be effective. They are pure cost centers, necessary evils for their owners. That's why so many of them get outsourced, further attenuating any accountability for their work.

Your experience is different than mine. I usually have an acceptable-to-good experience when I call a credit card company, which happens often enough. I have always gotten excellent phone service from my car insurance company (Progressive). YMMV I suppose.

A medical call center like the one described in the article doesn't need to be a cost center. I could easily see them being run as standalone companies.

You're right. I've gotten good results from Progressive. That's my one example.

The issue isn't so much that it's impossible to run a quality call center. It clearly isn't. The issue is that call center economics are rigged to favor operations that poorly serve customers.

The other people in this category (in the US) are physician assistants. As with many things, there is a religious level war over who is more competent.

In my experience, I have had less than satisfactory experiences seeing NP's and PA's, primarily because they clearly did not have the same depth of knowledge in a primary care setting. I remember once wondering if I was being seen by a medical student or something, then I looked at the name tag and saw that he was a PA. (Apply anecdotal disclaimers accordingly.)