I guess I spoke too broadly in this case. The primary I see isn't an MD, they are a PA-C. But I know that they're consulting with an MD behind the scenes as necessary.

I'm not exactly sure where I draw the line, and for me it's a lot of "I know it when I see it". I'm not suggesting any specific code here, just pointing out that there are positions all over the spectrum. I find the fact that a CID (Certified Interior Decorator) is a thing is absurd.

Maybe my requirement is that someone with an appropriate level is in the chain somewhere.