In fact, in organizations where physicians are reimbursed as an alternate funding plan, so it's not a direct fee for service—all of our hospitals in Ottawa function that way, where the physicians working within the hospital settings are on an alternate funding plan—in those environments you do have the opportunity to work with physician assistants and nurse practitioners.
In the pediatric emergency department, I work side by side with a nurse practitioner and they provide fantastic care, at a much lower cost.