Dear Dr. Gott: I am confused about the meaning of my doctor's announcement that the family practice centre I frequent will no longer admit patients to the hospital. The announcement went on to say there will be no effects on patients and that they are investigating the need to increase their clinic hours in order to provide patients more access to the clinic.

When I asked my doctor about it, she said that it is becoming common practice around the country. I can accept that my own doctor won't be coming to the hospital to check on me and will only receive reports from the specialists at the hospital. If I have to go to the ER and don't have a doctor with a relationship to the hospital, will I be treated differently? My family practice once had four doctors. Owing to retirement and other things, they are down to one doctor and two physician assistants. I don't know what a PA's qualifications are, but apparently they aren't allowed to admit patients.

I live in a small city that is running out of doctors. Should I try to find one that admits patients to the hospital, or does it not make any difference? In one year, I will be on Medicare and won't be able to find a new doctor then because nobody in town is accepting new patients if they are on Medicare.

Also, if my current doctor leaves the clinic, is a PA an adequate replacement?

Reply: Unfortunately, this is becoming common practice. Doctors awaken early, make hospital rounds (sometimes even before going to the office), see a full slate of patients, order testing and follow-up, and often get called to the hospital because a patient requires hands-on care midday regardless of the physician having to leave a waiting room full of patients.

Then there are the nursing-home patients who are seen according to a specific schedule unless a medical emergency requires immediate attention.

Then they can go home for dinner at the end of a very long day. He or she then could be "on call" for patients who might require hospital admission after hours, on weekends or on holidays.

Sometimes physicians cross-cover for one another, so they are on call for a day or so covering for several physicians, but then have a day or two off from admissions only. To provide an example, I still remember one Christmas a few years ago when I covered for several physicians and had 26 patients in the hospital. It goes without saying I had no intention of eating dinner with my family.

Things may not be as dramatic now as they were then, but you get the idea.

Today, many hospitals – even those in smaller communities – hire hospitalists to fill the gap. These people are hospital-based and extremely qualified. While they may not know you personally, they certainly take the pressure off difficult situations.

Now on to the PA issue. A PA is a licensed healthcare professional. He or she works under the direction of a physician, and is certified, state licensed and can diagnose, order and interpret testing, prescribe medications, and assist in other areas. Also, when issues arise that a PA might question, the physician is called in to review and direct the situation.

Acceptable practices vary according to training, experience and state law. I can't speak highly enough of the PAs I have had the pleasure to work with.

More and more offices are using them (and nurse practitioners, who are also invaluable) to ease the burden of a busy practice.

Dr. Peter H. Gott is a retired physician and the author of several books, including 'Live Longer, Live Better', 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook', which are available at most bookstores or online. His website is www.AskDrGottMD.com. Contact him c/o United Media, 200 Madison Avenue, fourth floor, New York, New York 10016.