If I'm already established with a specialist for an ongoing problem (eye and neuro for me), then I go there. All else, PCP. Sometimes she can treat it but I don't consider a quick referral to be a waste of time or middle-man scenario. I've been impressed with her choice of specialists and trust her judgement on the urgency of the issue. I also prefer to be seen by the specialist then return to my PCP if that's reasonable for the issue at hand.

I cut out the middle man when experience shows I should. For example, I had bursitis once and the PCP sent me to an orthopedist. The next time I had a shoulder injury, I went straight to the orthopedist. I would prefer PCP, but I find in this area where specialists are plentiful, PCPs are quick to refer.

When do you go first to your primary care, versus just going straight to a specialist (assuming your insurance allows).

I'm having some ear problems that I'm 100% sure isn't just an ordinary ear infection. Do I cut out the middle man and go straight to an ENT?