When is it necessary to see a physician rather than a mid level provider?


I recently took care of a patient in the hospital. She had worked as a medical writer, naturally, we hit it off trading information about blogging and information marketing. She had been living with type 2 diabetes for over 10 years. She informed me that recently her blood sugars were out of control.  Her last A1c was over 10%. Over the last year, she had gained a lot of weight. Her legs were swollen and she felt short of breath especially when walking. She said she had shared her health concerns with the nurse practitioner at her primary care physician's office. [...]