It is very hard to gain access to Dr. Ramaiah. After our first appointment, I came back again, waited over 45 minutes, and was seen by a physician’s assistant. Nobody asked or informed me. The assistant (and the scheduling person) explained that he prefers to send patients to the assistant after a a first visit (presumably unless there is a compelling reason not to). They make it very difficult to see him personally, saying for instance that there wail be a long additional wait, etc. Subsequent visits have been with the assistant, who although likable, certainly doesn’t have Dr. Ramaiah’s skills. And incidentally, since I pay a fixed co-pay (at the specialist rate), my out of pocket expense is the same for a highly trained surgeon or an assistant. This system allows the office to see more patients, but it makes it hard to form an ongoing, trusting relationship with the doctor.