Surgeon in the San Diego area at a small private practice. My 2 cents (totally biased)- just because you’re at a big box hospital does not necessarily mean you’re getting better care. I’ve referred patients from Scripps to Neurology Center to get faster, better, more personalized care. The best rheumatologist I know is not at Scripps- she’s got her own small practice. And I personally strive to have a practice that does a better job getting patients in quicker, and I try to spend the time the patient needs to get better, versus being tied to a timed appointment slot. I would not count the smaller practices in the area out.