Dr. Ragland smiled, resolute. “Listen, I’m pro-nurse practitioner — very much,” she said. “There’s no question we have to have them, but until we supplement their training they can’t substitute for us, representative.”

The lawmakers suggested a second meeting with members of Gov. Steven L. Beshear’s administration and ushered Dr. Ragland out. She made her way to the building’s cafeteria, where a group of nurse practitioners were celebrating the unanimous committee vote in favor of the bill expanding their authority.

“I don’t get the emphasis on primary care is so important, but primary care physicians aren’t,' ” she said, sitting across the room from the group.

Over the following weeks, the nurse practitioner bill won passage in the Legislature, and Governor Beshear signed it into law. Dr. Ragland had another meeting with the lawmakers, who agreed to keep discussing her proposal and perhaps bring some version of it to the Legislature next year.

In Taylorsville, the new patients are still coming. Dr. Jonsson’s practice has seen dozens of them — even though he left on Jan. 17 for five weeks in South Africa, where he helped at a remote clinic. While he was gone, Ms. Caldwell, the nurse practitioner, and Ms. Thomas, the physician assistant, handled the patient flow.

He had never been able to take more than a week off in private practice, he said — “if you did, you really didn’t earn anything that month because it all went to overhead” — and Baptist’s willingness to let him do so was another source of new happiness. The typical fears about hospital employment — pressure to refer only to other Baptist doctors, for example, or to bring in as much revenue as possible — have not burdened him, he said, at least not yet.

“I don’t know where I’ll be in 10 years,” he said, acknowledging that the uncertainty pervading his profession may lead him down yet another path. “Hopefully I’ll be here and hopefully I’ll be happy, right?”