From an MD no less!!

Specialties NP

Published

Stop calling nurse practitioners mid-level providers

Michael D. Pappas, MD | Physician | July 14, 2014

I really hate it when a nurse practitioner is called a mid-level provider.

Mid-level provider” isn't even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.

The term mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals as well as to the patients that they serve.

Let's be logical and think about this. Mid-level” implies that he or she provides middle of the road or average care, not high-level care. Who then delivers high-level care? It must be the MD, of course. So, who delivers the lowest level of care? Nurses?

Nurses are the foundation of medical care. They tell us (MDs) when they recognize a problem or a need for an intervention. Then, we act. They are not low-level providers. Therefore, if nurses are not low-level care providers, then nurse practitioners cannot be mid-level providers.

What do the patients and families think when they hear this? Don't worry Mom and Dad, a low-level and mid-level will take care of your sick child until the high level arrives.” That just sounds stupid.

It is also insulting to anyone who has decided to pursue higher education and improve oneself that he or she has finally achieved mid-level competence.

Maybe the term mid-level provider” got started based on the number of years in training. I understand that physicians have more years of school than practitioners. I get that. But, most of us know that we define ourselves after we begin working on our own and are responsible for our own decisions. The first 3 to 5 years after graduation is when we grow and decide what kind of clinician we will be.

Children and their parents want to receive excellent medical care delivered to them by a kind and gentle clinician. MDs don't have a market on that one. If, as a clinician, you can provide excellent medical care with humility, then you provide the highest level of care available. I don't care if the initials after your name are MD, NP, PA, or DOA. Children definitely don't care. They just want to get better.

So let's move out of the dark ages and join the age of enlightenment. Let's not insult our patients by telling them that we will provide mid-level care to them, and let's not insult our co-workers by calling them less than what they are.

Instead of a mid-level will be seeing your child,” how about, Our clinician will be right with you, and he or she will take excellent care of your child?”

Michael D. Pappas is a pediatrician and can be reached at Children's Intensive Caring.

Jules A, MSN

8,864 Posts

Specializes in Family Nurse Practitioner.

First I really could care less what anyone calls me and personally I don't find the term mid-level provider all that offensive. We are not on par with MDs education wise. Although I am able to operate independently in my state that does not mean I am equal to a physician. We are different. Our profession was created with a different goal in mind and the more we protest the sillier we look, imo.

Second I didn't see anything on his site that was disparaging to NPs and in fact he added that he married a nurse. There are complimentary things written about all his staff members.

Pediatrician Maumee Ohio | Best Kids Pediatrics Toledo | Pediatrician Perrysburg Ohio Children's Intensive Caring

Are you trying to clog up his email with indignant nurses' rantings. That will surely increase our perceived professionalism. If you don't like his philosophy don't work for him.

AspiringNurseMW

1 Article; 942 Posts

First I really could care less what anyone calls me and personally I don't find the term mid-level provider all that offensive. We are not on par with MDs education wise. Although I am able to operate independently in my state that does not mean I am equal to a physician. We are different. Our profession was created with a different goal in mind and the more we protest the sillier we look, imo.

Second I didn't see anything on his site that was disparaging to NPs and in fact he added that he married a nurse. There are complimentary things written about all his staff members.

Pediatrician Maumee Ohio | Best Kids Pediatrics Toledo | Pediatrician Perrysburg Ohio Children's Intensive Caring

Are you trying to clog up his email with indignant nurses' rantings. That will surely increase our perceived professionalism. If you don't like his philosophy don't work for him.

I think you may have read this wrong, it seems like a quoted article FROM the MD himself saying to stop calling NP , PA, midwives mid level providers

Specializes in Occ. Hlth, Education, ICU, Med-Surg.
First I really could care less what anyone calls me and personally I don't find the term mid-level provider all that offensive. We are not on par with MDs education wise. Although I am able to operate independently in my state that does not mean I am equal to a physician. We are different. Our profession was created with a different goal in mind and the more we protest the sillier we look, imo.

Second I didn't see anything on his site that was disparaging to NPs and in fact he added that he married a nurse. There are complimentary things written about all his staff members.

Pediatrician Maumee Ohio | Best Kids Pediatrics Toledo | Pediatrician Perrysburg Ohio Children's Intensive Caring

Are you trying to clog up his email with indignant nurses' rantings. That will surely increase our perceived professionalism. If you don't like his philosophy don't work for him.

You don't have a clue what you were reading do you? Before posting your snide comments try reading and comprehending a post so that you can respond in a thoughtful and intellectual manner rather than just jumping on your high horse and espousing your unfounded opinion.

Specializes in Occ. Hlth, Education, ICU, Med-Surg.
I think you may have read this wrong, it seems like a quoted article FROM the MD himself saying to stop calling NP , PA, midwives mid level providers

Exactly.

Jules A, MSN

8,864 Posts

Specializes in Family Nurse Practitioner.

I couldn't access a link to an article and if what I mistook as your petty diatribe on the topic was actually an article of his that you didn't bother to site properly please cut me some slack. Sorry if I missed understood his take on the issue however my opinion on the use of the term midlevel provider stands as above.

PG2018

1,413 Posts

Specializes in Outpatient Psychiatry.

I don't mind midlevel because there is a higher echelon of care. I had a patient last week some type of lesion in his brain or some type of epilepsy (temporal lobe maybe) perhaps caused by a lesion. You think I'm trained for that? I can do a decent neuro exam, but I've never had a standalone course in neuroscience, a clerkship in neurology or 2-3 months in a nuero rotation during a psych residency. I hooked this fish, but do you think I'm going to reel him in? No way. I'll image him and send him up the chain. This is where I don't mind being called a midlevel. I provide high quality outpatient care, but there's always a higher echelon. I suppose my connotation of midlevel refers to scope and not quality.

However, I want to commend the physician who is referenced. It is rare for one to dole out such helpful and positive remarks. I also think he is right.

anh06005, MSN, APRN, NP

1 Article; 769 Posts

Specializes in Cardiac, Home Health, Primary Care.
I don't mind midlevel because there is a higher echelon of care. I had a patient last week some type of lesion in his brain or some type of epilepsy (temporal lobe maybe) perhaps caused by a lesion. You think I'm trained for that? I can do a decent neuro exam, but I've never had a standalone course in neuroscience, a clerkship in neurology or 2-3 months in a nuero rotation during a psych residency. I hooked this fish, but do you think I'm going to reel him in? No way. I'll image him and send him up the chain. This is where I don't mind being called a midlevel. I provide high quality outpatient care, but there's always a higher echelon. I suppose my connotation of midlevel refers to scope and not quality.

However, I want to commend the physician who is referenced. It is rare for one to dole out such helpful and positive remarks. I also think he is right.

My thoughts as well: quantity vs quality. I especially feel this way being family practice. I am not an expert in everything. I know common issues and treatment for these but there are times I want my collaborating MD involved. Times I want specialists (PA, NP, MD, or DO) involved. I feel like the hub of a wheel and I have to send them on down a spoke sometimes.

I am not the highest level experience and expertise wise. But I do give high level care when I can and recognize when my level isn't enough. When in doubt: send them to a "higher level." I've had enough patients thank me for treatment, listening to their problems, trying different combos of meds, etc. to know I don't give mid level care....but do have a mid level education compared to some.

Psychcns

2 Articles; 859 Posts

Specializes in Psychiatric Nursing.

As noted above, I like thinking of it as a mid-level education compared to an MD, enough education to be a provider. I don't mind the term but enough people find it offensive or confusing so I try not use it. For me, as a CNS, "mid-level" or "provider" rolls off the tongue easier than APRN.

Specializes in Occ. Hlth, Education, ICU, Med-Surg.
I couldn't access a link to an article and if what I mistook as your petty diatribe on the topic was actually an article of his that you didn't bother to site properly please cut me some slack. Sorry if I missed understood his take on the issue however my opinion on the use of the term midlevel provider stands as above.

My mistake...I guess the part of your reply where you state "Second I didn't see anything on his site that was disparaging to NPs and in fact he added that he married a nurse" threw me off cause it sure makes it sounds like you accessed his site and then put together your well-thought out and comprehensive diatribe.

IsabelK

174 Posts

Specializes in Internal Medicine, Geriatric Medicine.

I am not a mid-level provider. I have as much formal education as a physician and in my field, I do exactly what a physician does. I object to the term on the premise that referring to myself as a mid-level provider diminishes the care I provide. Who provides low-level care?

Every physician has his or her specialties, strong points, etc. If any provider cannot recognize his or her own areas of strengths and weaknesses and is not willing to collaborate or refer when needed, that's mid-level or low-level care. I'd also say "RUN!".

I do not, however, claim to have the same education as a physician. I am a nurse first. Different focus. Not mid-level, not lower than, not less skilled than. Different.

Jules A, MSN

8,864 Posts

Specializes in Family Nurse Practitioner.
I am not a mid-level provider. I have as much formal education as a physician and in my field, I do exactly what a physician does. I object to the term on the premise that referring to myself as a mid-level provider diminishes the care I provide.

I'm so glad you wrote because I was becoming uncomfortable about how many times I agreed with you recently. ;)

I disagree that we have a comparable education to physicians especially when it comes to prescribing medications which makes up the bulk of our duties. Our education is horribly deficient in this area and again I think as more NPs hit the streets in the large numbers predicted this will become painfully obvious.

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