Do You get Upset When you are Called a Physican Extender

[AAC.271]

I've been reading up about campaigns to end the term physician extended/midlevel because it has become derogatory terms for NP's and PA's as they suggest we do not provide the highest level of care. It seems like there is a huge fight going on, but in all honesty, I don't really seem to care what term people refer to me as so long as they clarify that I am a Nurse Practitioner (student). I've never really met any physicians or patients who ever say this is [name] the sNP midlevel provider. I've only met people who, not in front of patients, speak about my role as a "midlevel provider" or "extender" which frankly doesn't tick me off. However, I've seen so many other NP's upset at being called such a term.

What are your thoughts? Some have suggested that we be addressed as High Level Provider, but imho that sounds a bit funky.

[CoolLikeThat]

Here the term used is APP (advanced practice provider) and I kinda like that better although I usually don't care what you call me as long as they still pay me.

[Kooky Korky, BSN, RN]

How about those of you with doctorates? Shouldn't you be called Doctor? You have earned it. Every other professional with an EdD or PhD or whatever doctorate is called Doctor. Except Pharm D's and JD's maybe.

Why aren't lawyers and pharmacists called Doctor?

[Jules A, MSN]

How about those of you with doctorates? Shouldn't you be called Doctor? You have earned it. Every other professional with an EdD or PhD or whatever doctorate is called Doctor. Except Pharm D's and JD's maybe.

Why aren't lawyers and pharmacists called Doctor?

Nurses aren't called Dr. in my medical system. That is a designation for physicians.

[Jules A, MSN]

Prolly not going to matter in the near future as every single RN I work with at multiple hospitals is now becoming a NP. I was always encouraging and helpful to outstanding peers who wanted to further their education but it is starting to wear on me. I get calls and emails from total strangers asking me to precept them for their Walden U etc. degree. Anymore it seems just the thing to do and that anyone who can write a tuition check can become a NP with most are now thinking they will be calling themselves Dr.

[babyNP., APRN]

Here is my problem with it:

It's the underlying tone of it that is used to lower an NP's status. It's probably not conscious for a lot of people, but the original intent that was conscious definitely is. Words do matter and even if we don't see an obvious effect of it, it's still there. For what it's worth, when I was looking for jobs as a NNP, the places that called their NPs "physician extenders" were some of the least paid places in which I interviewed. And would you call this title to someone that is in independent practice, like in a clinic? No, you just don't. I personally work in an ICU so I will always at least have a doctor for back up- but I just prefer to be called by my title that I have, which is "nurse practitioner."

There are really only 3 types of providers: MDs/DOs, PAs, and NPs. It's not that hard to call someone by their title. If you need to group PAs/NPs together, then you can always use the phrase "advance practice provider"

[Aromatic]

Prolly not going to matter in the near future as every single RN I work with at multiple hospitals is now becoming a NP. I was always encouraging and helpful to outstanding peers who wanted to further their education but it is starting to wear on me. I get calls and emails from total strangers asking me to precept them for their Walden U etc. degree. Anymore it seems just the thing to do and that anyone who can write a tuition check can become a NP with most are now thinking they will be calling themselves Dr.

Yeah pretty much. schools and nursing boards are cashing in on people's egos.

1. nurse wants to be np to be called doctor

2. apple to junky school (many do)

3. write papers

4. fight for clinical spots, if lucky, they finish clinical knowing how to do physical exam

5. beat that chest with WCS (white coat syndrome)

6. job hunt and complain why nobody will hire them even though they went to a junk school and have no idea what they are doing

7. cry and regret going back to school

8 continues to do floor nursing with doctorate degree

you can't really be an NP without some love for science that many of the wanna be called doctor types seem to lack

[BostonFNP, APRN]

I can understand why the NP activists are working on the term as they work towards independent practice/removing restrictions to practice.

We hear nurses talking about this frequently and we rarely hear physicians talk about it, but it is a two sided issue. Physicians retain the use of such terms because it forwards their agenda: protecting their practice, and often, their revenue stream. It is petty on both sides.

Regarding doctorates and "doctor" I never use the term clinically, though, just two days ago I was paged for a call from "Dr. Soandso". I get on the phone and she calls me by my first name and says this is "Dr. Soandso calling from CVS" so I responded this is "Dr. BostonFNP" how can I help you. I guess in retrospect that was also petty. FWIW, by physician partner calls me "Dr. BostonFNP" when speaking formally to patients or other providers.

[LaraRN86]

I really dislike the title Physician Extender, but I do not mind the term midlevel.

[Skippingtowork]

Here is my problem with it:

It's the underlying tone of it that is used to lower an NP's status. It's probably not conscious for a lot of people, but the original intent that was conscious definitely is. Words do matter and even if we don't see an obvious effect of it, it's still there. For what it's worth, when I was looking for jobs as a NNP, the places that called their NPs "physician extenders" were some of the least paid places in which I interviewed. And would you call this title to someone that is in independent practice, like in a clinic? No, you just don't. I personally work in an ICU so I will always at least have a doctor for back up- but I just prefer to be called by my title that I have, which is "nurse practitioner."

There are really only 3 types of providers: MDs/DOs, PAs, and NPs. It's not that hard to call someone by their title. If you need to group PAs/NPs together, then you can always use the phrase "advance practice provider"

I absolutely agree with you. Also, from a patient point of view, I don''t want to be seen by someone who appears to be a tool, dependent on someone else to initiate or complete the job. Those things you use to reach things that are too high for are extendors or reachers. An NP and PA are not in the same category. Also, if you only care about being paid, you'd work as a bedside nurse. Lots of money there.

[Skippingtowork]

Yeah pretty much. schools and nursing boards are cashing in on people's egos.

1. nurse wants to be np to be called doctor

2. apple to junky school (many do)

3. write papers

4. fight for clinical spots, if lucky, they finish clinical knowing how to do physical exam

5. beat that chest with WCS (white coat syndrome)

6. job hunt and complain why nobody will hire them even though they went to a junk school and have no idea what they are doing

7. cry and regret going back to school

8 continues to do floor nursing with doctorate degree

you can't really be an NP without some love for science that many of the wanna be called doctor types seem to lack

And that's why it's important for the smart people like yourself to precept all the wannabees so they don't cause you shame. On a serious note, medical students start there clinicals after 2 years of med school and are expected to be lacking in many areas, but they are taught by their CI's and preceptors. Also many NPs going back to school have not only nursing degrees, but other science degees in addition. So please be careful. One more thing, many people learn very well with hands-on application. I know people who rose above all their peers, but were thought to have come from a "j..k" school (I can't bring myself to be disrespectful.

Some people work the floor for monetary reasons. I can bet a lot of the floor nurses are making more than NPs. Sometimes the money is more important than doing what you love (for the moment).

Thank you for precepting. Continue the good work. It will be appreciated by the students you train, who may one day save your life.

[Cola89]

I don't really like the term "midlevel" for NPs and PAs, because it gives the implication that RNs are "low levels". That being said, I know I am not going to change much my voicing my mild annoyance at the use of that term. There is a hierarchy in healthcare, but we all make a concerted effort.

[DowntheRiver]

Wait, physician extender isn't a joke? I've never heard of that. I seriously thought you were making gibberish up.