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?â€
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.
Lol, I have to own the diatribe part. I did access his website but didn't see the article or hopefully it would have rung a bell so I could have recognized your post was un-sited work and I would have modified my response.
Again, Isabel, no one is suggesting you provide low quality care. Instead, website training. You are not as highly trained as a geriatrician who has a medical degree, residency training in FP or IM, and fellowship training in geriatrics. The masters is incompatible, and we all know the DNP, while lofty for many, doesn't have anything to do with medicine. I submit it has nothing to do with nursing either, but that's my perspective.
I do believe you're good at what you do during the day. I'm not being condescending, but I don't think your training is lateral to a physician.
Specializes in Internal Medicine, Geriatric Medicine.
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.
I think in this one, we have to agree to disagree.
This message was typed on my phone at a Chik Fil A. I have no idea what "Instead, website training" was referring to, lol.
Again, Isabel, no one is suggesting you provide low quality care. Instead, website training. You are not as highly trained as a geriatrician who has a medical degree, residency training in FP or IM, and fellowship training in geriatrics. The masters is incompatible, and we all know the DNP, while lofty for many, doesn't have anything to do with medicine. I submit it has nothing to do with nursing either, but that's my perspective.
I do believe you're good at what you do during the day. I'm not being condescending, but I don't think your training is lateral to a physician.
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.
This is a bad example because it just highlights different specialties of care, and it is true of MD's themselves.
If that patient you described is seen by an MD in a family practice or internal med office, they too are going to send them up the chain for more expert level care. Are they mid-levels too?
If a female patient comes into their PCP physician for ultrasound results that indicate severe endometriosis, and the PCP refers her to an OBGYN specializing in minimally invasive surgery to remove the growth, are they also midlevels for kicking it up the chain?
Likewise, when that very same OBGYN discovers a patient with diabetes and hyperlipidemia, he/she is going to kick the patient to you to manage it. They become a midlevel as well.
There is always someone in our field that has more education, and is more specialized. However, anyone working in healthcare long enough knows that the specialists are just as good at managing primary care issues as we are at treating brain tumors. We all serve a very important role, and as research has indicated time and time again, NP's compared to MD's have very similar if not better outcomes.
@Riburn. Good argument for calling us all the same thing. I like "provider. " I guess we could question what is the role of doctorally prepared clinicians..
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.
I appreciate that the MD in this article stood up for the mid-level provider by asking that the term not be used. It shows he has genuine respect for our role.
That being said, we are a mid-level role. Limitations on our scope of practice exist, which cannot be trained away. A physician can be trained to do a heart cath, for instance, and apply for privileges at a hospital to perform that procedure (I once worked with an OB/GYN who became a cardiologist and did heart caths). I seriously doubt NP's will ever reach that level.
I do see a huge benefit in role distinction, though. Most patients see me different, and I can't change that. But, the relationship we have is different. Sometimes they need things broken-down to their level, and ask us for a second-opinion that they can understand.
As for me, I use the mid-level term often. I have no problem with it.
@automotiveRN- You're again describing a specialization within the field. We have them too. A coworker that is an ACNP works for a large hospital in my city where he rounds as a hospitalist, intubates if need be, drops chest tubes, and also central lines. The hospital used to rely on ER physician's for the skills, and MD's to be the hospitalists. Both physicians still fill those roles when need be, but having an ACNP requires them to be there much less.
That MD that was an OBGYN and then became a cardiologist must have been very gifted indeed. Cardiology fellowships are some of the most competitive and hard to get specializations in the country. He would also have to redo a residency in Internal Medicine for a couple of years (if he didn't get that the first time around which many OBGYN's do not), then has to spend 2-3 years in the actual cardiology fellowship depending on how many certs he wants. It's not as simple as him walking into the Cath lab to be "trained" and kapow.......cardiologist. It's years away from their life.
From where I sit, the physician's that I work with (Family and Internal Med), don't provide different services than me, and the role is very similar. Yes they have more education and I look to them regularly for support, but the end result for the patient is identical. THEY COULD go and become a cardiologists, but so can you and I.
To me role distinction is more relevant the more specialized you get. From a primary care perspective, the line is very thin (which is probably why over 80% of physician's are choosing specialties, because they know their job can be performed just as effectively by NP's).
@automotiveRN- You're again describing a specialization within the field. We have them too. A coworker that is an ACNP works for a large hospital in my city where he rounds as a hospitalist, intubates if need be, drops chest tubes, and also central lines. The hospital used to rely on ER physician's for the skills, and MD's to be the hospitalists. Both physicians still fill those roles when need be, but having an ACNP requires them to be there much less.
That MD that was an OBGYN and then became a cardiologist must have been very gifted indeed. Cardiology fellowships are some of the most competitive and hard to get specializations in the country. He would also have to redo a residency in Internal Medicine for a couple of years (if he didn't get that the first time around which many OBGYN's do not), then has to spend 2-3 years in the actual cardiology fellowship depending on how many certs he wants. It's not as simple as him walking into the Cath lab to be "trained" and kapow.......cardiologist. It's years away from their life.
From where I sit, the physician's that I work with (Family and Internal Med), don't provide different services than me, and the role is very similar. Yes they have more education and I look to them regularly for support, but the end result for the patient is identical. THEY COULD go and become a cardiologists, but so can you and I.
To me role distinction is more relevant the more specialized you get. From a primary care perspective, the line is very thin (which is probably why over 80% of physician's are choosing specialties, because they know their job can be performed just as effectively by NP's).
Actually, I am old enough to remember when cardiologists could be any physician who was trained by someone, without a fellowship. So he was trained by another cardiologist, no fellowship needed, and received privileges in the hospital. After 50 caths, he had privileges in 3 other hospitals. He went on to learn interventional cardiology when it became available. We were all in the lab when the first balloons hit the shelves, the first stents hit the shelves, and the first drug-eluting stents hit the shelves. We all learned together.
You and I, however, can never become a cardiologist without medical school. Although, I have known PA's who do (or did) heart caths. Haven't seen one in many years, though.
Mid-level. It is what you are. Not down-playing our role, but I am also not going to pretend I am something I am not.
That's a great anecdote about a physician in a galaxy far far away, but it doesn't speak to medical practice today. The reality is anyone, MD or garbage man that decides to change disciplines and become a specialist has a few years to go. 50 caths and your golden doesn't fly anymore.
You seem to be defining a mid level based on whether or not you can go back and change to a new specialty completely ignoring role and quality.
In in terms of actual real world practice the difference between a family practice doc or any PCP physician and a NP in the same role is negligible. Call me a mid level all you want but im doing the same thing and pulling down the same paycheck. And as the MD that is the focal point of this article highlights, the care I'm providing is not mid level quality.
As a PCP whether NP or MD, we are the point guards on the court. We can shoot it or pass it off, but in the end, the ball always goes through our hands, and now more than ever the system is dependent on us.
This is from last year. Hmm. Well, I'll put my two cents in. LOL I think it is a well-intentioned post, but I, too, do not like the idea of clumping all clinicians together as the same in their "care". AN MD should be the highest level and would be the one able to diagnosis soup to nuts. I think NP's are fine but I think mostly for the common things and cases that present like textbook cases. Just my humble...
Jules A, MSN
8,864 Posts
Lol, I have to own the diatribe part. I did access his website but didn't see the article or hopefully it would have rung a bell so I could have recognized your post was un-sited work and I would have modified my response.