From an MD no less!!

[delawaremalenurse]

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.

[Psychcns]

This post is from last week. As an outpatient provider I can diagnose "soup to nuts" within my specialty. Neither I or an MD will know if this is a textbook presentation until the person is evaluated. Yes, an MD should have a higher or greater scope because of their extensive education. I don't think we fully understand what that should look like . I had an MD friend tell me "I want to be more than a provider." He is now doing a combo of leadership and clinical..

[lhflanurseNP, APRN]

I work in a community where there are only 2 nurse practitioners "on their own"...I am one, and the other is a DNP who used to work for the health department. What is a shame is that the physicians here feel the nurse practitioners know absolutely nothing other than what they are expected to know from what the MD/DO puts forth on the initial exam. I have had to refer patients for bypass, only to have the cardiology surgeon, and rehab doctor, tell the patient that they should be seeing "a real doctor". I have had that with patients that have I have referred to urologists also. Needless to say, I will not be referring further patients to these physicians. Twenty-two states in the union allow for full autonomy for nurse practitioners...that is almost half! Way to go NPs!!!!!