Stop Using The Term “Mid-Level Practitioner”

Bob Miller

Mid-level.  Subpar.  Inferior.  Terms that most would certainly not associate with someone who has obtained a graduate degree and possesses an advanced level of education and skill.

Yet, this exact term, “mid-level practitioner,” and all that it implies has been used to describe nurse practitioners and physician assistants for years and still continues to today.  Originating from the Drug Enforcement Administration’s term for “an individual practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice,” mid-level practitioner has gone from a term for governmental categorization to a widely used and misrepresentative label.

The degree of work, knowledge, and education required to become a Nurse Practitioner or Physician Assistant is certainly anything but middle of the road.  However, patients cannot help but envision just this when they hear that they will be seen by a mid-level practitioner.  Despite this individual’s capabilities, they walk into a room where they are immediately seen as inferior and less capable than a physician of providing care.  In reality, NPs and PAs are often the first to recognize areas of concern with patients and help alert doctors to lurking problems and treatment options.  They are the very foundation of solid, quality-driven health care.

While we still have a ways to go, there have been strides towards improvement.  Increasingly, medical practices and organizations are recognizing the importance of these providers and the demeaning associations that can come from a term such as “mid-level practitioner” in a highly competitive and education-focused field.  Instead, many are now referred to as “associate providers” or “advanced practitioners,” terms that more accurately reflect the scope of knowledge and work of an NP or PA.  Additionally, several states are now considered “full practice” for nurse practitioners.  Recognizing the value and skill of these providers, these states allow NPs to evaluate and diagnose patients, order and interpret diagnostic tests and initiate and manage treatments.  As more states follow suit and allow advanced practitioners to take on a greater scope of care, the importance of their roles will gain recognition.

At a time when dedicated, high-quality providers are needed more than ever, any and all advanced practitioners should be given their rightfully earned respect.  “Mid-level” obviously does not match their level of skill, education, or dedication to health care.  So, why would we continue to use it?  Rather than disparage these practitioners with such terms, let us all commit to using labels which suit their position and best convey their level of practice to patients.  Advanced practitioner is a good place to start.

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