Stop calling nurse practitioners mid-level providers


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.


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