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Middle of What?

Published May 31, 2012 7:43 AM by Renee Dahring
Every so often I feel like I need to go on a good rant. Most of the time I can contain myself, but about once a year I feel the need to get certain pet peeves out of my system.

Not a week goes by that I don't get a call from either a recruiter or a healthcare organization wondering why they are unable to fill their NP position. The first thing I ask them to do is to read their job ad to me. Almost all of them have one problem in common: They say they are seeking a "midlevel" provider.

Part of me is still surprised that this flawed term has managed to stick around so long. As a category of provider, it's not only unattractive, it's inaccurate and, well, just weird.

Let me explain.

Disclaimer: Because I am an NP my point of view is from the perspective of an NP. I don't want to presume to speak for PAs.

"Midlevel" is not a name of our choosing. Our profession already has a perfectly good name, and we would appreciate if everyone used it. We prefer to be called nurse practitioners or advanced practice nurses. I'm not sure who started the trend of calling us midlevels, but one profession should not get to name or define the role and activities of another. Please note that we don't go around making up categories and nicknames for those who work in other disciplines.

Second, what is that term - midlevel - supposed to mean anyway? Yes, I am familiar with the argument that the term is meant to denote the amount of education or training of the clinician, but do we really want to go down that road? If we were to start ranking healthcare providers using these criteria, why stop with NPs? Physicians who practice in specialties, such as neurology or infectious disease, have additional training beyond that of a family practice doctor. Shall we call them "extra-high-level" providers? Which in turn begs the question that if there are "midlevel" providers, does this mean that there are also "low-level" providers? I think you get my point.

It also seems to me that the labeling of some providers as "midlevel" could actually create a bit of a PR problem too. As a healthcare consumer, I would certainly have to wonder if the term "midlevel" implies that my health concern is "midlevel." Or does it mean the care I am receiving is "midlevel"? Neither option is very appealing.

Thank you, I feel much better now.






Now that Labor Day has come and gone, it's officially the end of summer. Fall is a good time to get back

September 4, 2013 4:20 PM

Yeah, I'd honestly never given it much thought before, but I'm pretty sure if I were told as a patient that I was going to be seeing a "mid-level provider," and if I didn't know what that meant, I'd certainly be expecting mediocrity!!

Kathleen Tucholke July 11, 2012 7:31 PM

100% agree, and admittedly laughing at the "extra-high-level" comment! Exactly who is calling us mid-level....? Not our patients :) Thanks for the great post!

Cheryl Nafziger, Family Practice - FNP-BC July 11, 2012 12:01 PM
Normal IL

I wholeheartedly agree with you.  The term is derogatory as well.  I am the director of our APRNs and PAs for our organization which includes about 200 people.  Whenever I hear the term midlevel provider used, I kindly tell the person that the preferable term is NP, PA, Advanced Practice nurses etc.  When I explain to the person that "mid level provider" means that someone then must provide low level care.  Do we then call the RNs, CMAs, LPNs low level providers?  I think not!! When they hear that they totally get the point and chuckle a bit.  I am proud to say that our meetings have improved in terminology and the term midlevel provider is not heard around here as much.  Keep educating people who hear the term.

Anne Boisclair-Fahey, , Director of Advanced Practice and Physician Assist University of Minnesota June 12, 2012 2:31 PM
Minneapolis, MN

I agree whole heartedly with the non use of the term Mid Level Provider. It is exactly what I have been stating for years. It also really irks me when I have been called "the nurse" is ready to see you now. Especially for first time patients this is really confusing for them. They wonder when they will see the "doctor" they had an appointment with.  Thanks for your thoughts@

Junemarie Williams, Psych - APRN, United Summit Center June 7, 2012 12:35 PM
Weston WV

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About this Blog

    Occupation: Nurse Practitioners and NP Recruiters
    Setting: correctional healthcare/career consulting/teaching
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