Posted by: notdeaddinosaur | October 19, 2015

“Stop Calling Us Mid-Levels,” Cry the NPs

Nursing is an honorable profession, neither superior nor inferior to medicine, but distinct from it. I learned this from nurses! Then last night I saw a commercial on TV for “Nurse Practitioners,” who are:

…leading the charge and growing the nation’s access to patient-centered, accessible, high-quality health care.

They’ve also got a chip on their collective shoulder over the term “Mid-level” provider. Can’t call them “Physician extenders” or “non-physicians” either. Fine. I’ll just call them “arrogant doctor-wannabes”. I was just being polite with the “mid-level” thing anyway.

Apparently their issue with the term “Mid-level” is the implication that the “mid” means “middling,” or somehow less than “high”, and that it refers to either the quality of their care, or their education, or whatever. I’m not really sure; it seems like such a stretch, trying desperately to find offense where none was ever intended.

It’s as silly as if I were to get all bent out of shape about “Primary” care being somehow inferior to “Tertiary” care, as provided in large downtown institutions, because “Tertiary” means “three”, which is more than “one”, which is “Primary.”

At issue is what kind of care is provided to what kind of patients for what kind of problems. First aid kits are the first line of defense most of the time. Hopefully even Nurse Practitioners can agree that not every little cut and scrape needs professional medical attention. “Mid-level providers,” individuals with approximately 1/3 to 1/2 of the training of a physician, are used in ERs and busy offices to “extend” services to more people than can be covered by physicians. Their care is not inferior to that provided by physicians. It’s just properly provided to care for problems requiring their levels of expertise, which is not the same as that of a physician.

I think that non-physician providers should care for healthy people and doctors should take care of sick people. Let the NPs do well baby and preventive care til the cows come home. Most of it is education anyway, which is their alleged forte. (Spoiler alert: It’s mainly because they have more time to spend with patients.) [plagiarized from myself]

Patients need all of us: Moms and Dads to bandage cuts and kiss skinned knees; mid-levels to stitch up simple lacerations and care for people who didn’t really need to come in, and doctors to figure out whether you’re tired because you have sleep apnea, depression, anemia from colon cancer, or something else.

Don’t try inundating me with stories about noble NPs who rush in to save the day from arrogant doctors. On the one hand, I can match you incident for incident with ignorant NPs and PAs doing harm practicing beyond their abilities. Then again, the plural of “anecdote” is not “data.” Get off your high horse about the term “Mid-level” and let’s join forces against the truly demeaning moniker of “Provider.”



  1. “Leading the charge?”

  2. Coming in late to this post as I just re-discovered your blog after some time.
    I’m not entirely sure what the gripe with the term mid-level is exactly. In my opinion as a mid-level (Nurse Practitioner) it’s an almost perfect fit. I am not a physician, I’m not as extensively trained, I didn’t do a residency, and though I’m board certified in my specialty and (horn tooting here) quite good at it, I have no problem acknowledging the fact that the physicians in my specialty know more than me.
    Nurse Practitioners nationwide can’t even seem to agree on a standardized scope of practice (each State has its own) or what our standard of education should be (most are Master’s prepared but there’s some Bachelor’s prepared NP’s still around and the proposed standard is a Doctoral degree). Heck, we can’t even agree which alphabet soup belongs after our name (NP, NP-C, FNP, FNP-C, APRN, APRN-C). I mean holy moly!!!
    I’m proud of what I do. I CHOSE not to go to medical school for a number of reasons, and I understood when I did it would mean a certain amount of limitation on my practicing abilities and swagger. I’m good with that. If I want the respect of my peers, I don’t demand it, I work hard to prove that I deserve it – and that’s how it should be.
    If NP’s want to advance their practice they would do well to quit squabbling among themselves and picking fights with the AMA and focus on what is supposed to be our mission anyway: The Patient.

  3. Provider…indeed.

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