Banish These Five Terms From Medicine?

Ariel Harsinay

Disclosures

September 26, 2018

3. Mid-level Provider

(noun): an individual, other than a veterinarian, physician, podiatrist, or dentist, who is licensed to dispense a controlled substance

Catherine Bishop, DNP, an oncology nurse practitioner at Johns Hopkins' Sibley Memorial Hospital, recently wrote about her experience of hearing the term "mid-level" for the first time when studying to become a nurse practitioner (NP).[6]

"I was puzzled. Was the term 'mid-level' a way of quantifying the amount of care that NPs and physician assistants provided? Was it a way of qualifying the type of care they provided? I felt confused and belittled. I was in the midst of graduate-level (advanced) education and as such would be practicing at an advanced level of nursing."

The term "mid-level practitioner" is used by the US Department of Justice's Drug Enforcement Administration to characterize healthcare professionals who monitor controlled substances. This description can include advanced practice nurses (nurse anesthetists, nurse midwives, clinical nurse specialists, and NPs) as well as physician assistants. While Bishop wrote that she does not intend to fight to change this name in legislation, she advocates avoiding the term due to its ambiguity.

"The title or term 'mid-level' is certainly not appropriate," she writes. "Virtually all advanced practice nurses have at least a master's degree and many hold doctorates. We are clinicians, educators, and researchers who are highly trained to care for and manage patients with a variety of illnesses."

This sentiment is shared by some physicians and other healthcare professionals. In an editorial post, Dr Michael D. Pappas, a pediatrician at Children's Intensive Caring in Toledo, Ohio, writes, "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."[7]

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