Attending - Midlevel Dynamics in the ED

[bobsquit3]

Can someone explain the aversion to midlevel? At the major academic center I'm at that's what everyone refers to PAs and NPs as (even CRNAs). It seems to be all about the context. It was mentioned earlier not to use it because we don't practice "mid-medicine" and are held to the same gold standard. Certainly true, and anyone who refers to it as that is ignorant. However, I see the term midlevel as indicating scope of practice and education level that is in the middle of an MD and RN. I enjoy the term midlevel actually, so I'm interested to hear your all thoughts.

[PACdan]

 

 

However, I see the term midlevel as indicating scope of practice and education level that is in the middle of an MD and RN. I enjoy the term midlevel actually, so I'm interested to hear your all thoughts.

Some PAs practice without restriction in their field. If they are practicing at their SP's scope, how is "midlevel" a good descriptor of scope of practice?

 

Secondly, for education we don't call bachelor's degrees "low-level", and many people probably would object to that. But they would be in the low-mid-high realm of Bachelor, Masters, Doctorate.

 

The term just leaves a bad impression with many. If there are viable and more accurate descriptors, why endorse midlevel? Just because?

 

[jen0508]

the official blanket term at my hospital for PA's, NP's, CRNA's etc is "APP" -- advanced practice provider-- which I like

 

I don't find "mid-level" offensive though

 

A lot of PA's find our title (physician assistant) itself offensive. If its so offensive, they should have gone to medical school to get a better title. my 2 cents.

[bobsquit3]

Jen, I certainly agree with you. PACdan, a bachelors is indeed a low level degree when compared to masters and doctorates. Just because people would object to it, doesn't make it so. It's just the reality of education. Maybe you practice in a incredibly progressive state, but it seems that every specialty (except maybe rural FP) the scope of practice for a PA is not the same as an MD (and for good reason!)

[PACdan]

Jen, I certainly agree with you. PACdan, a bachelors is indeed a low level degree when compared to masters and doctorates. Just because people would object to it, doesn't make it so. It's just the reality of education. Maybe you practice in a incredibly progressive state, but it seems that every specialty (except maybe rural FP) the scope of practice for a PA is not the same as an MD (and for good reason!)

"Low-level" isn't tossed around to refer to those who have earned bachelor's degrees due to its unnecessarily derogatory implications for something achieved.

 

I've seen scopes well outside of "rural FP" be full. Admittedly, it's not the norm. I have no idea if my state is progressive with PAs, I don't practice, I'm a student.

 

I'll strike this deal with you though. When the last PA program and working PA switch to all Master's degrees, use the term Master's Level Clinician instead of "midlevel". It even more succinctly defines the degree they hold, what could be your objection?

 

[Boatswain2PA]

Dan, let's reframe this argument for a minute.

I love my nurses (well, most of them).  They take great care of my patients, and they take great care of me.  They often keep me from screwing up, they are my sounding board for ideas, etc, etc, ad nauseum.....I love my nurses!

However their medical education is far inferior to mine.  They know what tests to order for most patients, but they don't really understand the "why" those tests are important.  They usually know exactly what's wrong with the patient, but they fail to think about "what else it could be". 

Therefore, in the medical hierarchy, I am above the nurses.

Same comparison can be made with mid-levels and physicians.  Their medical education is FAR superior to ours.  The standard of care for a residency trained/board certified physician is greater than ours. 

We are in the middle, therefore it is certainly appropriate to call us mid-levels. 

Lastly, your suggestion to switch to "Masters Level Clinician" is flawed when you apply this to the DNP programs.  I"ll be DAMNED if I will ever call a NP "Doctor" in a clinical setting....unless "Doctor" is followed by "Pepper".  

 

Well, unless that DNP agrees to call me "Master Master" (I have two masters degrees)....then I might acquiesce.

[PACdan]

It's not flawed, it just produces a result you don't like. Nor do I, btw.

 

Although one could argue that their doctorate is not a "clinical" doctorate, hence they still don't get the "doctor" title...except in the states where they already do :/

 

I certainly don't see the vast majority of PAs at the level of MDs. I agree with you. But I don't see them smack-dab in the middle between a nurse and a physician. The education, training and practice of a PA is skewed too far to the physician side (albeit less) to be "mid". If anything, the term works better for NPs.

 

[chris.shannon77]

Upper Mid-Level?

 

The lay person understands upper middle-class.

[PACdan]

Upper Mid-Level?

 

The lay person understands upper middle-class.

Technically yes, I think that fits. :)

 

Still a little wonky.

[andersenpa]

Dan, let's reframe this argument for a minute.

 

I love my nurses (well, most of them).  They take great care of my patients, and they take great care of me.  They often keep me from screwing up, they are my sounding board for ideas, etc, etc, ad nauseum.....I love my nurses!

 

However their medical education is far inferior to mine.  They know what tests to order for most patients, but they don't really understand the "why" those tests are important.  They usually know exactly what's wrong with the patient, but they fail to think about "what else it could be". 

 

Therefore, in the medical hierarchy, I am above the nurses.

 

Same comparison can be made with mid-levels and physicians.  Their medical education is FAR superior to ours.  The standard of care for a residency trained/board certified physician is greater than ours. 

 

We are in the middle, therefore it is certainly appropriate to call us mid-levels. 

 

Lastly, your suggestion to switch to "Masters Level Clinician" is flawed when you apply this to the DNP programs.  I"ll be DAMNED if I will ever call a NP "Doctor" in a clinical setting....unless "Doctor" is followed by "Pepper".  

 

Well, unless that DNP agrees to call me "Master Master" (I have two masters degrees)....then I might acquiesce.

This fails to recognize the effect of years in practice- where the rubber meets the road.

 

After 5-10 yrs the nurses are still practicing nursing.

In that same time you and the doc are practicing medicine in the same field. You will get the same exposure, and will arrive at the same scope and level of competency. (This best applies to primary care, IM, EM, and less so for surgical specialties)

[EMEDPA]

This fails to recognize the effect of years in practice- where the rubber meets the road.

 

After 5-10 yrs the nurses are still practicing nursing.

In that same time you and the doc are practicing medicine in the same field. You will get the same exposure, and will arrive at the same scope and level of competency. (This best applies to primary care, IM, EM, and less so for surgical specialties)

if allowed to see the same types of patients...if restricted to fast track for 10 years you will be good at the kind of cases that present to fast track. If you want to grow beyond that, you need to switch jobs every time you max out the learning potential of a particular facility. it's not our degrees that hold us back, it is our permitted scope of practice and levels of autonomy. it's "the man holding us down" and more often than not that man is a doctor....or an administrator, or worse yet,both.