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The term "midlevel"


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I provide gentle education to the residents and fellows (which is typically where I see the "midlevel" comments). Usually it's just because they are lazy and are not sure if I'm a CNP or a PA-C without looking at my badge, which inevitably is flipped over or something hiding my title. Saying "midlevel" makes them feel technically correct even if they can't remember NP vs PA. We have both in our group with identical responsibilities and we rotate coverage, so...

 

Everyone gets it eventually. Unless they don't want to. In those cases, I simply add the offender to my shit list and move on with my life.

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Forget Rank for now - I can't even get my own office to quit using the stupid apostrophe.

 

I am a Physician'S Assistant on the business cards the manager just printed..... deep sigh.

 

Our phone staff up front uses the term.

 

Seriously, why do I have to deal with this?????

 

It is hard enough to get patients to actually want to deal with stuff much less know what to call me.

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Nurses have a license to practice nursing - regular provider

Pharmacists can give out some immunizations and other meds - regular provider

Paramedics (who are licensed) practice medicine in the field but are limited - regular provider

 

NPs born out of RNs and the level of nursing and medicine they practice - advanced practice provider

PAs born out of military corpsman and medics who now have full scope of practice - advanced practice provider

 

APPs is a nice, politically meaningless term that doesn't piss in docs cheerios while recognizing we all practice the same medicine.  To me, "Doctor" is the term used to define ANYONE who does whatever they do at a high level and have a formal education to support it.  Doctors of Medicine are called Physicians.  Doctors of Philosophy are called Philosophers.  For that is the true nomenclature of the words meaning.  In the common vernacular, "doctor" means anyone in a building setting that cares for the sick or injured who isn't identified as a nurse, or some other provider or caretaker.  That usually encompasses MDs, DOs, PAs, NPs and even some clinical PharmDs.

 

G

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Nurses have a license to practice nursing - regular provider

Pharmacists can give out some immunizations and other meds - regular provider

Paramedics (who are licensed) practice medicine in the field but are limited - regular provider

 

NPs born out of RNs and the level of nursing and medicine they practice - advanced practice provider

PAs born out of military corpsman and medics who now have full scope of practice - advanced practice provider

 

APPs is a nice, politically meaningless term that doesn't piss in docs cheerios while recognizing we all practice the same medicine. 

 

G

That at least makes some sense. Thanks - this is literally the first time anyone has been able to explain this to me.

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  • 1 month later...

TreeJay,

 

Yes, in the truest sense of academia, they are considered philosphers of chemical science.  All goes back to the University of Bologna in the 14th Century.  But if you have a PhD, or Doctorate of Philosophy in chemistry - you are the recognized philosophic expert in chemistry. Remember what Philosophy is when defined in Latin or Greek - study of basic knowledge of something.  In this example - it is chemistry.  Its an academic argument - and that's what academics love to do: argue.  ;)

 

G

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Forget Rank for now - I can't even get my own office to quit using the stupid apostrophe.

 

I am a Physician'S Assistant on the business cards the manager just printed..... deep sigh.

 

Our phone staff up front uses the term.

 

Seriously, why do I have to deal with this?????

 

It is hard enough to get patients to actually want to deal with stuff much less know what to call me.

 

 

I would politely make them all disappear......

 

then if need be order my own...

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the doc probably doesn't realize the term "midlevel" is grating to both NPs and PAs. He probably doesn't know what to call us (the combined group of PAs/NPs). Probably some division head has a policy binder where the word midlevel is used over and over and over again in document after document.  Plus, midlevel is two syllables and APP is more than 5. And I do not want to be referred to as just an "APP". I can imagine the stupid jokes already... "Hey, there' an APP for that! hahah!" Just... no. If it really bothers you, just ask him to call you a PA or whatever you want to be called.

 

Personally, I would ignore the midlevel comment and read more into him wanting you to come to him with questions / concerns. He might be trying to tell you something about this NP's ability or personality. Tread carefully!

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I understand why it can be considered offensive to be called a "mid-level" because the care we provide is supposed to be high level... But I do not worry about it too much or make an issue out of it if I hear someone using the term. There is obviously a problem with what to call PAs to communicate what we actually do.

 

Now, referring back to the original post: I wouldn't necessarily get bent out of shape about the word midlevel - another likely scenario is that your supervising physician is subtly telling you that that particular NP is an unreliable source. Maybe they have overheard him/her giving you wrong answers to questions. There is a broad, broad spectrum of intelligence and ability in any profession. And I have seen some NPs who are, how do I put this diplomatically, unreliable sources. (In other words, who I wouldn't let take care of my family member or myself.) Of course there are also very good NPs. Similarly there are bad PAs and good PAs. And as we all know there are "bad apple" physicians, and usually everyone knows that they're bad (except the patients), and we communicate to new people subtly or not so subtly that those docs are bad.

 

Alternative scenario, maybe your supervising physician is just a jerk. I can't know without being there.

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I understand why it can be considered offensive to be called a "mid-level" because the care we provide is supposed to be high level... But I do not worry about it too much or make an issue out of it if I hear someone using the term. There is obviously a problem with what to call PAs to communicate what we actually do.

 

 

I am going to be a little harsh her but this is an incredibly short sighted, naive opinion which hurts our profession.

 

Words absolutely matter, why do you think that advertising matters, and sounds bites, slogans matter?

 

Words have HUGE power and words that do not accurately describe what they are supposed to can be hurtful.

 

 

A HUGE example of this - the HITECH funds...... Congress and the bill writers ASSUMED that PAs would be covered under the Doc's as they are assistants, but NP - as PRACTITIONERS were included in the law....

This is $44,000 PER PA

Times the 100,000 PAs

Assuming only 50% get it to be conservative

And it was a $2,200,000,000 mistake due to WORDING!

 

 

Words matter!!

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I am done being referred to as MidLevel.

 

"Hi, I am Jane Doe, PA - your primary care provider. I am Dr. G's partner in this practice."

 

I don't let folks call me what I am not. I don't assist anyone but the patient - so does a doc, so does a nurse, so does a tech, so does an MA......

 

I would rather be as ASSOCIATE or be able to say I am board certified in Family Practice by the AAFP.

 

Folks don't care when they are sick or hurt - Can I help them is all they care about - semantics don't matter.

 

When my professional colleagues want to describe me - I would certainly not want them to call me an Assistant or a Midlevel - that is going to be the hard part to change...................... particularly with our newly minted Dr. NP friends who insist on using DOCTOR as their title when that isn't what they do.

 

Back to my regularly scheduled Monday of joy.........................

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If it's a resident going on about you being a midlevel, you could remind them that you've at least graduated from your training and they're technically still stupid, oops, a student.

 

Thank frig we don't use the term here - in fact the Past CAPA President deemed it to be an unacceptable term of use, full stop, since it certainly isn't used as a positivie descriptor...except for NP's of course (just kidding...sort of).  ;-)

 

SK

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The last resident who decided to try to demean me - not knowing his attending was a friend of mine or a supporter of PAs AND standing behind us - ranted on and then I simply replied to him:

 

"I have done this since before you were in diapers. We can learn from everyone we work with including your mother who is a nurse I have worked with before." 

 

The attending snorted out loud behind him and then stared him down and walked away. Silent but deadly. 

 

This attending played with the devil often and, when asking questions on ER rounds, would consult me or the other PA when the residents couldn't answer the questions. We were usually right and tried to just answer the question and move on. The attending took great pride in the PAs showing up his baby doctors. Made for some uncomfortable moments but pride in knowing that we knew our stuff. 

 

That particular resident never crossed me again and his upper residents took consults from me readily knowing I had done the whole freaking workup and tied a bow on it to boot.

 

Take pride in your work, make it shine, do the right thing - look both ways before crossing the street and say Yes M'am and No sir.........................

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The extent to which some posters allow the term "midlevel" to play on their emotions suggests a PA inferiority complex. I think that walking around feeling wounded about being called a midlevel is a sign of insecurity. Be confident in your abilities and don't worry about physicians with anti-PA attitudes.

 

Colorado

A question to you

How long have you been out of School and practicing as a PA?

 

I ask this not to attack but just to point out that this is an issue that almost every PA grows into.  New grads, and up to the first 3-4 years you are learning and the dependence role is just fine, but after 5-10 years in one field you now it, you don't need hand holding and dependent status, and it becomes annoying to many of the more senior PA's.   If you search for my recent posts I have a long out explanation of this which I will not repeat here.

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I really think the easiest solution to all this is to just ask to be called - and call each other - what we are: a PA. Or an NP.  Or, if referring to a group consisting of both NPs and PAs, say "PAs and NPs."

 

I feel like this whole midlevel, APP, etc thing was created out of an effort to try to address both PAs and NPs collectively by someone who was not a NP or a PA. The result is confusing to the public and offensive to many of those working in both professions. I was reading a post earlier about someone's 70 year old meth patient. Do you think that guy has any clue what an "advanced practice practitioner" is or an "advanced practice clinician" or a "midlevel" or "physician extender" or whatever other all-encompassing terms people who are not PAs or NPs try to cook up?

 

We need solidarity as a profession - we've got enough problems trying to build public awareness of who we are, what we do, etc. There are PAs with 4 months experience and 40 years of experience, all with something to bring to the table. Let's just call each other - and, ask to be called - what we are: PAs.

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  • 3 weeks later...

 

 

We need solidarity as a profession - we've got enough problems trying to build public awareness of who we are, what we do, etc. There are PAs with 4 months experience and 40 years of experience, all with something to bring to the table. Let's just call each other - and, ask to be called - what we are: PAs.

 

Argreed 100%. 

 

Unfortunately, a lot of people think NP's are better trained because they are able to practice independently. And really, if you didn't know much about medicine or nursing, that would be a reasonable expectation, wouldn't it? 

 

According to Gallup polls, for the past 14 years nurses have ranked as the most trusted profession in America which is no doubt a testament to their formidable marketing prowess. What the general public doesn't realize is that the nursing profession has fostered a deranged cargo cult mentality that believes by taking some fluff courses and adding a bunch of letters after your name, you can acquire magic doctor powers. And they've successfully bamboozled the public into thinking this. So the lowly "Physician's ASSISTANT", who by his title alone relegates him to an ancillary role, must have less training, right?

 

I am working with a locum recruiter who keeps calling me an "NP." He actually just sent me a contract with my title listed as NP. I had to call back to get the contract changed and make sure the site I will be working for understands that I am an PA and not an NP. His response was "oh yeah, you guys need a doctor supervising you. Don't worry there will be a doctor on site. Ya know, with the way things are going, I think some day you guys will end up being able to collaborate with doctors and NP's."

 

I had to bite my tongue.

 

We as PA's need to do a lot better job of promoting ourselves, but unfortunately we simply lack the resources the nurses have. The entire nursing lobby can throw their full weight behind their Dunning-Kruger delusion and gaslight the public into believing they are competent to practice medicine independently. I hate to say it but we are losing the PR battle with the Noctors. 

 

Some days I wake up and wish I went to Noctor school. More prestige, more jobs, and like a fraction of the effort. And by fraction, I really mean like probably 25%, if that. Trust me I saw first hand the curriculum of the FNP students at the school I went to, and I think they were a little embarrassed by it themselves.

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Most of the time it doesn't bother me, because I dont think people are trying to be derisive, but I still think it needs to go. It has nothing to do with insecurity. It's inaccurate and a matter of professional respect. Who's the "low level" provider? The "high level"? We do the same damn job as physicians most of the time.

 

My employer just developed a PA/NP leadership branch on the admin side of things---a big deal---which means every clinic will have a lead PA.

 

I'm gunning for the job, and if I get it this "midlevel" thing is getting put to rest. No one says anything in correction, so it just continues on and on forever.

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I am working with a locum recruiter who keeps calling me an "NP." He actually just sent me a contract with my title listed as NP. I had to call back to get the contract changed and make sure the site I will be working for understands that I am an PA and not an NP. His response was "oh yeah, you guys need a doctor supervising you. Don't worry there will be a doctor on site. Ya know, with the way things are going, I think some day you guys will end up being able to collaborate with doctors and NP's."

 

I had to bite my tongue.

 

We as PA's need to do a lot better job of promoting ourselves, but unfortunately we simply lack the resources the nurses have. The entire nursing lobby can throw their full weight behind their Dunning-Kruger delusion and gaslight the public into believing they are competent to practice medicine independently. I hate to say it but we are losing the PR battle with the Noctors. 

 

Some days I wake up and wish I went to Noctor school. More prestige, more jobs, and like a fraction of the effort. And by fraction, I really mean like probably 25%, if that. Trust me I saw first hand the curriculum of the FNP students at the school I went to, and I think they were a little embarrassed by it themselves.

 

I would've answered that headhunter with a very sarcastic "Are you fu@k!n KIDDING me!", followed by a brief description of how the vast majority of NP programs are a JOKE compared to ANY PA program.  Then, if he didn't stop me, I would go into greater detail about NP's part time didactic and (often) 500 part-time clinical hour curriculums.  

 

I had to look up the Dunning-Kruger delusion.  That's a good one!

 

We must work in different areas or jobs, because I am seeing a greater shift toward PAs.  My primary job has said they won't hire another NP for the ED, and my busy part-time (30K visit a year EDstaffed from a major national EM group) much prefers PAs.  

 

But, again, the term "mid-level" doesn't bother me.  "More than a nurse, but not a Doctor" still applies.

 

 

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I would've answered that headhunter with a very sarcastic "Are you fu@k!n KIDDING me!", followed by a brief description of how the vast majority of NP programs are a JOKE compared to ANY PA program.  Then, if he didn't stop me, I would go into greater detail about NP's part time didactic and (often) 500 part-time clinical hour curriculums.  

 

I had to look up the Dunning-Kruger delusion.  That's a good one!

 

We must work in different areas or jobs, because I am seeing a greater shift toward PAs.  My primary job has said they won't hire another NP for the ED, and my busy part-time (30K visit a year EDstaffed from a major national EM group) much prefers PAs.  

 

But, again, the term "mid-level" doesn't bother me.  "More than a nurse, but not a Doctor" still applies.

 

 

Regarding the part highlighted--seriously?  I absolutely agree that this recruiter should be advised that his/her information regarding PAs is faulty, but I don't see any point in denigrating NPs or their training to do so. It serves no real purpose, and makes PAs look petty and bitter. 

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