What constitues a "Mid-level Provider"

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VFlutter

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The term mid-level provider or practitioner has been frequently used, somewhat loosely, on the forum over the past few days and I think it would be good to have a discussion as to what makes a mid level provider.

Currently the DEA only recognizes two groups as mid level providers, NP and PA.

Is the title something granted based on the position you are in or does it suggest a higher status and authority?

For example, is anyone who functions in a position in-between that of a Physician and lower professional a mid-level provider or are there some criteria that must be met?


Here are some criteria that I think are required for a group to be considered mid-level providers:

  1. Graduate level education
  2. Prescriptive authority
  3. Ability to assess, diagnose, and treat
  4. Ability to bill for services
  5. Ability to perform advanced procedures? This is questionable


So where do we set the bar or what are the minimum requirements?


Lets not turn this into a debate comparing professions.
 

ExpatMedic0

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Certified athletic trainer?
 

Veneficus

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"mid level" sounds better than "band-aid."

Basically a provider requiring an advanced degree, like physical therapy, PA, NP, etc, that is not a physician but desperately wants to call themselves one.
 

EpiEMS

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The term mid-level provider or practitioner has been frequently used, somewhat loosely, on the forum over the past few days and I think it would be good to have a discussion as to what makes a mid level provider.

This is a fascinating question -- I'm gonna review some literature to try and formulate more intelligent opinion.

Quickly, though, it's an efficient solution, in many cases, to a problem of physician supply (including the willingness of physicians to practice in certain areas, fields, etc.)
 

Bullets

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"mid level" sounds better than "band-aid."

Basically a provider requiring an advanced degree, like physical therapy, PA, NP, etc, that is not a physician but desperately wants to call themselves one.

What about those that have no desire to be an MD? Around these parts we are seeing more PAs and students who openly state they have no desire to attend the full medical school. My girlfriend is in PA school and she feels it is a better deal then being an MD. The ER is run by PAs at night with a MD on call, and there are usually just 2 MDs during the day with 5-6 PAs. They do 99% of the work, they run the trauma team, and they get paid a very similar amount of money. Since they work under the doctor, he carries all the malpractice insurance and they carry very little. "Mid level" seems to be the endgame for more students then ever before
 

abckidsmom

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What about those that have no desire to be an MD? Around these parts we are seeing more PAs and students who openly state they have no desire to attend the full medical school. My girlfriend is in PA school and she feels it is a better deal then being an MD. The ER is run by PAs at night with a MD on call, and there are usually just 2 MDs during the day with 5-6 PAs. They do 99% of the work, they run the trauma team, and they get paid a very similar amount of money. Since they work under the doctor, he carries all the malpractice insurance and they carry very little. "Mid level" seems to be the endgame for more students then ever before

Yeah, the ability to function as a physician without all that pesky medical school and buck-stops-here liability is nice.

I like the idea of mid-level providers but I think the idea was never meant to fully staff an ER, or a hospital, with PAs or NPs as things have progressed.
 

Veneficus

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What about those that have no desire to be an MD? Around these parts we are seeing more PAs and students who openly state they have no desire to attend the full medical school. My girlfriend is in PA school and she feels it is a better deal then being an MD. The ER is run by PAs at night with a MD on call, and there are usually just 2 MDs during the day with 5-6 PAs. They do 99% of the work, they run the trauma team, and they get paid a very similar amount of money. Since they work under the doctor, he carries all the malpractice insurance and they carry very little. "Mid level" seems to be the endgame for more students then ever before

Yep, it's a great idea.

Lesser educated, lesser dedicated, and less capable providers running around pretending and representing themselves as something they are not and taking money for it.

We have a word for that, we call them "quacks."

Undoubtably it is easier to be a quack then to be legitimate.
 

NYMedic828

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What about those that have no desire to be an MD? Around these parts we are seeing more PAs and students who openly state they have no desire to attend the full medical school. My girlfriend is in PA school and she feels it is a better deal then being an MD. The ER is run by PAs at night with a MD on call, and there are usually just 2 MDs during the day with 5-6 PAs. They do 99% of the work, they run the trauma team, and they get paid a very similar amount of money. Since they work under the doctor, he carries all the malpractice insurance and they carry very little. "Mid level" seems to be the endgame for more students then ever before

I don't think there is a lack of desire to be an MD. Everyone in healthcare wants to be a physician whether they admit it or not. The lack of ambition/desire/perserverence to attend medical school is what they are not willing to commit to. But that lack of ambition/desire does not mean they don't want to be an MD. It simply means they want to take a short-cut.

ERs may be run by PAs/NPs and nurses with a doctor on call but does that make it right, or does it just express the further lowering of standards to facilitate costs and profit over providing the highest medical care possible?

When I go to my IM doctor, I expect to see the doctor that I am paying to see. I don't expect to see someone with arguably half the education and dedication of the physician.


Edit: Dammit I was trying to beat Vene to responding. You suck.
 
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mycrofft

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About 5'6", 160 lbs...
 

Bullets

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I guess the question that is asked is, Why spend more time in school, more money on education, and take on greater liability for similar pay, workload and more hands on patients? I also do see the PAs representing themselves as doctors. They are always honest about their roles when asked. As with the EMT-Paramedic relationships, the Docs know who can be relied on and who cant. We know which EMTs and Medics are good and which arent. Same in the hospital. Every profession has its sand baggers and its superstars

I dont think a higher cert results in a higher level of dedication.
 
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NYMedic828

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I guess the question that is asked is, Why spend more time in school, more money on education, and take on greater liability for similar pay, workload and more hands on patients?

Because being a physician is not all about making money. Some actually believe in making a difference and curing disease instead of just treating it.

Physicians do that. Not NP/PAs/Nurses. (99% of the time anyway)

(Mind you I hope to be an NP someday, but only because I refuse to give up my dream job to be an MD like some around here did)
 
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I guess the question that is asked is, Why spend more time in school, more money on education, and take on greater liability for similar pay, workload and more hands on patients?

Not to side track this thread, but I have had the pleasure of interacting with some mid level providers that are more educated than the MD who's license they practice under.
 
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Summit

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Not to side track this thread, but I have had the pleasure of interacting with some mid level providers that are more educated than the MD who's license they practice under.

So are they the exception that proves the rule than physicians are better educated? C'mon! :lol::rolleyes::blink:
 

ExpatMedic0

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The American Academy of Nurse Practitioners (AANP) released a position statement in 2009 denouncing the use of several relegating terminology. Terms such as "mid-level provider," "physician extender," "limited license provider," "non-physician provider," and "allied health provider" when referring to nurse practitioners are discouraged by the AANP.[6] The American Academy of Nurse Practitioners prefers that nurse practitioners are referred to as "independently licensed providers," "primary-care providers," "health-care professionals," and "clinicians..... interesting
 
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So are they the exception that proves the rule than physicians are better educated? C'mon! :lol::rolleyes::blink:

I'm not saying mid level providers are better educated than MD's at all, however as you have stated there are exceptions to that rule.
 
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Clare

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Here is how it works in New Zealand

There are about 20 professions regulated under what is called HPCA or Health Practitioner Competency Act; Doctors, Nurses, Dentists, Optometrists, Anaesthetic Technicians, Chiropractors etc.

These groups have protection of title, can perform acts within their scope of practice, must have an annual practicing certificate and are held responsible to their professional council be it Medical, Nursing, Dental etc.

Each group may have different levels; e.g. there is dental therapist, dental hygenist, dentist etc and each has a specific scope of practice which limits what they can do. They are defined in broad terms and not specific interventions although going outside the bounds of their limits of knowledge etc is professionally unacceptable and you can get in a lot of trouble for it.

Prescribing is a different matter: Doctors can prescribe generally and within their specific vocational scope e.g. only an oncologist can prescribe cancer drugs, only a dermatologist can prescribe dermatology drugs, but all can prescribe general medicines like antibiotics.

NP can prescribe within their specific scope and even then it is tricky e.g. a diabetes NP can only prescribe certain drugs and cannot prescribe ACE inhibitors, it all depends who you are and where you work.

Dentists and Midwives can prescribe but only those drugs immediately related to the specific reason the person is consulting them, e.g. antibiotics can only be prescribed by a Dentist for something to do with teeth/mouth and a Midwife cannot prescribe abx as far as I know.

From next year Paramedic and Intensive Care Paramedic will be registered so they will have recognised legal ability as a healthcare provider but they won't be able to prescribe, in the future perhaps Extended Care Paramedic will be able to when they are introduced formally.
 

Bullets

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Because being a physician is not all about making money. Some actually believe in making a difference and curing disease instead of just treating it.

Physicians do that. Not NP/PAs/Nurses. (99% of the time anyway)

(Mind you I hope to be an NP someday, but only because I refuse to give up my dream job to be an MD like some around here did)

I dont understand what your trying to say? That only physicians can cure diseases? I think you sell the medical profession short when you suggest that 99% of healthcare workers only do so for the money. I doubt thats why most of us work in EMS

How about you get called what you are? Why is there this desire invent labels for everything beyond what they are? It seems specific to the medical field. i dont see cops, or lawyers or teachers worrying about this stuff
 
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