Called an NP a midlevel...

[Ashleigh99MD]

I got chewed out for calling referring to the NP/PA at work collectively as "midlevels." I was using the term while talking to a coworker, when an NP who works in a different department overheard me. She came over and told me that I was using an offensive term, then lectured me about how if she is a midlevel then does that make her staff low level.

I am a lab tech. Who on her staff is lower level than me?? I've heard several of the MDs and PAs I work with use the term. So what gives? Is it really an offensive term.

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[Lucca]

Oh god. It's spreading.

 

[RogueBanana]

I got chewed out for calling referring to the NP/PA at work collectively as "midlevels." I was using the term while talking to a coworker, when an NP who works in a different department overheard me. She came over and told me that I was using an offensive term, then lectured me about how if she is a midlevel then does that make her staff low level.

I am a lab tech. Who on her staff is lower level than me?? I've heard several of the MDs and PAs I work with use the term. So what gives? Is it really an offensive term.

 

[Lucca]

It's not an offensive term. It's a technical term I've seen used by anyone from Docs to Nurses to PAs to Politicians.

 

[BurghStudent]

Everything is offensive these days. Oxygen is offensive.

I can see why they would consider it offensive when our overlords are melting us all into a nebulous entity called provider.

Just take note of it, and carry on. Eventually, hopefully, you'll be in a position where it doesn't matter anymore.

 

[TaroBubbleTea]

Guess she was triggered. Don't sweat it and just move on.


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[efle]

I'd be sooo tempted to say "Sorry, doctor. Or no wait. I mean sorry, ma'am."

 

[gonnif]

https://www.aanp.org/images/documents/publications/useofterms.pdf


The term is formally opposed by both NP and PA associations. There is significant dislike of the term across NP, PA, and RNs across the country. I would suggest that by the time most of you are in practice it will be considered a term of derision. They are promoting changes in CMS to remove the term via regulatory processes. At the moment is remains the legal classification for purposes of billing

 

[Dagrimsta1]

I'd be sooo tempted to say "Sorry, doctor. Or no wait. I mean sorry, ma'am."

Pass this man a big fat J.

 

[RogueBanana]

https://www.aanp.org/images/documents/publications/useofterms.pdf


The term is formally opposed by both NP and PA associations. There is significant dislike of the term across NP, PA, and RNs across the country. I would suggest that by the time most of you are in practice it will be considered a term of derision. They are promoting changes in CMS to remove the term via regulatory processes. At the moment is remains the legal classification for purposes of billing

from the article

"As it would be inappropriate to call physicians non-nurse providers, it is similarly inappropriate to call all providers by something that they are not."

why does this entire document read as though they have a huge chip on their shoulders for not being docs?
They say that the term midlevel gives a false sense of hierarchy, but excuse me if i'm wrong, is Physician not the highest level provider? They must be mid level (between docs and regular nurses) by default.

 

[Lucca]

from the article

"As it would be inappropriate to call physicians non-nurse providers, it is similarly inappropriate to call all providers by something that they are not."

why does this entire document read as though they have a huge chip on their shoulders for not being docs?
They say that the term midlevel gives a false sense of hierarchy, but excuse me if i'm wrong, is Physician not the highest level provider? They must be mid level (between docs and regular nurses) by default.

if the medical profession does not have a hierarchy, I feel that all of my clinical experiences have bamboozled me.

 

[DokterMom]

from the linked article:

"In 2010, the IOM developed a blueprint for the future of nursing. A key recommendation of this report is that NPs should be full partners with physicians and other health care professionals."

and better still:

"When it is necessary to group providers for policymaking or other purposes, more appropriate terms may instead be: primary care providers; health care providers; health care professionals; advanced practice providers;clinicians; and/or prescribers."

Egads...

 

[RogueBanana]

from the linked article:

"In 2010, the IOM developed a blueprint for the future of nursing. A key recommendation of this report is that NPs should be full partners with physicians and other health care professionals."

and better still:

"When it is necessary to group providers for policymaking or other purposes, more appropriate terms may instead be: primary care providers; health care providers; health care professionals; advanced practice providers;clinicians; and/or prescribers."

Egads...

They think "Allied Health Provider" is too ambiguous but they're fine with "Health Care Provider" which is equally ambiguous?

 

[Dr.Sticks]

Well technically she is a mid level
I do not find that negative...
I wouldn't piss anyone off though where I worked or volunteered, probably not a good idea. People sometimes are connected in the strangest ways..

 

[summergirl]

A physician is top level, and if she thinks NP is not mid-level, then she is implying they are on the same level as physicians. I just don't get it, what is it about the NP profession that makes them think they should be on the same level as physicians as far as patient's medical care goes?? Their training is way shorter and simpler (can even do it online!) and their knowledge base of medical conditions is much shallower. Is it because of their high salary which is comparable to a primary care physician?? Because we can always change THAT.

 

[Dr. Stalker]

I got chewed out for calling referring to the NP/PA at work collectively as "midlevels." I was using the term while talking to a coworker, when an NP who works in a different department overheard me. She came over and told me that I was using an offensive term, then lectured me about how if she is a midlevel then does that make her staff low level.

I am a lab tech. Who on her staff is lower level than me?? I've heard several of the MDs and PAs I work with use the term. So what gives? Is it really an offensive term.

You are wrong. Clearly she is a doctor. Most likely a Princeton Med graduate *ba dum tss*

 

[RogueBanana]

A physician is top level, and if she think NP is not mid-level, then she is implying they are on the same level as physicians. I just don't get it, what is it about the NP profession that makes them think they should be on the same level as physicians as far as patient's medical care goes?? Their training is way shorter and simpler (can even do it online!) and their knowledge base of medical conditions is much shallower. Is it because of their high salary which is comparable to a primary care physician?? Because we can always change THAT.

I have a rather long response I want to write explaining what I believe (from first hand experience) is their reasoning behind it. However, this topic has been beaten to death on these forums and I don't want to contribute more negativity towards other healthcare providers. This thread will likely be closed anyway.

 

[Goro]

My response to her would be the same I use to any thin-skinned person.

"It's just a descriptor"

I got chewed out for calling referring to the NP/PA at work collectively as "midlevels." I was using the term while talking to a coworker, when an NP who works in a different department overheard me. She came over and told me that I was using an offensive term, then lectured me about how if she is a midlevel then does that make her staff low level.

I am a lab tech. Who on her staff is lower level than me?? I've heard several of the MDs and PAs I work with use the term. So what gives? Is it really an offensive term.

 

[Luka75]

I know a few people in NP school and Everytime they asked me Why NPs shouldn't be referred to as Dr., I always tell them :" for the same reason nurses and NPs don't think CNAs should refer to themselves as Nurses"... The lack of the required training.
If they don't want to be called mid-levels, they should come up with a more appropriate term.

 

[Dr.Sticks]

They wear white coats too..
Cool

 

[3member]

np are midlevels nps are midlevels midlevels midlevels

 

[shoal007]

They wear white coats too..
Cool

long ones at that....

any of you not in med school yet or currently in it, by the time youre a board certified physician, youll be calling all these NPs = providers or doctors. they will also get to call in while sick, if the weather is bad or they just dont feel like showing up.


as an attending, ive been schooled that i am a provider and so are the NPs and PAs. they do the same work with the same outcomes and should be paid the same.... where are our advocates and why am i paying $800/yr for my advocacy group. i dropped AMA and i swear that they spend most of the collection on collecting dues (i get a call, letter, or "bill" at least weekly.

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[Dr.Sticks]

long ones at that....

any of you not in med school yet or currently in it, by the time youre a board certified physician, youll be calling all these NPs = providers or doctors. they will also get to call in while sick, if the weather is bad or they just dont feel like showing up.

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Isn't that unethical?

 

[TaroBubbleTea]

long ones at that....

any of you not in med school yet or currently in it, by the time youre a board certified physician, youll be calling all these NPs = providers or doctors. they will also get to call in while sick, if the weather is bad or they just dont feel like showing up.

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I refuse to use the word "provider." I especially cringe when administration or faculty use it.

 

[Dr.Sticks]

OP: Print this image and give it to her as a an apology card.

 

[DokterMom]

They think "Allied Health Provider" is too ambiguous but they're fine with "Health Care Provider" which is equally ambiguous?

My honest take is that in the opinion of the AANP, "Allied Health Provider" is not ambiguous enough (in that the "Allied" clearly implies something other than doctor) and that "Health Care Provider" is just the right amount of totally confusing...

 

[RogueBanana]

OP: Print this image and give it to her as a an apology card.

That picture really rustled my jimmies....

 

[RogueBanana]

My honest take is that in the opinion of the AANP, "Allied Health Provider" is not ambiguous enough (in that the "Allied" clearly implies something other than doctor) and that "Health Care Provider" is just the right amount of totally confusing...

So.....they are hoping people will mistake them as being at the same level as a physician? Seems dishonest, but that's none of my business

 

[AnatomyGrey12]

Oh god. It's spreading.

Seriously though, it is absolutely insane.

They say that the term midlevel gives a false sense of hierarchy, but excuse me if i'm wrong, is Physician not the highest level provider? They must be mid level (between docs and regular nurses) by default.

The rationalization and mental gymnastics by some of these people to avoid this obvious fact is comical. A paramedic would never let an EMT claim to be a paramedic. The example above is spot on as well, if a CNA claimed to be a nurse they would be ridiculed and shot down so so fast, most likely in a very rude and demeaning manner. The problem is that the general public is so ignorant they don't even know they are getting swindled and legislators just see the bottom line so they choose to be ignorant.

 

[Endoxifen]

.

 

[AnatomyGrey12]

So.....they are hoping people will mistake them as being at the same level as a physician? Seems dishonest, but that's none of my business

I'm hoping their zealousness will be their undoing. If salaries become equal employers will just hire docs because they have more training. The CRNA market is already rapidly becoming saturated because they have opened so many schools. Then comes the responsibility that comes with having independent practice, if you want to practice without doc supervision you better be ready for the responsibility of your mistakes that stem from your lack of knowledge. The unfortunate thing is that it is most likely going to take patients dying from NPs who make ignorant mistakes to get people to understand how important the physician training is.

 

[deleted765155]

I'd be sooo tempted to say "Sorry, doctor. Or no wait. I mean sorry, ma'am."

"Did you just assume my gender?"

 

[Henchman21]

"Did you just assume my gender?"

 

[750335]

As much as I think she needs a chill pill or 10, I also think we really need to be careful about how hostile SDN makes us towards people that are not us like nurses and NPs.

 

[AnatomyGrey12]

"Did you just assume my gender?"

 

[deleted765155]

View attachment 215991

Get out of here Harambe

 

[RogueBanana]

I'm hoping their zealousness will be their undoing. If salaries become equal employers will just hire docs because they have more training. The CRNA market is already rapidly becoming saturated because they have opened so many schools. Then comes the responsibility that comes with having independent practice, if you want to practice without doc supervision you better be ready for the responsibility of your mistakes that stem from your lack of knowledge. The unfortunate thing is that it is most likely going to take patients dying from NPs who make ignorant mistakes to get people to understand how important the physician training is.

I agree. Its an unfortunate reality.

Most if not all of the nursing majors I know have a severe dunning-kruger complex. They think because they have a white coat and got a B+ in *Introductory* (not general) chemistry, they are on equal footing with pre-meds and even medical students. Conversely, most pre-meds and medical students I know are quite humble about how little they actually know.

Also, I just want to get this off my chest because I've been meaning to rant on this for a while:

I disagree with the Nursing programs having a "Minimum GPA"

now hear me out:

At my UNI, nurses have to maintain a " C- " GPA.

I understand it was put in place to keep scholastically inept nurses from graduating. But i've seen time and time again (as a university chem tutor) nurses who actively shoot for the minimum grade to pass. They get comfortable with C's, neglect their studies and go out drinking because "They won't kick me out, I have a C+ average".

This thought process horrifies me because we should be shooting to give our patients the best possible care.

I know that nurses aren't going to be making critical diagnostic decisions, and that realistically speaking we need to have a good amount of "less-trained" people in the hospital since it would be impractical to hire 100 doctors at full pay, when you can hire 20 doctors and 80 nurses with similar results.

That being said, If I were a nurse, I would want to be the best nurse I could be, and I honestly feel as though I wouldn't be able to do that if I didn't do well in my science courses. A culture of just getting by during nursing school is a recipe for poor patient outcomes, and it is unfortunately common within the nursing community, at least as far as I have seen in the northeast. No matter how hard these nurses try once they are actually in clinicals, they won't have the scientific knowledge they need to be the best caregivers possible.

*disclaimer* not all nursing majors are like this. Certainly not all nurses.

I just think it's time nursing started to police their own more, being a bit more critical of who they let graduate, enforce higher standards and make their role in the complex health system clear early on in training. Many Nursing professors at my uni have an open disdain for MDs, which bleeds into their students who then assume doctors are dumb and nurses are the real brains at the hospital. Reminding them that their skills are incredibly valuable, but limited in scope. I think it would keep some of the people with complexes from getting out into the real world and causing trouble. We can all do better, and I'm sick of nurses claiming to be experts and then as soon as **** hits the fan they say "i'm just a nurse"

​

/End rant.

 

[LutGholein]

offensive term

This is laughable. But it also reminds us that during clinicals you'll need to play on their terms-- with the push to call physicians, nurse practitioners, and physician assistants in the catch-all term of "provider" they are attempting to push an agenda--and the benefactor in this is the non-physicians and most of all the hospital networks hoping to cut corners.

Soon enough you'll see a two-tier health system with certain segments of the population having access only to certain types of "providers"(non-physicians) but if you intend to get through the rest of your medical education without skirmishes you'll have to bow your head because the NPs have a lot of power in the hospital--if they say it's an offensive term-- it's an offensive* term while you're a student and a resident.

 

[Psai]

They are midlevels. No one is a low level. They're pretending to get offended on the behalf of others to push their agenda. **** em.

 

[Endoxifen]

I think we should all take a moment to try and empathize with the NPs and PAs. Obviously they feel that they aren't getting the respect that they deserve. Regardless of whether you agree with them or not, imagine going into work every day with the impression that people are looking down on you. It's understandable why they would feel offended by "mid-level". That being said, I absolutely agree that they should not have the same power as physicians. Considering the incidence of physician error alone, it worrying to think that people with less training could gain that level of responsibility. Still, we need to consider our coworkers' position.

 

[Princeton Medical Student]

You are wrong. Clearly she is a doctor. Most likely a Princeton Med graduate *ba dum tss*

You called?

 

[bioboy23]

OP: Print this image and give it to her as a an apology card.

 

[SydSing]

OP: Print this image and give it to her as a an apology card.

 

[TaroBubbleTea]

I think we should all take a moment to try and empathize with the NPs and PAs. Obviously they feel that they aren't getting the respect that they deserve. Regardless of whether you agree with them or not, imagine going into work every day with the impression that people are looking down on you. It's understandable why they would feel offended by "mid-level". That being said, I absolutely agree that they should not have the same power as physicians. Considering the incidence of physician error alone, it worrying to think that people with less training could gain that level of responsibility. Still, we need to consider our coworkers' position.

The problem I see with this is that they are demanding respect that is not commensurate with their level of education and training. I see nothing factually wrong with the term midlevel. By purporting it is offensive, midlevels are implying that their expertise is supposedly equal to that of a physician.

 

[Astra]

this thread gave me cancer

 

[Endoxifen]

The problem I see with this is that they are demanding respect that is not commensurate with their level of education and training. I see nothing factually wrong with the term midlevel. By purporting it is offensive, midlevels are implying that their expertise is supposedly equal to that of a physician.

There is nothing denotatively wrong with midlevel, but to them, it draws attention to their supposed inadequacy. Now, I'm not saying that "provider" is a good idea either. It needs to be clear that they are an NP or a PA and not a physician. However, the pathos of their argument is pretty clear.

 

[Dr.Sticks]

I dare everyone to watch the entire video linked below without facepalming.

As someone who has been admitted in the hospital I spent more time with the doctor
The nurse would come in to check vitals, the doctor would visit more often and actually update me on my care.
So I don't really get what she is saying....

 

[RogueBanana]

I dare everyone to watch the entire video linked below without facepalming.

Didn't even make it 20 seconds. As soon as she said "I graduated high school with 40 college credits" I closed the tab.

 

[zero0]

The last hospital I was at was pushing to get doctors to stop using the term "midlevel." The propaganda is strong. I'd be careful about using that word in the future until you're an attending. Then I recommend you use it as much as humanly possible.

 

[NotASerialKiller]

I dare everyone to watch the entire video linked below without facepalming.

What she says in this video is completely reasonable. She says nursing is less of a commitment in terms of years of training, more conducive to raising a family, and although being a NP isn't the same as being a family doc that more medicine-related route is available. She even went out of her way to say that even though she was a strong student in high school the pre-med path has the uncertainty of not getting in. What's so ridiculous about this to you? That a nurse dared to think that medicine was an option available to her? Do you honestly think that every single nurse is just someone who couldn't handle the path to medicine?

There are a lot of obnoxious little sh**s in this thread, especially ones who haven't even gotten accepted to med school and already think they're better than nurses. Pretty disgusting