I’ve never understood the need that we humans have to come up with categories, subcategories, umbrella categories, and nano-subcategories for any given topic. The unnecessary term “mid-level provider” — frequently used to describe PAs and NPs — is a particularly annoying example of this.

It bothers me for a couple of reasons. First, it’s describing a group of professionals as something we are not. By calling us mid-level providers, the title makes clear that we most certainly are not “high-level providers,” a category I assume is intended for physicians to occupy. However, I’ve never heard physicians being referred to as high-level providers.

Second, the term implies that if mid-level providers exist, then “low-level providers” must too. Who would that be? Nurses? The implied and emphasized hierarchy of this terminology is considered insulting by many providers I’ve spoken with.

Another movement in the medical provider name-game is calling PAs, NPs, and sundry other groups “advanced practice clinicians.” Making it all even more confusing for patients is yet another push to use the term “advance practice registered nurses,” which of course is different from “advance registered nurse practitioners.”

All of this is leaving patients scratching their heads in a medical world in which they often are rightfully befuddled by the jargon that crops up at every turn. Many of my patients throw their hands in the air and simply give up trying to understand all of the titles. They just want to be evaluated and treated effectively by someone who is competent, friendly, and efficient. I often encounter patients who, in spite of my explaining repeatedly that I am not a physician but a PA, continue to address me as “doctor,” or just “doc.” They’ll stop me in the hallway and tell their friend, “There’s Dr Jim. He’s my doctor!” I usually gently remind them that I am not a doctor, but they often just laugh and say, “Whatever, you’re a doctor to me!”

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If I wanted to further mystify people as to what my role entails, I would say, “Well actually, my job title is officially known as a mid-level provider. It includes other types of providers, too. Have you heard it before?” At this point, the conversation would probably end, and they would walk away understanding even less about my job. 

I wonder sometimes if the term mid-level provider might be the result of a syllable shortage of sorts. Most PAs and NPs I know would rather be called just that, or even simply physician assistants and nurse practitioners. Let’s count the syllables: Mid-le-vel pro-vi-der is 6 syllables, while P-A’s-and-N-P’s is 5 syllables.

So as we can see, even if there were a national syllable shortage, using “mid-level provider” would not be the solution.