5 Things You Shouldn’t Call NPs or PAs

Steam comes out of my ears when someone calls me a mid-level. Or a non-physician, physician extender, allied health provider, or limited-license provider. I am a nurse practitioner (NP), which is actually fewer syllables and more meaningful than these other absurd descriptors anyway. Are nurse practitioners real doctors? Why yes they are – you can read more about that here.

Use of slang like mid-level and extender contribute to a public misunderstanding of our role; they imply a need for dependence on physicians, and they obfuscate the uniqueness of our profession.
To set the record straight, this article lists and discusses five names that you should never call NPs or PAs, whether you’re a physician, nurse, recruiter, manager, patient, or family member. The article ends with an overview of how to respectfully refer to an NPs and PAs as well as some resources for further reading.

Mid-level Provider

The U.S. Department of Justice’s Drug Enforcement Administration (DEA) uses “ mid-level practitioner” to describe anyone other than a physician, dentist, veterinarian or podiatrist who dispenses controlled substances (21 C.F.R. § 1300.01(b)) Some states also use “mid-level” in their statutes. Minnesota, for example, uses “mid-level practitioner” to describe both NPs and PAs (Minn. Stat. § 144.1501(f)).

In their position statement, the American Association of Nurse Practitioners (AANP) contends, “The term ‘mid-level provider’ implies that the care rendered by nurse practitioners is ‘less than’ some other (unstated) higher standard.” The AANP explains that this term calls into question the legitimacy of an NP’s ability when in fact they provide high-quality and cost-effective care equivalent to that of physicians. I couldn’t agree more.

Non-Physician

Would you call a physician a non-nurse? Probably not. It’s certainly erroneous to attest that the healthcare system is comprised of physicians and a bunch of other nameless disciplines who are not physicians. In actuality, the healthcare system would disintegrate without the contributions of all healthcare professionals, including those not categorized as physicians.

Imagine an NP or PA introducing herself to a patient: “I’m Melissa, your non-physician.” Using this vague, collective language confuses patients. Unfortunately, the Centers for Medicare and Medicaid Services (CMS) continue to use the term non-physician to describe both NPs and physician assistants.

Physician Extender

It’s unethical to describe any person as a mere extension of another. People are separate beings with their own individual rights and responsibilities. This concept applies to healthcare as well. Nurse practitioners are a distinct discipline that emphasizes disease prevention and health promotion. We reject the old medical ethics of paternalism and instead promote respect for patient autonomy. Nurse practitioners and PAs are not the third arm of an invisible physician. They are each a separate profession with their our own rights and responsibilities.

Allied Health Provider

A thorough Internet search reveals that no one seems to agree on the definition of an allied health provider. The Association of Schools of Allied Health Professions defines allied health as encompassing professions who identify, evaluate and prevent medical conditions. By that vague definition, aren’t all clinicians allied health?

In their position statement on terminology describing nurse practitioners, the AANP asserts, “The usage of the term ‘allied health provider’ has no clear definition or purpose in today’s environment.” They concluded by indicating that allied health is not an appropriate designation of nurse practitioners. It sounds like it isn’t a good descriptor for anyone, physician assistants included.

Limited-License Provider

Nurse practitioners earn either a master’s or doctorate degree in their area of clinical specialty, and they are educated to function independently from physicians. Upon graduation, they pass a national certification exam, demonstrating their mastery of a body of knowledge in a particular medical specialty. In order to provide care, they must hold both a registered nurse (RN) license and an NP license from the state within which they practice.

Any limitations to their to practice is more related to the laws in a given state than to the NP’s professional competencies. Limited-license implies it is some fault of their own when in fact it’s merely a reflection of outdated laws. Rather than describing them as “limited,” let’s focus on removing their scope of practice barriers as recommended by the Institute of Medicine, Federal Trade Commission, Robert Wood Johnson Foundation, and AARP.

If Not These, Then What?

The answer is pretty easy. Just call us nurse practitioners and physician assistants. It is what we went to school for, and it is what we call ourselves. It’s a sign of respect for the value and the unique contributions of our professions. Besides, when is it ever appropriate for one group to use slang or demeaning terminology to describe another? Never. When in doubt, call us what we are: nurse practitioners and physician assistants.

If it is necessary to describe a group of providers for policymaking purposes, the AANP recommends the following acceptable terms:

• Primary care provider
• Health care provider
• Health care professional
• Advanced practice provider
• Advanced practice clinician
• Prescriber

Further Reading:

• Carolyn Buppert’s Nurse Practitioner’s Business Practice and Legal Guide, Fifth Edition. This is one of my favorite texts for understanding the laws regulating NP practice. It is an asset to anyone involved in policy making or promoting the NP role in healthcare.
• Dreher and Glasgow’ Role Development for Doctoral Advanced Nursing Practice, First Edition. This book covers many controversial topics including the NPs use of the title “doctor.”
• The American Association of Nurse Practitioner’s position paper titled, “Use of Terms Such as Mid-Level Provider and Physician Extender.”

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To continue reading this article, check out the new online community for NPs & PAs: Clinician 1. There you’ll find continuing education, patient cases, medical quizzes, job boards, and featured articles like this one from me!