‘Mid-Level Provider’ Is a Big Miss for Everyone

As we enter a new year, let alone be it the World Health Organization’s “Year of the Nurse and Midwife,” it feels as though debating over our professional titles, particularly in regard to physicians versus nurse practitioners, is a time-waster at best and completely misses the mark on what matters most to the people we serve.

In a recent article that labeled nurse practitioners as “mid-level providers,” questioning whether they would threaten patient safety if left to practice without physician supervision, we see once again a degrading and complete mislabel of nurse practitioners’ education and ability. Most importantly, it does nothing to further patient care and develop sustainable, evidence-based solutions to America’s ever-looming health care problems. 

The growing responsibility of nurse practitioners has been a long time in the making and increasingly necessary with provider shortages across all health professions. Our immense population, a large aging sector, and increasingly complex chronic diseases, comorbidities and social determinants of health are forcing the way we provide care to look different than it did even 30 years ago. 

There is a need for nurse practitioners to know more and do more. It’s why curriculum has expanded and focused deliberately on leadership, efficiency, economics and interdisciplinary teamwork.

In general, all health care professionals must be prepared for the changing needs and dynamics of our global and fluid society. It’s not enough to just trudge along doing things the way they always have, particularly through a hierarchical lens that is no longer authentic. We need to work interprofessionally, rely on the strengths of providers in their own right, and allow those who have earned the credential to practice at the top of their license and ability.

Years of research show that nurse practitioners do provide equal care to physicians, oftentimes at a lower cost, have high rates of patient satisfaction, and do improve patient outcomes. NPs have advanced education that prepares them with the skills to diagnose, treat and manage patients. 

They provide health promotion and education and fill an important gap in our current system of care. They focus on disease prevention through patient education and advocating for healthier lifestyles, rather than waiting until the point of treatment when the burden on cost and the patient is much higher.

So, while it’s easier to go back and forth over whether our title makes a difference, it’s not an efficient use of time or the knowledge we all worked so hard to achieve. We ought to spend our time finding ways to increase access to care, developing innovations that work for the patient and working collaboratively so that both value and quality exist in our health care system.

Credentials are important, and I will certainly always wear my nursing stripes with pride, but the world has larger issues to tackle besides understanding just what kind of care a “mid-level provider” provides. For most patients, it matters far less whether you’re an NP, a PA or an MD, as it does whether you listened, heard and provided evidence-based treatments and high-quality care.


Patricia Davidson is dean and a professor at the Johns Hopkins School of Nursing.

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