Talk:Mid-level practitioner

WHO Definition

Can we incorporate the World Health Organization's definition of mid-level practitioner? That would be:

"A health provider: a. Who is trained, authorized and regulated to work autonomously, AND b. Who receives pre-service training at a higher education institution for at least 2-3 years, AND c. Whose scope of practice includes (but is not restricted to) being able to diagnose, manage and treat illness, disease and impairments (including perform surgery, where appropriately trained), prescribe medicines, as well as engage in preventive and promotive care.

References

POV Bias

This article seems to take a POV that is from that of Mid-Level Lobbyist. Wikipedia should be careful not to endorse biased perspectives.

ExtraEggWithNoodles (talk) 06:41, 15 August 2023 (UTC)

Wikipedia follows the best available reliable sources, even if some people think those sources are 'biased perspectives'. MrOllie (talk) 15:18, 20 November 2023 (UTC)

Wikipedia is an amalgamation of editors with varying interests and levels of writing experience who agree to follow a set of guidelines. Whether or not wikipedia uses best available and reliable sources is not a matter of objectivity but of the standards of the editors of the particle article. In fact, any editor with experience comes across dozens of articles that are poorly written and cite poor sources, else there would never be the need for editors and the website could revoke its editing privileges from all users.

The ability of mid-levels or their role is by far not a settled issue, in fact it is a continuously moving topic as backed by existing sources, and any article in the subject that seeks to maintain Wikipedia:Neutral point of view, as backed by guidelines should acknowledge and understand that when vetting sources. Perhaps it may be wise to view the Wikipedia Guidelines and Content Policies before editing.

- AH (talk) 22:10, 22 November 2023 (UTC)

Social worker not mid level

There is no citation for social workers being considered mid level. They are not a medical profession either and do not practice medicine in any form. Social work should be removed. 47.161.179.194 (talk) 09:14, 21 November 2023 (UTC)

For purposes of this section, “nonphysician practitioner'” means a clinical psychologist, licensed clinical social worker, physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. Hue16459 (talk) 20:33, 21 November 2023 (UTC)

I don't see where that article is cited for that specific section and also it says "for the purpose of this section." That does not make social workers mid levels just because the one agency uses it to make policy easier to . Additionally if you were to add social workers based on that, it should be changed to licensed clinical social workers - not just "social workers." 47.161.179.194 (talk) 23:46, 21 November 2023 (UTC)

Again, that section is specifically in regards to DEA. Since social workers are not listed by DEA it needs to be removed. 47.161.179.194 (talk) 23:50, 21 November 2023 (UTC)

You are correct in the placement is incorrect. I linked to the US Governments definition of a non-physician practitioner who is able to bill medicare for services rendered. LCSW should be the correct term as this license is required to work in a hospital. Hue16459 (talk) 23:53, 21 November 2023 (UTC)

I did not realize that was what you were referring to. Hue16459 (talk) 23:54, 21 November 2023 (UTC)

gotcha no problem. Yeah I think social work would be more accurately described as non physician practitioner than mid level. This article overall could use a lot of work. 47.161.179.194 (talk) 00:01, 22 November 2023 (UTC)

Also sorry i forgot to specify dea 47.161.179.194 (talk) 00:04, 22 November 2023 (UTC)

In my opinion there is no reason for this page to still exist. DEA number has its own page as to all of the providers listed on this page. This page only exists because individuals are trying to keep alive the term mid-level which is no longer used in practice and a term that has clearly evolved into either advanced practice provider or most recently non-physician practitioner. Hue16459 (talk) 00:40, 22 November 2023 (UTC)

I forgot to mention, lcsw isn't required to work in a hospital, only bill (or licsw depending on the state) an lbsw can work in hospitals just not provide therapy or diagnosis 47.161.179.194 (talk) 00:16, 22 November 2023 (UTC)

Assistant physicians

This article need to be addressed as the terminology in in conflict with the licensing of assistant physicians. Missouri law now allows for the licensure and practice of assistant physicians who are graduates of a medical school but are ineligible for licensure as a physician due to being unable to complete a residency training program. These doctors may only refer to themselves as assistant physicians and are required to maintain a collaborative practice agreement with a supervising physician. The law states "The collaborating physician is responsible at all times for the oversight of the activities of and accepts responsibility for primary care services rendered by the assistant physician." Additionally the law further states that "an assistant physician shall be considered a physician assistant for purposes of regulations of the Centers for Medicare and Medicaid Services (CMS)". This means that medical school graduates are classified as mid-level practitioners under both the WHO definition and the controlled substance act referenced on this page which refer to terminology from 2011. The modern appropriate terminology recognized by CMS is non-physician practitioner. Hue16459 (talk) 20:33, 21 November 2023 (UTC)

Requested move 12 December 2023

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: procedural close. Initiated by block evasion. Best, (closed by non-admin page mover) Reading Beans (talk) 01:15, 30 December 2023 (UTC)

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Mid-level practitioner → Advanced practice provider – Advanced practice provider is the best and most widely used term to define all non-physician practitioners. Hue16459 (talk) 01:16, 12 December 2023 (UTC)

This move discussion is a followup discussion based on the outcome of the deletion discussion.

WP:NAMECHANGES is relevant for this suggested move

The definition used for this page relies on a publication from the WHO from 2010. This WHO publication relied on studies published in 2001, listed as reference 2, that used the term mid-level which is a term no longer generally used in academic journals or by government bodies. I utilized pubmed to perform a search of peer reviewed scientific journal articles. In the last 5 years there were 1060 for APP and 88 for MLP a ratio of 12:1 and in the last year there were 285 for APP and 18 for MPP a ration of 15:1 which helps illustrate the terms declining prevalence. Also the Google Ngram viewer further illustrates that the term advanced practice provider is the more widely used term as compared to mid-level practitioner.

In searching the WHO website the term mid-level practitioner (MLP) was replaced by the term mid-level health worker (MLHW). Please review the most recent publications from the WHO. 2021 "This most recent WHO review defines a MLHW as follows: “A mid-level health worker is not a medical doctor, but provides clinical care (may diagnose, manage and treat illness, disease, and impairments) or engages in preventive care and health promotion.” Mid-level health workers are also those whose training has been shorter than doctors (2 to 4 years) but who perform some of the same tasks as doctors. ii,iii"

"iii In this brief, we consider graduate nurses/Registered nurses as being outside the purview of the category of MLHWs, unless where trained nurses themselves undergo to become clinicians performing functions similar to doctors (for e.g. nurses who take up the bridge course to become CHOs at Health and Wellness Centres). Nurse practitioners who undergo more prolonged training are also excluded from this definition." Hue16459 (talk) 01:26, 12 December 2023 (UTC)

• Oppose. It is quite easy to find instances of major health care organizations like the WHO using this term recently, for example this document from 2019, in addition to those already cited in the article, as well as the OP's own cite just above from 2021. Ngram is a little tough because some spell the term without a hyphen, or substitute 'provider' for 'practitioner', but accounting for that shows 'Advanced practice provider' is not more widely used. There's no policy based reason to move this - rather, it seems to be an attempt to gain advantage in a content dispute over at Nurse practitioner. - MrOllie (talk) 01:31, 12 December 2023 (UTC)

  The new editor posted this because I suggested it. WhatamIdoing (talk) 02:53, 12 December 2023 (UTC)

• Support. In the last 10 years, the preference for "APP" over "MLP" in the medical journals indexed by PubMed has become even more stark, going from 7:1 in favor of APP to 15:1 in favor of APP, which means that it is the WP:COMMONNAME for WP:MEDRS sources. Since 2012, APP has become significantly more popular in English books, according to Google Ngram Viewer, and since 2014, MLP (in all its spelling variations) has been declining. There are certainly still some sources that use the older language, but there's no particular need for us to stick with the older terms. WhatamIdoing (talk) 02:39, 12 December 2023 (UTC)
• support agree w/ WAID--Ozzie10aaaa (talk) 13:28, 13 December 2023 (UTC)
• Oppose. MrOllie's ngram seems to be correct and undisputed. Finding select subsets of the literature/web that are different isn't as compelling. RudolfoMD (talk) 03:12, 14 December 2023 (UTC)

  I dispute it. He adds variations on MLP but not on APP, and then says that all the variations on MLP add up to slightly more than a single version of APP. However, if you add variations on APP (such as advanced practice clinician and advanced clinical practitioner) or alternatives (e.g., non-physician practitioner) , then it is not true that the sum of all MLP names and punctuations is the most common. Also, I suggest that you look at MrOllie's link with just two years' worth of smoothing. The trend is up for APP and either flat or down for all forms of MLP. WhatamIdoing (talk) 03:56, 14 December 2023 (UTC)

  APP doesn't pull ahead when I add the variations. Looks like a tie.

  The article would have major problems after a name change, is there a draft of the article that would be correct with the change? RudolfoMD (talk) 05:18, 14 December 2023 (UTC)

  I don't think it would have major problems. It would benefit from a quick copyedit to reduce (but not eliminate) the number of times that the MLP name is mentioned. I would expect that to take me about 10 minutes to do. WhatamIdoing (talk) 17:08, 14 December 2023 (UTC)

  Mid-level practitioner is WAY ahead with mid-levels included, FWTW. RudolfoMD (talk) 18:22, 14 December 2023 (UTC)

  And APN is clearly the dominant term. advanced practice nurse dominates. I strongly oppose a move to anything else. RudolfoMD (talk) 18:28, 14 December 2023 (UTC)

  We already have Advanced practice nurse - this article is about a less specific category that includes APNs as well as some others. MrOllie (talk) 18:36, 14 December 2023 (UTC)

  Well, well. non-physician is even more dominant. I oppose a move to anything else. RudolfoMD (talk) 18:14, 16 December 2023 (UTC)

  “Non-physician” and “mid-levels” are not appropriate search terms as these include a multitude of unrelated topics. Non-physician practitioner is the newest term to replace advanced practice provider however this term is not prevalent enough to surpass APP at this point in time to satisfy Wikipedia policies. Hue16459 (talk) 18:37, 16 December 2023 (UTC)

  Mid-Levels is a neighborhood in Hong Kong. I also find it used in mathematical calculations about storms, discussion of museum membership levels, as a shorter way of typing Militarized interstate dispute [1], describing the rank of US federal government employees, indicating sections of the forest understory, and more. I checked the first 100 books containing that term in Google Books. 90% of them had nothing to do with healthcare, and even some of those were talking about other things (e.g., osteocalcin levels, aka N-MID levels, evaluating hairs in a scalp biopsy). The ones that I checked that were actually relevant only used mid-levels after first giving a longer version of the name (e.g., "The mid-level providers are trained... argue that mid-levels' training cannot..."), so that search does not identify any new previously unaccounted-for uses, and it adds an enormous number of completely irrelevant sources. WhatamIdoing (talk) 16:49, 15 December 2023 (UTC)

  It is well known that the smoothing technique used by ngrams produces trends that don't exist. You should always turn it off for discussions like this one. MrOllie (talk) 14:32, 14 December 2023 (UTC)

  I also disagree. The ngram shows data from 1970-2019 but the term APP was only introduced in 2010. Even with a smoothing of zero if you look at the data from 2010 until 2019 you can see that APP has dramatically outpaced MLP. Here is the same ngram with the dates changed from 2008-2019 which shows the downfall of the term MLP in 2010. Additionally, the default setting for google ngram is a smoothing of three so returning the default to that setting here you can better visualize the transition of the term from MLP to APP starting in 2010. I would also argue that doing a search of all peer reviewed medical journals is not finding subsets of the literature when that is the appropriate literature to use to identify the prevalence of a medical term. Hue16459 (talk) 04:53, 14 December 2023 (UTC)

  Policy is : Article titles are based on how reliable English-language sources refer to the article's subject. Change the policy and then you can validly make that argument. And you already !voted. Boxed guidance is: "Please base arguments on article title policy, and keep discussion succinct ..." RudolfoMD (talk) 05:44, 14 December 2023 (UTC)

  The COMMONNAME sub-section of the Wikipedia:Article titles policy looks for "the name that is most commonly used (as determined by its prevalence in a significant majority of independent, reliable, English-language sources)" – assuming that one exists. I suggest to you that:

  • In English-language sources, using a dataset that includes many sources that are not reliable and therefore are irrelevant as far as the policy is concerned, both MLP and APP are currently used, perhaps about equally, but the use of APP is clearly increasing, and the use of MLP is either flat or declining.
  • In English-language sources that are very likely reliable (i.e., medical literature), APP is used far more often than MLP (currently 15 to 1).

  IMO the COMMONNAME subsection of the policy supports a preference for APP because the title is preferred in MEDRS sources. However, if you disagree, then I think your next step is to either demonstrate that:

  • when two names are used approximately equally among books of mixed reliability, one of them is significantly more common than the other, or
  • that since the approximately equal use in books of mixed reliability means COMMONNAME doesn't apply, MLP is preferred on the main policy grounds (for which COMMONNAME is meant to be only an analytical shortcut), namely: that it is recognizable, natural ("one that readers are likely to look or search for and that editors would naturally use to link to the article from other articles" – note that MLP is not used at all in many highly relevant articles, such as Physician assistant), precise (e.g., won't be confused with a neighborhood in Hong Kong), concise, and consistent with similar articles (if any).

  WhatamIdoing (talk) 17:03, 15 December 2023 (UTC)

  Sadly the medical literature is not reliable. Reproducibility crisis, Reporting bias, a high false positive rate in clinical medicine and biomedical research and all that. It also "includes many sources that are not reliable". You don't make the assertion that books as a whole are not very likely reliable as indicators of use of language. Because that would be an absurd claim.

  However, if you disagree, then I think your next step is to either

  • change the policy (with consensus)
  • concede the point. (That last sentence is mainly showing how pushy you're being.)

  It's not like we can identify reliable sources one-by one to get an accurate count. The generalization that as indicators of use of language, only the published literature is relevant simply contradicts policy. RudolfoMD (talk) 18:33, 16 December 2023 (UTC)

  The existing policy requires that COMMONNAME (which is only one small part of the policy) be evaluated wrt to reliable sources, not wrt to every book scanned by Google. The problems you name with the medical literature are important real-world problems, but they are not relevant problems. But if you prefer restricting the medical literature to MEDRS ideal, then the ratio for MEDLINE-listed review articles published in the last five years is 17:1 in favor of "advanced practice provider". WhatamIdoing (talk) 02:10, 17 December 2023 (UTC)

  AGAIN: Books as a whole are reliable as indicators of use of language, and appropriate for article title policy. Your next step is to identify a huge number of particular books that are not reliable for that purpose. The reliability problems I identified with the medical literature impact MEDLINE-listed review articles. Obviously. I don't buy your ratios as fit for purpose - they aren't even verifiable - no sources. Don't mislead readers regarding policy.

  Article title policy says usage is to be evaluated WRT to ALL reliable sources, not just in reliable articles in the medical literature, which you haven't measured anyway.

  What are you doing? Please think about it and stop. I've already urged you to "Please base arguments on article title policy, and keep discussion succinct". You are not respecting that request. This is not cool. If you must continue to express yourself, do so under your own !vote, please.

• Notice that below, WAID hasn't listed a single book. (Or I listed a huge number of MEDLINE-indexed entries that are not reliable for the purpose.)

  RudolfoMD (talk) 03:50, 18 December 2023 (UTC)

  You can verify the ratio yourself, by putting (quoted phrase) "mid-level provider" into PubMed and clicking the buttons for 5 years, MEDLINE, and Review. Do the same for "advanced practice provider". Searching PubMed is exactly as verifiable as searching Google Books.

  Here is a partial list of "a huge number of particular books that are not reliable" and that are included in Google Books (and that are not included in the PubMed search):

  • self-published books
  • books that reprint Wikipedia articles
  • works of fiction
  • outdated books

  These types of sources are not reliable sources; therefore, a search that includes them is not appropriate. WhatamIdoing (talk) 16:41, 18 December 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.