midlevel

[asdf]

I have been attempting to define the word "midlevel" the past couple of
weeks. Can anybody provide any documentation as to when we started to be
called midlevel providers? I would also want information on who is
considered a midlevel provider other than NPs and PAs? Are ODs?
Chiropractors? Psychologist? Physical therapy? etc...

Thanks Dean FNP

[Hychkok]

That's a very good question, Dean. If you find out, let me know.
If by OD you mean DO, doctor of osteopathy, I would say that they are not
midlevel practitioners. At least not here in NYS. They are fully independent
practitioners and head up some medical departments. As far as psychologists
go-- I suppose it depends. My husband is a CSW in private practice and he is
reimbursed at the same level as psychiatrists for a psychotherapy session. If
he feels a patient needs medication, he will refer to a psychiatrist. But his
practice is also fully independent-- he needs no MD or PhD to be on file in the
state capital. (An interesting note-- a friend of his in PA recently lost her
independence when the state of PA decided that only PhDs or MDs could be
reimbursed for psychotherapy in a private practice setting. Scary)
I'm not sure about physical therapy. They seem to like to think they are
totally independent first level practitioners, but since they work on referrals
from MDs and have seen their practices greatly altered by managed care, I think
that they should be made to be categorized as midlevels too. (I am rather PO'd
that my physical therapist made a remark to me about how my being a nurse
practitioner will be 'a little less blue collar' than being a plain old nurse.
I wanted to say "Blue collar this dude-- I have more years of education than
you do", but he was working on my neck).
I wonder if it has to do with education. Do chiropractors or podiatrists have
more than 6 years of college? Many NPs have 7 years of schooling if they went
to post-master's programs, but that 7th year never seems to count because it is
a 'certificate program'. Screw 'certificate program'-- I was at university
taking a full load for 12 months.
Speaking of health care practitioners-- why have dentists been able to
totally avoid managed care caps? I was just charged a whopping $3500 for oral
surgery that took about 45 minutes. My insurance *may* cover $650 of that. The
last time I had virtually the same procedure done, I was charged $900. Why are
dentists allowed to routinely ask for several hundred percent over the fees
that managed care will pay when the rest of us bums are so restricted in what
we can charge?

[Hychkok]

Please scratch my reply vis-a-vis CSWs and psychiatrists getting the same
reimbursement for psychotherapy. My husband had given me this impression in the
past, but tells me that it isn't true. He says that MDs get more than PhDs, and
that PhDs get more than CSWs with an MSW. He says that he doesn't think that
clinical psychologists with a PhD are considered mid-level, but are higher than
that.

[Hychkok]

I did a web search and all I could find under the various 'midlevel provider'
sites were NPs, PAs and midwives. I couldn't find out how the appelation came
to be used. I rather dislike it-- reminds me of '*junior* high school'.
Apparently, we are the only ones who fit the designation. (Pharmacists were
another group I wondered about when it came to the designation 'midlevel
provider'). Obviously, the term is used only with those whose practices are
directly overseen by a physician. My guess would be that the AMA came up with
the term, perhaps with the help of managed care behemoths.
BTW-- my husband tells me that there is a move afoot---(he says it has
actually begun in some areas, but that's hearsay)-- to allow psychologists to
prescribe medication after taking several pharmacology classes.

[asdf]

Thanks for your insight, I reached the same results searching the web and
associated web dictionaries. I will try doing a search at some of the Government
sites. With OD I was referring to an optometrist. DOs arethe same in scope of
practice to the MDs in all areas in the US that I am aware.
Regarding independence, I have complete autonomy with my current practice. I have a
collaborative agreement with a physician for RX privileges. The physician reviews 2
patient charts per month for QA only. If a psychologist cannot RX one could could
consider that role as midlevel as they cannot provide care for a number of clients.
In another words, midlevel is a poor term to define many providers. I do understand
why a PA would be considered a midlevel as they are an assistant to a physician.
Under this framework it makes sense, physical therapy assistant, nurse assistant,
Dental assistant, etc... all those roles that depend on a professional to be
accountable for the midlevel's activities with patients.
I don't know enough about Dentists, and associated costs to make a fair comment.
Thanks for the information, please respond with any additional information that you
come across.

Dean

[Hychkok]

I suppose the very fact that we can prescribe pharmaceuticals is what makes
us 'midlevel practitioners'. In one sense, it sets us apart from other groups
because they cannot prescribe medications, and for us, that's a good thing. On
the other hand, it requires us to have a physician on record as being willing
to 'oversee' our Rx writing, which is kind of a limiting thing for us. Some
people will always ses us as people who need to have a physcian around
somewhere, even if not actually on the premises, in order to practice.
I suppose though, that I prefer the term 'midlevel practitioner' to the term
'physician extender', which reminds me of 'Hamburger Helper'.