Mid-level practitioners, also called non-physician practitioners, advanced practice providers, or commonly mid-levels, are

health care provider A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often rece ...

s who assess, diagnose, and treat patients but do not have formal education or certification as a

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

. The scope of a mid-level practitioner varies greatly among countries and even among individual practitioners. Some mid-level practitioners work under the close supervision of a physician (such as doing pre-op and post-op assessment and management, thus allowing surgeons to spend more of their time operating), while others function independently and have a scope of practice difficult to distinguish from a physician. The legal scope of practice for mid-level practitioners varies greatly among jurisdictions, with some having a restricted and well-defined scope, while others have a scope similar to that of a physician. Likewise, the training requirement for mid-level practitioners varies greatly between and within different certifications and licensures. Because of their diverse histories, mid-level providers' training, functions, scope of practice, regulation, and integration into the formal

health system A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations. There is a wide variety of health systems aroun ...

vary from country to country. They have highly variable levels of education and may have a formal credential and accreditation through the licensing bodies in their jurisdictions. In some places, but not others, they provide healthcare, particularly in rural and remote areas, to make up for physician shortages.

Definitions

The

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

includes in this category all healthcare providers with all of the following qualifications: * trained and legally authorized to provide healthcare, * having at least two years training at university or other institution of higher education, and * able to diagnose and treat medical conditions, within the scope of their training and licensure, by prescribing medication and/or performing surgery.

MLPs by country

Canada

In Canada there are four "allied primary health practitioners" identified under the National Occupational Classification (NOC) section 3124:

physician assistant A physician assistant or physician associate (PA) is a type of non-physician practitioner. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes be ...

nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications an ...

midwife A midwife (: midwives) is a health professional who cares for mothers and Infant, newborns around childbirth, a specialisation known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughou ...

, and anesthesiologist assistant. Nurse practitioners are permitted to provide several, but not all, of the health care services physicians provide.

India

In 2016, a new mid-level healthcare provider role was introduced in India(Dealing With modern Medicine), known as Community Health Officer (CHO) or Nurse Practitioner, Physician Associate/Assistant. The role was intended to support the community-level Health and Wellness Centres in India. Community Health Officers (CHOs) and Physician Associate/Assistant (PA), also called Mid Level Health Providers (MLHPs) and non-physician practitioners(Physician Associate/Assistant), are trained in Health Sciences model who have a defined scope of modern medicine practice. In

India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...

Nursing Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...

, '' AYUSH and Healthcare Professionals (Healthcare profession like Physiotherapy, Physician Assistant/Associate, Optometrist Etc. prescribed in NCAHP ACT 2021, NCAHP,MOHFW, Government of India)''are eligible for this cadre. This means that they are trained in Modern Health Sciences model and legally permitted to provide healthcare in fewer situations than physicians but more than other

health professional A health professional, healthcare professional (HCP), or healthcare worker (sometimes abbreviated as HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a Nursing, nur ...

s. In India, Community Health Officer or Nurse practitioner, Physician Associate/Assistant are other names for mid-level practitioner. Apart from doctor and nurses there was a list of Healthcare providers as recently NCAHP,Ministry of Health and Family Welfare published Guideline in Ayusman Bharat digital Health Mission control of health related cases in rural areas of India. According to these guidelines, symptomatic cases can be triaged at village level by tele-consultation with a Physician Associate/Assistant or a Community Health Officer (CHO).

South Africa

In 2008, a new mid-level practitioner role was introduced in South Africa, known as clinical associates. The role was intended to support the district hospital workforce.

United Kingdom

Mid-level practitioners in the UK are known as Advanced Clinical Practitioners (ACP) or Advanced Practitioners (AP) and occurred as an evolution of many differing professions which use various titles such as 'Extended Scope Practitioner'. Historically there has been debate over the consistency of quality in these senior clinicians and therefore it became necessary to generate a distinguished definition of the ACP role. The ACP: * Is a registered healthcare practitioner with a minimum of 5 years clinical experience (2 years in a senior clinical role) * Has acquired expert knowledge and complex decision-making skills which may be an extension of their traditional scope of practice * Will undertake a two-year level 7 (

Master's degree A master's degree (from Latin ) is a postgraduate academic degree awarded by universities or colleges upon completion of a course of study demonstrating mastery or a high-order overview of a specific field of study or area of professional prac ...

) training course in Advanced Practice * Will maintain training and CPD requirements ACPs may practice in the acute setting (ED, critical care, etc.) or community

General Practice General practice is personal, family, and community-orientated comprehensive primary care that includes diagnosis, continues over time and is anticipatory as well as responsive. Definitions A general practitioner (GP) is a doctor who is a consu ...

/ Family Medicine. The majority can independently assess, investigate (through blood tests / imaging etc.), diagnose and formulate a treatment plan including prescribing medications or referring to specialist care. The deployment of ACPs is considered to be part of a Value Based Recruitment framework driven by Health Education England (HEE). This seeks to appoint clinicians based upon their competencies, values and behaviours in support of collaborative working and delivering excellent patient care.

Physician Associates

Physician Associates (PAs) practising in the United Kingdom is the equivalent title to

, these clinicians are described as "dependent practitioners", meaning that they require supervision at all times by a physician. They cannot prescribe medications nor can they request tests that use ionising radiation such as X-rays.

United States

In the United States, mid-level practitioners are health care workers with training less than that of a physician but greater than that of nurses or medical assistants. The term mid-level practitioner or mid-level provider is related to the occupational closure of healthcare. This concept centered around physicians as the ultimate professional responsible for healthcare. As healthcare demands have increased in the United States due to an

aging population Population ageing is an overall change in the ages of a population. This can typically be summarised in a single parameter as an increase in the median age. Causes are a long-term decline in fertility rates and a decline in mortality rates. Most ...

, a physician shortage and the implementation of the

Patient Protection and Affordable Care Act A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health ...

of 2010 there has been a shift toward more independence in practice for professionals such as

physician assistants A physician assistant or physician associate (PA) is a type of non-physician practitioner. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes b ...

, nurse practitioners,

pharmacists A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...

, and dental therapists.

Concerns about terminology

In recent years some organizations and specialties have proposed the discontinuance of the term ''mid-level'' in reference to professional practitioners who are not physicians. Each organization prefers to use their specific title, and physicians' organizations are concerned about title inflation. *preferred even over

, which was what the acronym historically stood for

Drug Enforcement Administration

The term mid-level practitioner as found in the DEA classification in Section 1300.01(b28), Title 21, of the

Code of Federal Regulations In the law of the United States, the ''Code of Federal Regulations'' (''CFR'') is the codification of the general and permanent regulatory law, regulations promulgated by the executive departments and agencies of the federal government of the ...

is used as a means of organizing drug diversion activities. The term ''mid-level practitioner'' as defined by the DEA Office of Diversion Control, "...means an individual practitioner, other than a

dentist A dentist, also known as a dental doctor, dental physician, dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in provi ...

veterinarian A veterinarian (vet) or veterinary surgeon is a medical professional who practices veterinary medicine. They manage a wide range of health conditions and injuries in non-human animals. Along with this, veterinarians also play a role in animal r ...

, or

podiatrist A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...

, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice." Some health professionals considered mid-level practitioners by the United States DEA include: * Ambulance services * Animal shelters * Certified chiropractors * Doctors of Oriental Medicine * Euthanasia technicians * Homeopathic physicians * Medical psychologists * Naturopathic physicians *

Nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications an ...

s (including nurse midwives,

nurse anesthetist A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy. Nurse anesth ...

s, and clinical nurse specialists) * Optometrists *

Physician assistant A physician assistant or physician associate (PA) is a type of non-physician practitioner. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes be ...

s * Registered pharmacists

References

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External links

Global Health Workforce Alliance: mid-level health workers
Health care occupations