Mid-level practitioner

Mid-level practitioners, also referred to as advanced practice clinicians, are health care providers who have received different training and have a more restricted scope of practice than physicians and other health professionals in some states, but who do have a formal certificate and accreditation through the licensing bodies in their jurisdictions.

Mid-level practitioners have practiced around the world for more than 100 years. Because of their diverse histories, a multitude of mid-level health worker categories can be found in different countries under different titles, e.g. auxiliaries, assistants and technicians. Their training, functions, scope of practice, regulation, and integration into the formal health system vary from country to country. Mid-level practitioners have many different titles, e.g. physician assistant, clinical officer, pharmacist, or nurse practitioner. They are increasingly being used to render services autonomously, particularly in rural and remote areas, to make up for physician shortages.

MLPs by country

South Africa

South Africa conceptualized and introduced a new mid-level practitioner known as clinical associates in 2008 to contribute to the quality of district hospital care.

United States

In the United States, mid-level practitioner is an identifier used by the Drug Enforcement Administration (DEA) to monitor and control the diversion of controlled substances. Although many health professionals are identified by the term "mid-level practitioner" the medical community generally distinguishes two separate categories: advanced practice registered nurses and physician assistants.

The US Medicare system terms both advanced practice nurses and physician assistants as "non-physician practitioner" (NPP). Medicare will pay for emergency department services when these services meet the critical care services definition and requirements.

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 is not a health care designation and must not be confused with the term as it is defined above. The DEA uses the term mid-level as a means of organizing its drug diversion activities. The term mid-level practitioner as used by the DEA Office of Diversion Control include clinicians, other than a physician, dentist, veterinarian, or podiatrist, who are licensed, registered, or otherwise permitted to dispense a controlled substance in the course of professional practice. Some health professionals considered mid-level practitioners by the United States DEA solely for the purposes of drug diversion control include:

• Nurse practitioners
• Certified Nurse-Midwives
• Certified Nurse Anesthetists
• Clinical nurse specialists
• Doctors of Oriental Medicine
• Euthanasia technicians

• Homeopathic physicians
• Medical psychologists
• Naturopathic physicians
• Optometrists
• Pharmacists
• Physician assistants

Controversy

The American Academy of Nurse Practitioners (AANP) released a position statement in 2009 denouncing the use of several relegating terminology. Terms such as "mid-level provider," "physician extender," "limited license provider," "non-physician provider," and "allied health provider" when referring to nurse practitioners are discouraged by the AANP. The American Academy of Nurse Practitioners prefers that nurse practitioners are referred to as "Nurse Practitioners," "independently licensed providers," "primary-care providers," "health-care professionals," and "clinicians."

See also

• Allied health professions
• Health human resources

External links

• Global Health Workforce Alliance: mid-level health workers

• Lehmann U, Mid-level health workers: The state of the evidence on programmes, activities, costs and impact on health outcomes - A literature review. Geneva, World Health Organization, 2008.
• World Health Organization, Global Health Workforce Alliance, Mid-level health providers: a promising resource to achieve the health Millennium Development Goals. Geneva, 2010. http://www.who.int/workforcealliance/knowledge/resources/Final_MLP_web_2.pdf
• Doherty J et al., "Developing a new mid-level health worker: lessons from South Africa’s experience with clinical associates." Global Health Action 2013, 6: 19282.
• http://www.cms.hhs.gov/transmittals/downloads/R1776B3.pdf, Medicare Carriers Manual by the Centers for Medicare and Medicaid Services (CMS) pursuant to Transmittal 1776, implemented on October 25, 2002, Accessed 11 June 2011
• http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5993.pdf, Medicare Carriers Manual by the Centers for Medicare and Medicaid Services (CMS) pursuant to Transmittal 1548, 2008, Accessed 11 June 2011
• http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html, U.S. Department of Justice Drug Enforcement Administration, Office of Diversion Control, Mid-Level Practitioners Authorization by State, Accessed 11 June 2011.
• http://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf, U.S. Department of Justice Drug Enforcement Administration, Office of Diversion Control, Mid-Level Practitioners Authorization by StateChart, Accessed 11 June 2011.
• http://www.aanp.org/AANPCMS2/Publications/PositionStatementsPapers/MLP.htm, Use of Terms Such as Mid-Level Provider and Physician Extender, American Academy of Nurse Practitioners, 2009 (Revised 2010), Accessed 11 June 2011.
• http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960214-6/fulltext Devi, Sharmila, US nurse practitioners push for more responsibilities, The Lancet, Volume 377, Issue 9766, Pages 625 - 626, 19 February 2011, doi:10.1016/S0140-6736(11)60214-6, Accessed 11 June 2011.