A “mid-level provider” is a common, though often debated, shorthand term for healthcare practitioners who deliver patient care services but are not physicians (MD or DO). The preferred professional terminology is Advanced Practice Provider (APP) or, more specifically, Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA). The term “mid-level” is still widely used by the public, in certain government regulations, and historically to describe a provider who functions between the scope of a registered nurse and a physician.
Primary Professions Under the Mid-Level Umbrella
The category of Advanced Practice Providers is primarily composed of two distinct professions: Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs). While both groups require graduate-level education and perform similar clinical duties, their training models and professional histories differ significantly. The most common type of APRN is the Nurse Practitioner (NP), but the umbrella also includes:
- Certified Nurse Midwives (CNM)
- Certified Registered Nurse Anesthetists (CRNA)
- Clinical Nurse Specialists (CNS)
- Nurse Practitioner (NP)
Nurse Practitioners follow a nursing-model approach to training, which emphasizes holistic, patient-centered care and disease prevention. NP students must first be licensed as a Registered Nurse (RN), typically holding a Bachelor of Science in Nursing (BSN). They then pursue a graduate degree, which is either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). NP programs require advanced coursework in areas like pathophysiology and pharmacology, often specializing in a specific patient population, such as family health or pediatrics.
Physician Assistants, in contrast, are trained under the medical model, which is structured similarly to medical school curricula. PA programs are typically at the master’s degree level and focus on a generalist approach, emphasizing disease pathology, diagnosis, and treatment across the lifespan. This model prepares PAs to practice across various medical and surgical specialties with a broad foundation. While both professions require intensive clinical training, PA students often complete around 2,000 clinical practice hours in rotations covering diverse healthcare settings.
Authority and Scope of Practice
The clinical duties performed by Advanced Practice Providers are extensive, generally encompassing the assessment, diagnosis, and management of patient conditions. These providers routinely:
- Take medical histories
- Perform physical examinations
- Order and interpret diagnostic tests
- Formulate comprehensive treatment plans
A defining component of their authority is the ability to prescribe medication, which is granted to both NPs and PAs in all 50 states and the District of Columbia. The level of autonomy and the specific range of services a provider can perform is defined by their “scope of practice,” which varies dramatically based on state law.
For Nurse Practitioners, state practice authority is typically categorized into three levels: full, reduced, or restricted. Full practice authority allows NPs to evaluate, diagnose, treat, and prescribe independently without mandatory physician oversight. Roughly 27 states and the District of Columbia have enacted full practice authority for NPs. In states with reduced or restricted authority, NPs must maintain a collaborative agreement with a physician or operate under some form of physician supervision for at least one element of their practice. Prescribing authority, while universal, may still be restricted, particularly regarding Schedule II controlled substances, with some states imposing limits on the types of drugs or the supply length.
Working Models and Patient Care Integration
Advanced Practice Providers integrate into the healthcare system through models that range from direct physician supervision to full practice independence. Historically, Physician Assistants have operated under a supervisory model, meaning a physician retains legal responsibility for the care provided by the PA. However, this model is evolving, with some states transitioning toward a collaborative relationship for PAs, which affords greater practice flexibility.
Collaboration is a more flexible concept than supervision, often involving a formal agreement between the APP and a physician for consultation and case review, without requiring the physician’s physical presence or direct oversight for every decision. These providers are fundamental to the modern strategy of team-based care, designed to expand patient access to medical services.
APPs function as a crucial component in addressing growing healthcare provider shortages, especially in primary care, rural regions, and underserved urban areas. By managing a significant portion of patient visits, APPs allow physicians to concentrate on the most complex cases, ultimately increasing the overall capacity of the healthcare team.