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Musings: Blog of the JAAPA Editorial Board
Monday, July 07, 2014
On another level
Harrison Reed, MMSc, PA-C
 
Remember that awful nickname your older brother gave you? Or the one mean kids shouted at recess? It made your skin prickle, fists clench, and eyes glow crimson. Now, imagine your boss walks into your office tomorrow and calls you that very name.
 
If the scenario sounds silly, you may not have paid attention to recent national chatter about the physician assistant (PA) profession. The issue of professional title and terminology has embroiled our ranks and—for the second straight year—dominated conversation at national conferences. But the often-discussed idea of changing the profession’s official title has wrestled focus away from another, and perhaps more disturbing, issue: the slew of unofficial nicknames heaped on PAs by outsiders and, far too often, adopted by our own.
 
You have read them in job postings and news articles, each more inaccurate and uninventive than the last: “advanced practice provider,” “non-physician,” “midlevel,” “physician extender.” I’m willing to bet you don’t use them on your resume or to introduce yourself to patients. Nonetheless, these terms have persisted, and even gained acceptance, through sheer repetition.
 
One in particular seems to roll off the tongue of PAs and NPs more than the others. “Midlevel” has become the frontrunner of accepted substitutes. Never mind that it takes more letters to spell than “PA or NP.” This often-used term is also one of the most demeaning.
 
The single word expresses several false implications. The first is that there is a strict tiered hierarchy in healthcare and PAs and NPs occupy the (imaginary) middle rung. I’m not sure who the “low level” providers are, but I bet whoever coined the term “midlevel” imagined registered nurses on that bronze podium. I pity the first human resources representative with the guts to slap “low-level provider” on an RN job list.
 
The term’s ambiguity adds more danger. Does “midlevel” refer to the provider’s training, skill set, or performance? If physicians provide a high level of medical care, then surely a “midlevel” label implies a product of lesser quality. To the contrary, mounting evidence suggests PAs’ patient outcomes and satisfaction are on par with physicians.
 
Major healthcare organizations have noticed the problem with these substitute names. In February, the Society of Hospital Medicine vowed to abolish the use of such terms and instead refer to professions by their official titles. “Admittedly there may be times when using terms like ‘allied health’ are more expedient,” the Society of Hospital Medicine’s official blog stated, “but the potential for alienating members of the hospitalist family outweighs the need for convenience.”
 
Users of these shortcut names rarely have malicious intent. Often, the words come from a perceived convenience and ignorance of the potential for insult. Large organizations in particular, however, should understand the attitudes they unintentionally project toward the very people they hope to attract. Employers send subtle but strong messages through the diction of their websites and recruitment materials.
 
The PA profession has a responsibility to protect its brand. While debate rages about the accuracy and relevance of the term “physician assistant,” it should not distract from—or worse, condone—the generic labels that threaten to dilute our identity. Regardless of the mixed feelings toward our professional name, it is a title we own. Let’s not have it usurped by one that we don’t.
 
Harrison Reed practices critical care at the Cleveland Clinic in Cleveland, Ohio. Follow him on Twitter @HarrisonReedPA. The views expressed in this blog post are those of the author and may not reflect AAPA policies.
 
7/12/2014
David E. Mittman said:
I commented on this problems two years ago and again last year on Clinician 1. We are not middle level anything. We are full professionals who practice medicine. Please do not refer to yourself as a middle level professional. As far as our "title", the AAPA has come out with a plan to "brand" the letters "PA" to represent our profession. Let's all get behind that and go with it. I never was hired to assist anyone. I was hired to diagnose and treat people. Dave Mittman, PA, DFAAPA President, PAs for Tomorrow www.pasfortomorrow.org
7/12/2014
Dr. Reamer L. Bushardt said:
The Society of Hospital Medicine's rationale is hard to argue with, and the concept of changing language for the sake of a team member's respect is encouraging.