• Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

Letters to the Editor: Overutilization of mid-levels won't benefit patients or PCPs


The main problem with midlevels is that they are being used in a manner in which they are neither trained nor competent to perform.

In the May 21, 2010, issue, you asked for opinions ("From the Editor: Where will midlevels fit in?") about the potential benefits and pitfalls of greater utilization of midlevels by primary care.

The main problem with midlevels is that they are being utilized in a manner in which they are neither trained nor competent to perform. Midlevels were originally intended to be practice "extenders" by providing assistance with tasks that really did not require a physician, such as gathering information, administering vaccines, writing prescriptions, etc. For those types of duties, both nurse practitioners and physician assistants perform very well.

But currently, midlevels are frequently being used as primary care "providers," with all of the same privileges normally given solely to physicians, including consultation performance and diagnostic decision-making. Many subspecialty physicians are using midlevels to perform new consultations in both inpatient and outpatient settings. Even some hospital emergency departments are using midlevels to assess emergency department patients.

In my experience, usage of midlevels increases the cost of healthcare for patients. Anecdotally, midlevels tend to order more tests to compensate for their lack of medical knowledge. In Tennessee, midlevels are the largest prescribers of schedule II drugs. They lack a physician's diagnostic abilities, so they refer more patients to subspecialists.

Unfortunately, the inappropriate usage of midlevels as primary care providers has the potential to worsen after universal healthcare leads to larger numbers of Medicaid patients and fewer physicians willing (or able) to see them.

Kingsport, Tennessee

Related Videos
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health