Tuesday, 07 Apr 2020

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Stop Calling Me That

This rant is addressed to the Internet, all worldly publications, the ACR/ARHP, and our good friends at Elsinore Brewery.

For the love of God. PLEASE stop calling nurse practitioners (NPs) and physician assistants (PAs) "Non-Physician Providers". And do not call us "midlevels". Do not call us "physician extenders".

The collective proper nosology is Advanced Practice Providers  (Acronym of the Day: APPs).

This may be a variant of tone-deafness for those who are not NPs, PAs, or APPs.  But, try to imagine how insulting it is for a APP professional to be referred to as any of the following: 

  1. Non-Physician Providers -  Why link APPs to the profession that he or she never aspired to be a member of ?  Is your child’s teacher a “Non-physician educator”? No? Huh. Imagine that. So, you just go ahead and call the teacher a “teacher”, because that is what he or she trained for many, many years to be?  An APP is and "advanced practice provider", not  "non-nuclear physicist provider" or a "non-firefighter provider" or a "non-professional wrestler provider". Funny how the english language works.
  2. Mid-level Provider - Whose practice is defined as being in the "middle". The middle of what, exactly? Does that make physicians "high level providers"? Are RNs "low level providers"?  Using the "midlevel" term is a verbal could be viewed a a verbal swipe, designed to put APPs in their place. Much in the same way racist terms are incorrectly used.  Such verbiage reinforces a real or imagined hierarchy. APPs do not practice at the middle of anything. We practice at the highest level of our extensive training and expertise.
  3. Physician Extenders - This sort of sounds more a marital aid, than a career choice. If you are a physician and you want to extend yourself, go right ahead. Do not define another INDIVIDUAL as an appendage, or a mere aextension of you.  Just… don’t.

Written with much Love for Rheumatology, APPs and Rheumatologists,


(Psychosocial Bio:  Betsy Kirchner is a very quiet and introverted NP who has worked with Len Calabrese for over 17 wonderful years. She loves rheumatology. She loves rheumatologists. She has the utmost respect for the dedication, sacrifice and intelligence that goes into the practice of medicine. Her dad is a physician. Her cousins are physicians. Some of her best friends are physicians. All she is asking for is a basic level of professional respect. She realizes this is less of a “bio” and more of an “extension of a rant”. Clearly a nerve has been struck. Emergency yoga might be in order.)

The author has no conflicts of interest to disclose related to this subject

Betsy Kirchner is a board-certified Family Nurse Practitioner. She earned her undergraduate degree in English Literature and Medieval Studies from Ohio Wesleyan University and her Master of Science in Nursing from Case Western Reserve University. She is currently working towards her Doctor of Nursing Practice at The Ohio State University.

Betsy has worked at the Cleveland Clinic Foundation since 2000 in the Immunology department, primarily with Dr. Len Calabrese. She provides care for patients with HIV, rheumatoid arthritis, vasculitis, lupus, and psoriatic arthritis as well as other autoimmune inflammatory diseases. She is board-certified in Rheumatology Nursing, and is on the Board of Directors of the Rheumatology Nurses Society. Betsy has published several articles and book chapters and has spoken at select national and international meetings. Her work-related areas of interest include vaccines, immune related adverse events from checkpoint inhibitors, and the effects of nutrition, activity and stress on the immune system.


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