The Entitlement of Respect

If you want respect just because of a title, go to medical school.

That may sound harsh… but I believe it to be true.  Let me explain a little further.  I have heard time and time again how demeaning and insulting the term “midlevel provider” is when referring to Nurse Practitioners (NPs) and Physician Assistants (PAs).  Arguments such as “nothing I do is midlevel” have been made time and time again by NPs and PAs who are striving to gain the respect and recognition of their peers in the medical community.  The latest term that all sides have mostly agreed upon is “Advanced Practice Provider” or APP, although I feel that this term is still a somewhat vague representation of what our role entails in today’s healthcare system. 

With the advent of doctoral level APP programs such as the Doctor of Nursing Practice (DNP), even more controversy has arisen as well as criticism from the physician community.  Some voice concerns about the potential misleading of patients by a DNP introducing themself as “Doctor” when they are not a physician.  Other physicians argue that there is still not enough science being taught in the doctoral programs, let alone the Masters level programs.

Entitlement. That’s what many of us feel. “Because I am                 , I deserve                     .”  This term is being used frequently these days in the political arena but it extends into our hospitals and clinics as well.  Entitlement is not always a negative word. For instance, consider a phrase such as, “Because I am an APP, I deserve to be treated just like a physician because I provide comparable care.”  A quick Internet search will yield several studies that will align with that statement, regarding patient satisfaction scores, outcomes, mortality, etc.  However, that data did not just happen over night. That is the result of years and years of hard work and dedication to improving the health of the people we serve.  The result of countless hours of studying and pursuing the latest technological advances and most innovative new strategies.  Entitlements become a problem when they become the focus of APPs.  When we get stuck on the labels and terminology used to refer to us, instead of keeping our focus on improving patient care.

So how should we approach this topic? What battles should we fight?  This is a delicate and complex question, but it is my opinion that instead of arguing semantics and labels, we should expend our energy on refining our knowledge base and honing our bedside skills.  How do we overcome obstacles such as not having access to “physician only” lounges and “physician only” parking spaces?  The only way is to continue to build bridges with the medical community and earn their respect; not to keep perpetuating the rift between APPs and physicians by complaining that we aren’t getting what we think we should.

The solution is not to write yet another blog about how the term “mid-level” is so demeaning. Instead, spend your time listening to a podcast on an unfamiliar topic then write a review. Read an UpToDate article on something you saw in practice last week. Watch a how-to procedural video on Youtube and share it with your colleagues. Take on a student and precept them. Impress your physician counterparts with the depth of understanding you have on a particular topic. We must get out of our own way and continue to become better providers tomorrow than we are today.

In summary, I would say this: Let your work ethic and your patient care/relationships speak for you, not the letters behind your name.

I recently heard this quote – “The world is changed by your example, not your opinion.” Make your example be a catalyst for change today.



As always, these thoughts and opinions are my own, and not representative of my employer. Please feel free to share your comments below.