midlevels

Midlevels is a term used in healthcare to describe clinicians who have more training than a registered nurse but less than a physician. Historically, it has encompassed roles such as physician assistants and nurse practitioners, though the exact meaning and included professions can vary by country and context. In the United States, midlevel providers are typically involved in diagnosing and treating patients, writing orders, and prescribing medications, often under physician supervision or within a collaborative practice agreement. The degree of supervision and autonomy varies by state and by professional scope of practice.

Physician assistants complete accredited master’s programs and are certified by the National Commission on Certification of Physician Assistants (NCCPA). Nurse practitioners hold master’s or doctoral degrees and obtain certification from boards such as the American Association of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC). Other roles sometimes grouped with midlevels include certified nurse-midwives and certified registered nurse anesthetists, depending on jurisdiction and regulatory definitions.

The label midlevel is increasingly viewed as imprecise or outdated in policy and professional circles. Many prefer terms such as advanced practice provider (APP) or advanced practice clinician (APC) to reflect a standardized emphasis on advanced training and diverse scopes of practice. In practice, midlevel providers play a major role in addressing workforce shortages, particularly in primary care and rural areas, and can deliver high-quality care in many settings when appropriately supervised and integrated into care teams.

Globally, the concept exists with varying terminology and regulatory authority. In the UK, Canada, and other regions, related roles include physician associates and other forms of advanced practitioners, illustrating a broader international trend toward expanding the reach of non-physician clinicians.