Mid-level practitioners, also called assistant practice clinicians and non-physician practitioner, are trained health care providers who have a defined scope of practice. This means that they are trained and legally permitted to provide healthcare in fewer situations than physicians and some other health professionals, but in more than other health professionals. For example, a mid-level provider may be trained for and legally permitted to perform some surgical procedures, but not others. They may have extensive education and a formal certificate and accreditation through the licensing bodies in their jurisdictions. Because of their diverse histories, mid-level providers' training, functions, scope of practice, regulation, and integration into the formal health system vary from country to country. Mid-level practitioners have many different titles, e.g. physician assistant, anesthesiologist assistant, clinical officer, nurse anesthetist, or nurse practitioner. They are increasingly being used to render services autonomously, particularly in rural and remote areas, to make up for physician shortages.
In Canada there are four identified allied primary health practitioners. They include: physician assistant, nurse practitioner, midwife and anesthesiologist assistant. These four providers are identified under the national occupational competency: NOC 3124: Allied Primary Health Practitioners.
In 2008, a new mid-level practitioner role was introduced in South Africa, known as clinical associates. The role was intended to support the district hospital workforce.
United Kingdom
Mid-level practitioners in the UK are known as Advanced Clinical Practitioners and is an evolution of many differing professions which use various titles such as ‘Extended Scope Practitioner’ or ‘Advanced Practitioner’. Historically there has been debate over the consistency of quality in these senior clinicians and therefore it became necessary to generate a distinguished definition of the ACP role. The ACP:
Is a registered healthcare practitioner with a minimum of 5 years clinical experience
Has acquired expert knowledge and complex decision making skills which may be an extension of their traditional scope of practice
Will undertake a two-year level 7 training course in Advanced Practice
Will maintain training and CPD requirements
This is an emerging role and is showing a good deal of promise in meeting the demands of the UK's rapidly evolving healthcare requirements. ACPs may practice in the acute setting or community General Practice / family medicine. The majority can independently assess, investigate, diagnose and formulate a treatment including prescribing medications or referring to specialist care. The deployment of ACPs is considered to be part of a Value Based Recruitment framework driven by Health Education England. This seeks to appoint clinicians based upon their competencies, values and behaviours in support of collaborative working and delivering excellent patient care.
In recent years some organizations and specialties have proposed the discontinuance of the term mid level in reference to professional practitioners who are not physicians. Perhaps unsurprisingly, each organization prefers to use their specific title, and physicians organizations are concerned about title inflation.
Drug Enforcement Administration
The term mid-level practitioner as found in the DEA classification in Section 1300.01, Title 21, of the Code of Federal Regulations is used as a means of organizing drug diversion activities. The term mid-level practitioner as defined by the DEA Office of Diversion Control, "...means an individual practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice." Some health professionals considered mid-level practitioners by the United States DEA include:
