The Midlevel Paradoxes

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Compiled from Reddit

1. The Duality of Practice Paradox

NPs: “We can do everything that a doctor does. We can diagnose, prescribe, and treat. We practice medicine!”

Also NPs: “Nooo, it wasn’t malpractice I swear! I wasn’t practicing medicine, I was only practicing healthcare! You can’t hold me to the same standards as doctors!”

2. The Bridging the Botox Gap Paradox

NPs: “Nurse practitioners bridge the healthcare gap since there aren’t enough providers. You elitist doctors refuse to work in rural areas, so we go to those places instead. We serve the underserved.”

Also NPs: “As soon as I get my DNP, I will move to Miami and open up a Botox clinic. Either that, or ketamine center.”

3. The Lifestyle Paradox

NP/PAs: “We are the same as doctors.”

Also NP/PAs: “We took a shorter route to medicine. I could have been a doctor but I chose not to. While you suckers wasted your twenties/early thirties to become a doctor, I did the same thing in one to two years and now I have the time to raise a family and enjoy my life and hobbies. I work only 40 hours a week while those residents slave away for 90, but I swear we are the same as doctors!"

4. The I Don’t Get No Respect Paradox

NP/PAs: “You doctors don’t respect us!”

Also NP/PAs: goes on TikTok to make disparaging video about doctors

5. The Patriarchy Paradox

NPs: “The MD/DO degree is rooted in misogyny. They don’t like us because we are women.”

Also NPs: doesn’t seem to realize that 60% of graduating medical students are women

6. The PAs Can Practice but Graduate Physicians Cannot Paradox

This one speaks for itself.

7. The Equal Outcomes Paradox

NP/PAs: “Our patient outcomes are equal to that of doctors! Check out this study published in [insert midlevel journal]!”

Also NP/PAs: cites heavily biased study laden with conflict of interest wherein the midlevels were supervised by attending physicians

8. The Egoistical Doctors Paradox

NPs: "Ugh, doctors are so egoistical. They only care about their titles!"

Also NPs: "Excuse me, it's Doctor [insert name], NP, NP-C, DNP, ANP, ARNP, PMHNP, FNP, ATM, FOX, HDTV."

9. The Family Paradox

NPs/PAs with a family: "I could have gone to medical school and been a physician, but I'd rather have time for my family than slave away in clinics all day. Physicians just don't have time for family."

Also NPs/PAs with a family: "I do everything that a physician does--the exact same job." (yet somehow with the same job, they have time for their family...)

Also honorable mentions:

10. The Ego-Education Paradox

NPs/PAs: "Doctors have such an ego--they think that just because they went to medical school, they know everything!"

Also NPs/PAs: "We did med school in half the time and don’t need residencies or supervision because we’re so much smarter."

11. The Med School Acceptance Paradox

NPs/PAs: "I could have gone to medical school if I wanted to."

Also NPs/PAs: attend diploma mill online programs that accepts anyone with a pulse (less so PAs but online diploma mill PA programs are peeking over the horizon now)

12. The Degree-Title Paradox

NPs: "I've earned the right to be called doctor, not nurse."

Also NPs: knowingly attends a nursing program, while also implying that they are somehow better than nurses/the title nurse

PAs: "Don't call me Physician Assistant. I'm no one's assistant."

Also PAs: knowingly attends a Physician Assistant school to get a master's degree in "Physician Assistant Studies"

13. The Doctor/Physician Title Paradox

Physicians: "We'd like to introduce this bill that would require truth-in-advertising and protect physician titles, including "Dr.", "Physician," "Dermatologist," etc. You would have to expressly, verbally inform the patient that you are [title] and not a physician. Additionally, we'd like to protect the the prefix "Dr." in a clinical setting since vernacular English has aligned "Dr." and physician in a clinical context."

NPs/PAs: "Doctors have such big egos! They don't own those titles!!! Who cares about titles anyway? REEEEEEE"

Also NPs/PAs: *Made legislation that explicitly and broadly protects "Physician Assistant" and "Advanced Practice RN" titles in nearly six times as many states as the highly variable and limited laws protecting the usage of "Physician"/"Dr."/specialist titles, while no states protect terms like "resident"/"residency-trained", "fellowship"/"fellowship-trained", or "board-certified."*

14. The Rural Access Paradox

NPs/PAs: "We need independent practice so that we can help rural people! They need healthcare too."

Also NPs/PAs: currently refusing to work in rural environments even though there's no legal restriction that means they can't right now

15. The Greed Paradox

NPs/PAs: "Doctors are greedy. They only care about money which is why they don’t like us."

Also NPs/PAs: "I’m a new grad with zero experience, can I open up my own clinic aka med spa so I can rake in the cash?"

16. The Pay Parity Paradox

NPs/PAs: "We help to decrease healthcare costs!"

Also NPs/PAs: "We deserve equal pay and reimbursement to physicians! We should be able to directly bill for our services with pay parity!!"

17. The Workload Paradox

NPs/PAs: "We do the same job as physicians!"

Also NPs/PAs: "We should only see low acuity, bread-and-butter cases. Physicians can take on the higher acuity patients!"

Also also NPs/PAs: "One patient every 15-30 minutes?? That's totally unreasonable! You're overworking us!"

18. The Overtime Paradox

NPs/PAs: "We care so much about your patients, that's why we're willing to spend extra time with them."

Also NPs/PAs: "I'm a salaried employee. If you want me to work more than 40 hours a week, you need to pay me overtime! Those are Labor Laws!!"

Meanwhile, physicians are explicitly exempted from overtime wage laws 🙃

19. The Truth in Advertising Paradox

CRNAs/NPs/PAs: "We absolutely want our patients to know who we are and what our qualifications are. We definitely are not trying to deceive patients."

Also CRNAs: "Call me (nurse) anesthesiologist."

Also NPs: "Call me Dr. Karen. I can do everything that an MD can do."

Also PAs: "I have a Doctorate in Medical Science, so please call me Doctor. Additionally, my preferred title is Physician Associate or Assistant Physician."

20. The Holistic Paradox

NPs/PAs: "We treat the whole patient, not just the disease."

Also NPs/PAs: shotguns labs and imaging, so they can specifically treat anything abnormal without understanding any of the underlying pathophysiology, ultimately destroying the homeostatic mechanisms keeping the patient alive