Wikipedia:Articles for deletion/Mid-level practitioner

The following discussion is an archived debate of the proposed deletion of the article below. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.

The result was keep‎. Closing as there is a clear consensus to keep, given the submissions are unianimous. No counter arguments to the keep rationale provided, other than by the nominator. There is no active discussion ongoing, with no reasonable prospect of the consensus changing. (non-admin closure) — MaxnaCarta ( 💬 • 📝 ) 01:27, 1 December 2023 (UTC)[reply]

Mid-level practitioner[edit]

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The page only uses two sources to define mid-level practitioner, both of which are outdated. The term is no longer notable nor is it a term that requires its own page. All professions listed on this page have their own individual pages.

1. WHO Definition

The definition used for this page relies on a publication from the WHO from 2010. This WHO publication relied on studies published in 2001, listed as reference 2, that used the term mid-level which is a term no longer generally used in academic journals or by government bodies. I utilized pubmed to search for all articles published in the last ten years. For the term "mid-level practitioner" there were 105 results and for the term "mid-level provider" there were 506 results. In contrast for the term "advanced practice provider" there were 34,169 results.

In searching the WHO website the term mid-level practitioner (MLP) was replaced by the term mid-level health worker (MLHW). Please review the most recent publications from the WHO.

2021 "This most recent WHO review defines a MLHW as follows: “A mid-level health worker is not a medical doctor, but provides clinical care (may diagnose, manage and treat illness, disease, and impairments) or engages in preventive care and health promotion.” Mid-level health workers are also those whose training has been shorter than doctors (2 to 4 years) but who perform some of the same tasks as doctors. ii,iii"

"iii In this brief, we consider graduate nurses/Registered nurses as being outside the purview of the category of MLHWs, unless where trained nurses themselves undergo to become clinicians performing functions similar to doctors (for e.g. nurses who take up the bridge course to become CHOs at Health and Wellness Centres). Nurse practitioners who undergo more prolonged training are also excluded from this definition."

2. Categorizing by Country

This article does not list any reference that uses the term mid-level practitioner in the countries of the United Kingdom or Canada. With India and South Africa using the term mid-level to define allied health professional which do not include NPs or PAs. Please refer to the most updates CMS guide for terminology within the United States.

3. Drug Enforcement Administration

The article also lists the US DEA and controlled substance act as being the basis for categorizing NPs and PAs as mid-level practitioners within the United States. This however is the only organization that uses the term and this is presumably only because this section of the controlled substance act was last published in 2011. No US federal law since has used the term mid-level practitioner. 29 CFR § 825.125, and 45 CFR § 160.103 both include nurse practitioner in the definition of a health care provider and have no definition for mid-level practitioner. Official communication from the DEA to prescribers refers to all professions simply as registered practitioners. Also please take note that the DEAs Q&A uses the same updated language. Lastly there is already a Wikipedia page for DEA Number and DEA numbers are simply a registration between a provider and the DEA to issue controlled substances. A provider who writes prescriptions but not for controlled substances does not need a DEA number.

Conclusion

The term mid-level is no longer generally used to describe advanced practice providers in any country, nor is it a term of notability requiring its own wikipedia page. This term was used in the past simply to group all healthcare providers other then physicians into a single category. The terms advanced practice provider or non-physician practitioners are simply defined by a dictionary and do not require a wikipedia page. — Preceding unsigned comment added by Hue16459 (talk • contribs) 21:30, 24 November 2023 (UTC)[reply]

Comment. Participants in the discussion may want to review Talk:Nurse practitioner#Mid-level once again. It would appear that the nominating editor has been on a heavy-handed spree toward this term. —C.Fred (talk) 00:17, 25 November 2023 (UTC)[reply]
- The nom is not unique in this regard in any respect whatsoever. The idea that healthcare providers with less training than a physician (e.g., Physician assistant, Clinical officer, Nurse practitioner) are "mid" rather than "high" is very much disliked by many people with those licenses. Most NPs, for example, would prefer to see their profession marketed as "the highest level of nursing" rather than the "highest level of medical care, except for the physicians". WhatamIdoing (talk) 03:55, 25 November 2023 (UTC)[reply]
Keep, perhaps even Speedy Keep. The article has plenty of references and easily meets WP:GNG, and it is trivial to find more, such as this from the Journal of Health Care Finance or this from the journal Health Sciences Research. And contrary to the above, it is quite easy to find instances of major organizations like the WHO using this term, for example this document from 2019. Claims that this term is no longer used are obviously mistaken. It appears that this AFD is motivated by a desire to gain advantage in a content dispute over at Talk:Nurse practitioner, where a series of single purpose accounts have been trying to get mention of this term removed - it seems to be a political issue for nurse practitioner groups. I've already filed a WP:SPI on the OP. - MrOllie (talk) 00:24, 25 November 2023 (UTC)[reply]
Please note that this is the user that has so far failed to participate in the mediation request or the discussion on the talk page. This is also the same user that has been reverting all attempts to modify the term for years. This request is not related to the other although the points I have made bridge across both issues.
1. The Journal of Health Care Finance article that you provided is referring to the state of California which is one of the 11 states that have restricted practice laws for NPs requiring them work exclusively under the supervision of a physician. The Journal of Health Sciences Research article is from 2016. As mentioned in my initial post "I utilized pubmed to search for all articles published in the last ten years. For the term "mid-level practitioner" there were 105 results and for the term "mid-level provider" there were 506 results. In contrast for the term "advanced practice provider" there were 34,169 results." There will always be limited journals that still use this term although it is an incredibly small number.
2. The WHO article you listed is referring to United States Medicare reimbursement from 2016. The CMS article I listed in my initial post is from Medicare in 2023 and does not use the term mid-level but instead advanced practice non-physician practioner to now identify NPs and PAs.
3. I am not a nurse practitioner nor am I associated with any nurse practitioner group. I am also only a single use account at this point because I am new to wikipedia and this topic has consumed all my time. I am also not an SP.
Hue16459 (talk) 01:40, 25 November 2023 (UTC)[reply]
Please note that this is the user that has so far failed to participate in the mediation request or the discussion on the talk page. This is false, and can be easily checked at the talk page in question. - MrOllie (talk) 01:43, 25 November 2023 (UTC)[reply]
You did not debate any information you simply rejected all edits and stated "On Wikipedia we follow the best available sources, and for this article that means the World Health Organization. We cannot use lesser sources to undercut their description of this profession" implying that there is only one source that can make this determination and the same source I have now shown uses different terminology. You also stated "At any rate, I'm done arguing here until the SPI comes back." You did not comment on the approximately 25 posts I made starting after I posted the mediation request or provide any additional evidence to support your point of view. Hue16459 (talk) 02:10, 25 November 2023 (UTC)[reply]
You did not comment on the approximately 25 posts I made - No one is obligated to respond to every comment you make, particularly when you are WP:BLUDGEONING the talk page 25 times in four days, often by posting walls of text. At any rate, I am done engaging in such back and forth on this AFD. It is off topic here. MrOllie (talk) 02:17, 25 November 2023 (UTC)[reply]

The PubMed counts are wrong. They pick up any article that uses those words in any possible combination – "advanced practice provider", but also sentences like "The provider should practice these advanced skills". The correct numbers are 1,305 for APP and 180 for MLP(a ratio of about 7:1). WhatamIdoing (talk) 03:51, 25 November 2023 (UTC)[reply]
This is correct, I did make a mistake and I agree with these numbers. Thank you. Hue16459 (talk) 05:01, 25 November 2023 (UTC)[reply]
In the last 5 years there were 1060 for APP and 88 for MLP a ratio of 12:1 and in the last year there were 285 for APP and 18 for MPP a ration of 15:1 which helps illustrate the terms declining prevalence. Hue16459 (talk) 15:03, 25 November 2023 (UTC)[reply]
- Yes please view the talk page where I have contributed heavily to a conversation attempting to remove the term mid-level practitioner from the page for the same reasons I have stated here. Although the argument may appear heavily handed it is not my intention. I simply have a strong belief that this term should be changed based on current evidence. I placed a request on the dispute resolution noticeboard where the other editor has so far declined to participate. Additionally on the talk page only one other user has engaged in the conversation. Hue16459 (talk) 01:13, 25 November 2023 (UTC)[reply]
Note: This discussion has been included in the deletion sorting lists for the following topics: Health and fitness and Medicine. WCQuidditch ☎ ✎ 02:00, 25 November 2023 (UTC)[reply]
Keep, of course. I think the new editor has (understandably) misunderstood the way Wikipedia works. Even if you accept the claim that the terminology is outdated, Wikipedia has all sorts of articles on outdated topics (e.g., Turnspit dog). WhatamIdoing (talk) 03:58, 25 November 2023 (UTC)[reply]
I am new to Wikipedia so I am trying to learn as fast as I can. Is mid-level practitioner not a neologism? And because it is a neologism if it does meet the notability requirements then shouldn’t the most widely accepted and common term be used. In this case that is “advanced practice provider” not “mid-level practitioner”. Hue16459 (talk) 05:25, 25 November 2023 (UTC)[reply]
@Hue16459, the article is about the professional ranking itself (rather than about the word per se), so it doesn't technically matter whether the 50-year-old name for it is a neologism. However, if you think the article title is outdated and should be changed, then the relevant process is at Wikipedia:Moving a page. (Hint: Your best argument for that is likely to be WP:COMMONNAME; the evidence we found above of declining use of the older name and increasing use of the newer one in the medical literature will be relevant, as will this Google Ngram.) It might be best to start that a few days from now, because moving a page (=changing its title) during an AFD can break some of the tools. Feel free to leave a note on my talk page if you need help setting it up. WhatamIdoing (talk) 06:33, 26 November 2023 (UTC)[reply]
I very much appreciate your willingness to collaborate on this. Thank you. Hue16459 (talk) 15:30, 26 November 2023 (UTC)[reply]
keep per WAID rationale--Ozzie10aaaa (talk)
Keep Notability is WP:NOTTEMPORARY. The article may well need re-writing and improving, and maybe even moving or splitting, but nothing presented is a reason for deletion. Bondegezou (talk) 13:51, 29 November 2023 (UTC)[reply]

The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.