Recruiting and Incorporating Mid-Level Providers

  • Peter Borowsky
  • Jacob Blanchett
  • Kyle Pilz
  • Eric C. Makhni


Although relatively new to the field of healthcare, mid-level providers have become effective and reliable resources to expand clinical productivity – especially in the field of orthopedic surgery. Despite common misconceptions, the hiring of such individuals into a healthcare organization does not create a financial burden. In fact, there are many ways to incorporate these individuals into the healthcare team, with each supporting the notion that having a mid-level provider significantly increases revenue, clinic throughput, and patient access to care. Interviewing and hiring a mid-level provider to become a part of the clinical team is a process that can be customized and adapted based on the physician’s needs, thereby mitigating the burden of the hiring process. Furthermore, just as the interview and hiring processes allow for flexibility, so too does the manner in which the physician chooses how to use mid-level providers. Possible options include having mid-level providers see additional patients in clinic while the supervising physician performs surgical cases, having mid-level providers assist with administrative work and patient contact, and having mid-level providers serve as a first assist during surgical procedures. The manner in which the physician assistant or nurse practitioner is used greatly depends on the goals and desires of the physician, again allowing for a system that can best meet the needs of individual clinics or organizations. In summary, the incorporation into and use of mid-level providers in the orthopedic clinic is a practice whose benefits far outweigh the burdens needed to successfully recruit these providers. Here, we report effective strategies regarding how to incorporate mid-level providers into the orthopedic clinic, as well as the myriad of benefits provided by having these individuals as part of the healthcare team.


Mid-level practitioner Physician extender Advanced practice provider Nurse practitioner Physician assistant Certified athletic trainer Clinic throughput Patient satisfaction Incident-to billing Cost-effective care Scope of practice Prescriptive authority 


Author’s Disclaimer

For purposes of this chapter, the term “mid-level practitioner” (MLP) will be utilized to loosely bundle the “nonphysician” group of advanced practice providers and clinicians entailing nurse practitioners (NPs), physician assistants (PAs), certified athletic trainers (ATCs), and other physician extenders such as nurse midwives, nurse anesthetists, and physical therapists.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Peter Borowsky
    • 1
  • Jacob Blanchett
    • 1
  • Kyle Pilz
    • 2
  • Eric C. Makhni
    • 1
  1. 1.Division of Sports Medicine, Department of Orthopedic SurgeryHenry Ford Health SystemWest BloomfieldUSA
  2. 2.Department of Sports Medicine, Midwest Orthopedics at RUSHRUSH University Medical CenterChicagoUSA

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