It has been quite some time since I’ve written on this blog. Lately though, one issue that has become increasingly troublesome is the use of the word “provider” as a blanket term to cover any professional who provides healthcare. I did not go to provider school, but rather medical school, followed by 4 years of psychiatric training before starting my own practice back in 1993. I am and will remain a doctor, NOT a provider. Recently, I spoke with a friend of mine who works as an attorney for an insurance company in their contracts department. She explained that insurers use the word provider in their language as a short cut. Ok, I can see that, but the problem runs so much deeper reducing the word count in a contract.
In her MommyDoc blog, Dr. Niran Al-Agba, a pediatrician in the state of Washington writes:
“Provider” was first utilized by The Third Reich, who embraced this moniker to degrade Jewish physicians as medical professionals. The historic root and use of the word “provider” deserves our attention and reflection because if we forget the tragic mistakes of history, we may be doomed to repeat them. While the more recent movement to disrespect the education and training of physicians was the brainchild of the federal government and corporatized medicine, this disdain for medical expertise has occurred before–to Jewish physicians living in Germany in 1937, before World War II. (https://peds-mommydoc.blogspot.com/2019/02/if-you-call-me-provider-i-will-assume.html)
In their article “Promoting Trust and Morale by Changing How the Word Provider Is Used,”
Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. In 1965, Medicare began using provider for entities qualifying to receive Medicare reimbursement.1 Over the years, the use of the term has expanded to include an ever-enlarging set of individual health care professionals who qualify for payment, especially those in primary care, in addition to institutions (eg, hospitals, clinics, treatment centers) and third-party payers. As such, the term has become part of everyday language in health care delivery, for example, the popular use of the phrase primary care provider. While convenient and a source of pride for some, such use also poses risk for unintentional and potentially detrimental consequences.
I don’t equate insurance companies with Nazis, hate crimes, or the persecution of anyone considered “other.” Instead I aim to draw a line connecting the past and present and highlight the more sinister undertones of the term provider. As doctors we are being diluted and marginalized by the influx of less trained “providers.” Our field is being squeezed more and more by profit driven insurance companies, health care administration “systems,” hedge funds and private equity firms. If “provider” stands for any health care professional, where is the distinction?
Undoubtedly, there are many very competent nurse practitioners and physicians assistants. Physicians assistants, however, typically earn their title in 24-27 months. Even more worrisome is that some PA’s are pushing to be called physician associates, which would further blur the line defining roles. Nurse practitioners typically earn their masters degree in 2-3 years then sit for the APRN certification exam within a year. With at least 8 years of education and training, physicians are most often the best equipped to handle medical and surgical issues. It’s not a coincidence that PA’s work under a physician and often CRNP’s in some settings need a physician as a supervisor.
I am not implying that the other types of health care professionals are unnecessary or not important. Many times they are the first line of care or improve access to care. Otherwise closed practices can see more patients. Underserved areas see improved access to care. With the worsening shortage of physicians, many of whom are seeking early retirement if possible, this trend will continue. My focus, rather, is on the term provider.
If you look at a health care system’s entry on a Google search you’ll see a link for “find a provider.” It’s pervasive. Insurance company directories always use that term. Many times I have had patients complain that they went to see their doctor and instead had to see the PA or nurse practitioner. Sometimes this has occurred in the context of a lengthy doctor-patient relationship. It’s not right and ultimately it leads to more fragmented and often less than optimal care.
One organization that has done it right is Southern California Permanente Medical Group. Their Board of Directors passed a resolution in 2006 that prohibits the use of the word “provider” to describe physicians in our medical group.
The American Academy of Family Physicians (AAFP) published a position paper in 2018 stating the following:
The term ‘provider’ implies that the relationship between the patient and physician is a commercial transaction. The underlying premise of the ‘provider’ based environment is that health care delivery is essentially a market-based enterprise based on a market ethic. This contradicts the Academy’s position that the core of the family medicine specialty lies in ‘…the patient-physician relationship with the patient viewed in the context of the family.’ ”
Furthermore, our patients deserve to know who is treating them. Provider is such a non-specific and therefore meaningless term and contributes further to the decay of medical care. It’s one more assault on health care that contributes to the general sense of numbness and increasing depersonalization of direct patient care. As far back as 2012, Hans Duvefelt, MD wrote:
“Medical provider” is part of the Newspeak of America’s industrialized medical machine. It implies, as Hartzband and Groopman wrote in The New England Journal of Medicine, that: ” … care is fundamentally a prepackaged commodity on a shelf that is “provided” to the “consumer,” rather than something personalized and dynamic, crafted by skilled professionals and tailored to the individual patient.” (https://www.kevinmd.com/2012/04/implications-provider-doctor.html)
Nurse practitioners have their own unique approach and skill set. Physician assistants are not doctors but can diagnose and treat of people while working with a doctor. Physicians have the most training and education to understand, assess, diagnose and treat illness as well as to promote wellness and prevention. We as doctors need to stop accepting being called “providers.” Call us what we are. This mandate goes way beyond the degree we have earned. I’m concerned about the depersonalization of medical care as private (for-profit) insurers and the government have increasingly treated it as a commodity or an asset that they can mold and shape. For my part, I simply won’t answer to the term provider anymore. If asked if that is who (what) I am, I always answer, “no, I am the doctor.”
Thanks.