There is so much wrong with your post I don’t even know where to begin.
You seem happy to place a higher value on the commerce aspect of medicine, which is never how it has been done, but how it has been transformed by this Epstein class. It is one thing to gratefully accept a good rate of pay for an excellent job, it is quite another to make medicine a 'business." That has been done to us. A standard must exist.
Further, holding an ideal is what our groups do and the ideal is that no matter what, the patient’s benefit comes first. Always. No excuses.
The pushback on this is frightening to me. The behavior in the marketplace is already there. For a number of years now I have heard our young physicians saying things that burn my ears so badly they are nothing but crisp slices of ash now.
Holding the patient’s good at the center of everything we do - is what we do. If someone is opposed to that, doesn’t understand that, or doesn’t want to do that then I would highly suggest choosing a different career.
I AM NOT A PROVIDER!!!!!!! I am a physician, a doctor and a surgeon!!!!!! However, reality is that I have to pay for office rent, medical supplies, malpractice, employee payroll and health insurance, malpractice insurance, "professional" dues, educational loans, continuing education and an EMR Just to name a few; BEFORE I GET A DIME!!!!! Not to mention "professional" fees for my lawyer, accountant, IT, plumber and electrician! A chicken and a basket of grandma's bread does not pay those bills. I wish I didn't have to, but that is the reality IMPOSED on us by "BIG government" and "Big Insurance" who have decreed that it is our "Professional" responsibility to support THEM by "providing" (hence the term provider) care for "Their" customers at rates which have essentially no rationale other than to save them money. So yes, I "provide" for a whole lot of other people with my profession but NOT for my patients!! "Professionals" are supposed to have the highest moral character and should not dirty their hands with such unmentionables as money. I have loved my profession for 50 years but at least have the courtesy of not calling me a provider.
I am not a provider. And I recognize that there is a value exchanged for my services. My job is to serve the patient (the intention being relational, not transactional). I will be compensated for that service, but that cannot be my primary motivating force. The actions we take in our as physicians can be taken with various mindsets. Both “transactional” (I do this for you, patient, just to get paid) and “toxic martyr” (I do this for you for free and don’t dare talk or think about money) are inferred by the term provider. What physicians need to learn to foster is a service-forward mindset. Providing a service and serving are two different things.
I'm a physician. I do not identify as a provider. That term is way too broad. Otherwise, all service providers are providers too. Plumber, electrician, etc. We all have our own titles. Ours is called physician. Be proud of your title, or seek the tittle you wish to have. Thanks.
A lot of semantical distinctions in the discussion. Interesting topic. If we are all to be called ”providers”, I will call myself a “physician provider” and refer to my NP as a “non-physician provider”. But increasingly, patients call all of us “doctor” with no distinction as to the educational background. That non-distinction becomes understandable when you realize many physicians (including specialists and sub specialists) have turned over the front-line care of their patients to the non-physician provider in their office. Further confusion is now emerging with NPs and PAs obtaining their PhDs and calling themselves “doctor”. Of course, they are, but most patients do not bother to understand the
Dr. NP or Dr. PA received their doctorate in a 2 year on-line program rather than the rigors of 4 years of medical school followed by 3-8 years of postgraduate training.
I don't understand all of this discussion. I also don't understand the ACP position statement if it focuses on "provider" as an allusion to the economic realities of a professional.
I have never heard the term "provider" used to signify a business relationship. It is pushed by hospital systems and others who want a big label for several different professionals who are able to diagnose and prescribe: ie, ARNP/DNP, PA, physicians. It falls under the sentiment of not wanting to differentiate amongst these. In some specialties, there is little difference in the job description. The public has a good understanding of what a "doctor" is but not always the other professionals listed (though definitely do more so now than in past).
This has been pushed by hospitals. They went so far as to remove "Dr." or "physician" from name tags worn on the job, even getting to the point of putting one's first name in bold letters with "provider" or "physician" in much smaller letters underneath.
All of this is the push to remove any shred of what public respect or differentiation there is for a "doctor". the goal of the big systems is to make everyone equal and all of these "providers" more on the level of anyone else on the team. To think of the team as a whole - just one, big, equal "team". We should all go by our first name.
I'm not sure why the ACP would take that tack on why "provider" is used. I don't think they got it right at all. It's funny - I had not read the ACP position but was surprised they'd speak out against the use of "provider". Now I find out they actually didn't.
The term "provider" was injected into the clinical site of medicine to diminish the power, role, and voice of physicians. Full stop.
That there are still people that don't understand the political ramifications of calling us providers is fairly shocking to me and quite disheartening.
That the ACP continues to try to diminish it is extremely telling of their dark and corrupt underpinnings.
Yes! so strange that anyone would think that "provider" is being pushed to make the relationship seem transactional. Absolutely not. It is a push to diminish any shred or a nod to "authority" that "doctor" provides.
Appreciate the comments! I get the resistance to “provider” language and the upset with the bureaucratic/managerial aspects of our work environment that interfere with our doing the work in the way we know we ought to do it—as some of you have experienced from the patient perspective. I would say a couple of things. 1) our work environment has been deteriorating since the 90s for sure and a tipping point of sorts happened 2009-2010 with the HITECH Act and the ACA, which brought well intended (but, I would say, catastrophic) industrial quality control efforts and, especially, dysfunctional EHRs into our world. As a result, some of the most important aspects of what we do have become much more difficult and obstructed. 2) the answer to that is not to deny the economic character of our work, as it seems to me the ACP (and maybe some of you) would advocate. It is instead to wrest some control of our work environment away from those who now manage us—although it will take federal legislation at this point to reverse much of the damage from well intended but pernicious legislation ranging from Stark laws back in the day preventing physician ownership of clinical enterprises to the more recent “meaningful use” EHR mandates.
First, high tech forced the immediate use of EHRs. This was not 'well intended'. It was pushed on us the same way AI is being pushed on us. This was rigged in the back rooms, bribed in the halls of congress, by the same corrupt technology folks bringing us AI. Why did they do it? Why did they give us such a broken system? The goal of the system was to keep us typing to get data right from the heads and minds of doctors. That is why 55% of our time was spent on EHR. That's where they wanted us. Back in that time period, it was so obvious that it could be easily fixed, and they were not fixing it. It was frustrating. Now the full curtain has been pulled back.
They took 55% of our time from our patients, our families, our communities, and our lives. They did it without consent. They did it without payment.
I seriously think a class action lawsuit is in order.
I can't believe doctors haven't figured that out yet.
It seems like you don't understand what's happening. It seems like most docs still don't understand what's happening. It's a testament to the lack of a functioning physician organization. It is a testament to the ability of tech companies to manipulate the minds of individual doctors. As they did with the insane anti-vax nonsense and other right-wing memes that have polluted our atmosphere
I have begged physicians for years to form a new organization and to keep out the money changers, but unfortunately, everyone is busy. If you question this, look at the criminal backgrounds of the people doing it
i was aware of the change, less aware of the impact of HITECH in bringing it about until recently. as of 2009-10 it was obvious that hospital health records accessible online were evolving organically, and mostly in aid of clinician communication. It was messy but it was also going in a good direction. HITECH and the ACA blew all that up; and clinical life took a bad turn thereafter. Its ironic that the one EHR that more or less still works is the one that government inertia has kept from ruination (until now): CPRS in the VA system.
I appreciate that you thought it was going in the right direction, but the truth is the amount of time physicians spent on EHR never went down. This was part of the plan. The entire goal of making the EHR was to keep doctors on the computer. With as much detail as possible to gather data
The EHR was never built to help us or help patients. That is the truth, and it was evident way back then. People like me that tried to say the truth were dismissed as being anti-technology, which again could not be further from the truth. They squelched rebellion with the HITECH law.
This time with AI, as they're trying to force it against our will, I promise you it's not good for us. How are these quieting push back now? They are feeding exciting pieces of information into white male physician/investor algorithms so that they're very, very excited about building something with AI. The excitement has reached a frenzy state.
Tech companies are using the Amazon technique. Amazon would recruit good-hearted entrepreneurs to build businesses, test the market, define the products, and identify the problems. Working their hearts out, they succeeded in planting their little entrepreneurial flag. Once the model was working well, Amazon would 1. build the product itself,
2. a little better and a little cheaper, and then
3. put the entrepreneurs out of business.
Tens of thousands of good-hearted people trying to build a business were crushed under the wheels of Amazon, and not one person tried to stop them.
Now we have the Amazon technique on steroids. Just yesterday, a company that you probably use, Wispr Flow, that was funded with $58 million in capital was just put under in a matter of minutes. Google built and put out a free product, and Wispr Flow is no more. Once Wispr Flow is down, Google can charge for it, and nobody will stop them. This is how it's going to work.
Furthermore, the tech leaders have all said they want to do away with most humans. That is their answer to global warming. That is their answer to everything. This is a video I recommend everybody watch. There is more. This is not a joke https://www.youtube.com/watch?v=W1dIC287Zz0&t=1535s Watch that, I have more.
As I have entered my senior years, healthcare has felt more and more fractured to me. After a fall with concussion last year, it took weeks to get assessment and help for the concussion and BPPV. The ED only seemed concerned about my broken collarbone and discharged me to Ortho. My PCP finally got involved in getting me help for the vertigo, which was assessed and corrected by Neuro with follow up to Physical Therapist. The PT told me I had other vestibular issues that needed to be addressed~ and that my eyes were not working correctly. Then Humana and my PT’s practice had a parting of ways so I asked my ophthalmologist for help. He told me what I was seeing in my eyes was just the reflection of my cataract lenses. I decided I just might have to live with the visual problems. But after a few months, I paid out of pocket to return to my PT and have her write up what she was seeing. Took that to Ophthalmologist yesterday, who examined me and became very, very apologetic that he had missed what was going on. I have now been referred to Neuro-Ophthalmology, 14 months after my fall.
The unfortunate truth is that healthcare doesn’t truly provide a gatekeeper anymore, especially for seniors. We
The fact that we are paid money to show up every day does not itself compromise our mission, any more than it does a truck driver or a judge. I sell hours of my life, for money. In the current era, many of us can pick and choose among many ‘suitors’ for our skills. So long as I’m not paid by the head (I’ve refused RVU arrangements), I can maintain as much economic ‘purity’ and clinical objectivity as reasonably possible. I prefer that firewall.
Too many words to say the simple " doctors have fallen off the pedestal". As a physician myself seeking medical care I can not find a doctor accepting patients. My friends and family routinely make jokes about doctors boosting "billable hours". Our profession has lost the respect we once enjoyed and now sadly just another provider in the marketplace. I think it is too late to turn that ship around.
I think this article unnecessarily complicates a very simple issue. I don't think that the "offense," if I may, of physicians being called providers is based on any deeper economic basis/definition. And thus the justification based on economics is misleading. Let's start with the very acceptable term of "PCP", primary care provider. It would be wonderful if there were enough physicians in the US or world so that this role could be designated to physician professionals only. But that is never going to be the case. We need the help of nonphysician health care "providers" to address our shortage realities. As a physician, I am a proudly a Primary Care PROVIDER, and I welcome other qualified health care workers to share that title with me, with that same pride.
This is a great article. There is a semantic sense in which the term provider can be used as a catch all as well - a term for any person or entity involved in the provision of healthcare. In general, I prefer the term doctor when referring only to doctors. And I also think that doctors seeking to make a profit is not a states that excludes them from behaving in ethical, patient centered ways. But providers of healthcare include a wide range of professions. I don't think subsuming doctors into this category is derogatory when you are trying to be general in speaking of those who produce healthcare (dentists, doctors, nurses, advanced practice providers, hospitals, etc.)
In other forms of business, when the service you are paying for is substandard or does not materialize, there is a way to regain your funds or force the proper service to be provided.
With doctors, benefit or no, you pay. If they were providers, they would have to prove they had done the work they were paid for.
If doctors were still paid what the patient could afford, they would have good times and bad times like the rest of us.
You cannot sugarcoat the ‘guaranteed payment plan despite service provided’ form of business that medicine has become
The intuitions most docs I know have on this are not in line with your position at all. We are not, and never will be, "providers." The reduction of our title devalues our profession. If it sits well with you, great. But to really understand what this does, it is not to consider the respect you get from patients or the transactions completed, but to understand that it is a classification scheme intended to equate your work with that of nurses, PAs, and "other providers." It is a word game to literally decrease your reimbursements and value in systems. It is not about respect in society.
There is so much wrong with your post I don’t even know where to begin.
You seem happy to place a higher value on the commerce aspect of medicine, which is never how it has been done, but how it has been transformed by this Epstein class. It is one thing to gratefully accept a good rate of pay for an excellent job, it is quite another to make medicine a 'business." That has been done to us. A standard must exist.
Further, holding an ideal is what our groups do and the ideal is that no matter what, the patient’s benefit comes first. Always. No excuses.
The pushback on this is frightening to me. The behavior in the marketplace is already there. For a number of years now I have heard our young physicians saying things that burn my ears so badly they are nothing but crisp slices of ash now.
Holding the patient’s good at the center of everything we do - is what we do. If someone is opposed to that, doesn’t understand that, or doesn’t want to do that then I would highly suggest choosing a different career.
I AM NOT A PROVIDER!!!!!!! I am a physician, a doctor and a surgeon!!!!!! However, reality is that I have to pay for office rent, medical supplies, malpractice, employee payroll and health insurance, malpractice insurance, "professional" dues, educational loans, continuing education and an EMR Just to name a few; BEFORE I GET A DIME!!!!! Not to mention "professional" fees for my lawyer, accountant, IT, plumber and electrician! A chicken and a basket of grandma's bread does not pay those bills. I wish I didn't have to, but that is the reality IMPOSED on us by "BIG government" and "Big Insurance" who have decreed that it is our "Professional" responsibility to support THEM by "providing" (hence the term provider) care for "Their" customers at rates which have essentially no rationale other than to save them money. So yes, I "provide" for a whole lot of other people with my profession but NOT for my patients!! "Professionals" are supposed to have the highest moral character and should not dirty their hands with such unmentionables as money. I have loved my profession for 50 years but at least have the courtesy of not calling me a provider.
You're just a provider, until you realize you can be promoted to "disruptive physician."
I am not a provider. And I recognize that there is a value exchanged for my services. My job is to serve the patient (the intention being relational, not transactional). I will be compensated for that service, but that cannot be my primary motivating force. The actions we take in our as physicians can be taken with various mindsets. Both “transactional” (I do this for you, patient, just to get paid) and “toxic martyr” (I do this for you for free and don’t dare talk or think about money) are inferred by the term provider. What physicians need to learn to foster is a service-forward mindset. Providing a service and serving are two different things.
I'm a physician. I do not identify as a provider. That term is way too broad. Otherwise, all service providers are providers too. Plumber, electrician, etc. We all have our own titles. Ours is called physician. Be proud of your title, or seek the tittle you wish to have. Thanks.
A lot of semantical distinctions in the discussion. Interesting topic. If we are all to be called ”providers”, I will call myself a “physician provider” and refer to my NP as a “non-physician provider”. But increasingly, patients call all of us “doctor” with no distinction as to the educational background. That non-distinction becomes understandable when you realize many physicians (including specialists and sub specialists) have turned over the front-line care of their patients to the non-physician provider in their office. Further confusion is now emerging with NPs and PAs obtaining their PhDs and calling themselves “doctor”. Of course, they are, but most patients do not bother to understand the
Dr. NP or Dr. PA received their doctorate in a 2 year on-line program rather than the rigors of 4 years of medical school followed by 3-8 years of postgraduate training.
I don't understand all of this discussion. I also don't understand the ACP position statement if it focuses on "provider" as an allusion to the economic realities of a professional.
I have never heard the term "provider" used to signify a business relationship. It is pushed by hospital systems and others who want a big label for several different professionals who are able to diagnose and prescribe: ie, ARNP/DNP, PA, physicians. It falls under the sentiment of not wanting to differentiate amongst these. In some specialties, there is little difference in the job description. The public has a good understanding of what a "doctor" is but not always the other professionals listed (though definitely do more so now than in past).
This has been pushed by hospitals. They went so far as to remove "Dr." or "physician" from name tags worn on the job, even getting to the point of putting one's first name in bold letters with "provider" or "physician" in much smaller letters underneath.
All of this is the push to remove any shred of what public respect or differentiation there is for a "doctor". the goal of the big systems is to make everyone equal and all of these "providers" more on the level of anyone else on the team. To think of the team as a whole - just one, big, equal "team". We should all go by our first name.
I'm not sure why the ACP would take that tack on why "provider" is used. I don't think they got it right at all. It's funny - I had not read the ACP position but was surprised they'd speak out against the use of "provider". Now I find out they actually didn't.
The term "provider" was injected into the clinical site of medicine to diminish the power, role, and voice of physicians. Full stop.
That there are still people that don't understand the political ramifications of calling us providers is fairly shocking to me and quite disheartening.
That the ACP continues to try to diminish it is extremely telling of their dark and corrupt underpinnings.
Yes! so strange that anyone would think that "provider" is being pushed to make the relationship seem transactional. Absolutely not. It is a push to diminish any shred or a nod to "authority" that "doctor" provides.
Appreciate the comments! I get the resistance to “provider” language and the upset with the bureaucratic/managerial aspects of our work environment that interfere with our doing the work in the way we know we ought to do it—as some of you have experienced from the patient perspective. I would say a couple of things. 1) our work environment has been deteriorating since the 90s for sure and a tipping point of sorts happened 2009-2010 with the HITECH Act and the ACA, which brought well intended (but, I would say, catastrophic) industrial quality control efforts and, especially, dysfunctional EHRs into our world. As a result, some of the most important aspects of what we do have become much more difficult and obstructed. 2) the answer to that is not to deny the economic character of our work, as it seems to me the ACP (and maybe some of you) would advocate. It is instead to wrest some control of our work environment away from those who now manage us—although it will take federal legislation at this point to reverse much of the damage from well intended but pernicious legislation ranging from Stark laws back in the day preventing physician ownership of clinical enterprises to the more recent “meaningful use” EHR mandates.
First, high tech forced the immediate use of EHRs. This was not 'well intended'. It was pushed on us the same way AI is being pushed on us. This was rigged in the back rooms, bribed in the halls of congress, by the same corrupt technology folks bringing us AI. Why did they do it? Why did they give us such a broken system? The goal of the system was to keep us typing to get data right from the heads and minds of doctors. That is why 55% of our time was spent on EHR. That's where they wanted us. Back in that time period, it was so obvious that it could be easily fixed, and they were not fixing it. It was frustrating. Now the full curtain has been pulled back.
They took 55% of our time from our patients, our families, our communities, and our lives. They did it without consent. They did it without payment.
I seriously think a class action lawsuit is in order.
I can't believe doctors haven't figured that out yet.
It seems like you don't understand what's happening. It seems like most docs still don't understand what's happening. It's a testament to the lack of a functioning physician organization. It is a testament to the ability of tech companies to manipulate the minds of individual doctors. As they did with the insane anti-vax nonsense and other right-wing memes that have polluted our atmosphere
I have begged physicians for years to form a new organization and to keep out the money changers, but unfortunately, everyone is busy. If you question this, look at the criminal backgrounds of the people doing it
Were you aware of this?
Was anyone aware of this?
https://carlagoldenhart.substack.com/p/share-before-it-gets-taken-down-the?r=2bqvtz
i was aware of the change, less aware of the impact of HITECH in bringing it about until recently. as of 2009-10 it was obvious that hospital health records accessible online were evolving organically, and mostly in aid of clinician communication. It was messy but it was also going in a good direction. HITECH and the ACA blew all that up; and clinical life took a bad turn thereafter. Its ironic that the one EHR that more or less still works is the one that government inertia has kept from ruination (until now): CPRS in the VA system.
Totally up for the new organization!
I appreciate that you thought it was going in the right direction, but the truth is the amount of time physicians spent on EHR never went down. This was part of the plan. The entire goal of making the EHR was to keep doctors on the computer. With as much detail as possible to gather data
The EHR was never built to help us or help patients. That is the truth, and it was evident way back then. People like me that tried to say the truth were dismissed as being anti-technology, which again could not be further from the truth. They squelched rebellion with the HITECH law.
This time with AI, as they're trying to force it against our will, I promise you it's not good for us. How are these quieting push back now? They are feeding exciting pieces of information into white male physician/investor algorithms so that they're very, very excited about building something with AI. The excitement has reached a frenzy state.
Tech companies are using the Amazon technique. Amazon would recruit good-hearted entrepreneurs to build businesses, test the market, define the products, and identify the problems. Working their hearts out, they succeeded in planting their little entrepreneurial flag. Once the model was working well, Amazon would 1. build the product itself,
2. a little better and a little cheaper, and then
3. put the entrepreneurs out of business.
Tens of thousands of good-hearted people trying to build a business were crushed under the wheels of Amazon, and not one person tried to stop them.
Now we have the Amazon technique on steroids. Just yesterday, a company that you probably use, Wispr Flow, that was funded with $58 million in capital was just put under in a matter of minutes. Google built and put out a free product, and Wispr Flow is no more. Once Wispr Flow is down, Google can charge for it, and nobody will stop them. This is how it's going to work.
Furthermore, the tech leaders have all said they want to do away with most humans. That is their answer to global warming. That is their answer to everything. This is a video I recommend everybody watch. There is more. This is not a joke https://www.youtube.com/watch?v=W1dIC287Zz0&t=1535s Watch that, I have more.
As I have entered my senior years, healthcare has felt more and more fractured to me. After a fall with concussion last year, it took weeks to get assessment and help for the concussion and BPPV. The ED only seemed concerned about my broken collarbone and discharged me to Ortho. My PCP finally got involved in getting me help for the vertigo, which was assessed and corrected by Neuro with follow up to Physical Therapist. The PT told me I had other vestibular issues that needed to be addressed~ and that my eyes were not working correctly. Then Humana and my PT’s practice had a parting of ways so I asked my ophthalmologist for help. He told me what I was seeing in my eyes was just the reflection of my cataract lenses. I decided I just might have to live with the visual problems. But after a few months, I paid out of pocket to return to my PT and have her write up what she was seeing. Took that to Ophthalmologist yesterday, who examined me and became very, very apologetic that he had missed what was going on. I have now been referred to Neuro-Ophthalmology, 14 months after my fall.
The unfortunate truth is that healthcare doesn’t truly provide a gatekeeper anymore, especially for seniors. We
become invisible as we age.
I did not like being addressed as “Dear Provider” but liked the letter addressed to “Dear Referral Source” (in a Christmas letter) even less.
Fascinating article. And, I don’t care.
“Do well, by doing good.” That’s how it works.
The fact that we are paid money to show up every day does not itself compromise our mission, any more than it does a truck driver or a judge. I sell hours of my life, for money. In the current era, many of us can pick and choose among many ‘suitors’ for our skills. So long as I’m not paid by the head (I’ve refused RVU arrangements), I can maintain as much economic ‘purity’ and clinical objectivity as reasonably possible. I prefer that firewall.
Regardless: I am NOT a provider.
I am a doctor. It still means something.
Pardon the rambling post.
Too many words to say the simple " doctors have fallen off the pedestal". As a physician myself seeking medical care I can not find a doctor accepting patients. My friends and family routinely make jokes about doctors boosting "billable hours". Our profession has lost the respect we once enjoyed and now sadly just another provider in the marketplace. I think it is too late to turn that ship around.
I think this article unnecessarily complicates a very simple issue. I don't think that the "offense," if I may, of physicians being called providers is based on any deeper economic basis/definition. And thus the justification based on economics is misleading. Let's start with the very acceptable term of "PCP", primary care provider. It would be wonderful if there were enough physicians in the US or world so that this role could be designated to physician professionals only. But that is never going to be the case. We need the help of nonphysician health care "providers" to address our shortage realities. As a physician, I am a proudly a Primary Care PROVIDER, and I welcome other qualified health care workers to share that title with me, with that same pride.
This is a great article. There is a semantic sense in which the term provider can be used as a catch all as well - a term for any person or entity involved in the provision of healthcare. In general, I prefer the term doctor when referring only to doctors. And I also think that doctors seeking to make a profit is not a states that excludes them from behaving in ethical, patient centered ways. But providers of healthcare include a wide range of professions. I don't think subsuming doctors into this category is derogatory when you are trying to be general in speaking of those who produce healthcare (dentists, doctors, nurses, advanced practice providers, hospitals, etc.)
In other forms of business, when the service you are paying for is substandard or does not materialize, there is a way to regain your funds or force the proper service to be provided.
With doctors, benefit or no, you pay. If they were providers, they would have to prove they had done the work they were paid for.
If doctors were still paid what the patient could afford, they would have good times and bad times like the rest of us.
You cannot sugarcoat the ‘guaranteed payment plan despite service provided’ form of business that medicine has become
The intuitions most docs I know have on this are not in line with your position at all. We are not, and never will be, "providers." The reduction of our title devalues our profession. If it sits well with you, great. But to really understand what this does, it is not to consider the respect you get from patients or the transactions completed, but to understand that it is a classification scheme intended to equate your work with that of nurses, PAs, and "other providers." It is a word game to literally decrease your reimbursements and value in systems. It is not about respect in society.