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.
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.
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.
Very well said and right on target. It is worth noting that many of the ethical concepts discussed here are pertinent to most all professionals. In that context I recommend the book 'Conflict of Interest in the Professions (edited by Michael Davis & Andrew Stark - Oxford University Press 20011).
I am a physician, or doctor, or provider if you prefer, but I am not familiar with the stances of the ACP (not my specialty). I wonder if the ACP is as vocal and worried about other forces that threaten to make doctors primarily economic agents – insurance companies, health system consolidation and the fact that most physicians are now employees, not independent. The influence of these factors dwarfs the effect of labels.
I went into Pre-Med way back in 1956 because medicine was a respected profession and a good way to make a living. You acquire a body of knowledge that people value. They come to you for advice and management and they pay you in return. There is a longstanding ethical component to what we do related to the type of service we provide but there are very few Albert Schweitzer's among us. Hopefully we learn about this aspect of the profession in med school but there is considerable variation in how much physicians incorporate these attitudes into their daily practice.
The medical social media is filled with doctor complaints about inadequate salaries and excessive work. I think the worst aspect of modern medical practice is the abandonment of physician autonomy over to large medical conglomerates and the progressively impersonal nature of medical practice. Back in the "good old days" when patients paid doctors directly there was a heck of a lot more personal attention and charity involved. Kudos to the guys and gals who are doing what they can to get back to that arrangement.
As far as being called a "provider", it never bothered me. I earned my respect by always doing the best job I could for the people who chose to come to me and pay me for the knowledge and help I gave them. What did we think was going to happen when we gave over payment for our services to insurance companies and government bureaucracies?
Only skimmed the article, so FWIW: I believe calling doctors “providers” is purposeful to minimize the differences and lower patient expectations. I fully support mid-level providers, but not sure I like what could be the end goal…
I always thought physicians didn't like the word "provider" because it lumped them in with NPs and PAs.
As a nurse, we have had the fact that it is a "calling" used against us economically - such as, you went into nursing because it is a calling, you shouldn't be concerned with how much you get paid. When a service is provided, one should expect to get paid a living wage for it, unless you willingly volunteer your service. It doesn't matter whether it is a calling or not. I
There is nothing wrong with making money at your calling, your job, your profession. The problem comes when someone in your profession takes advantage of their position and causes economic or physical harm to their client so that they may profit.
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.
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.
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.
Very well said and right on target. It is worth noting that many of the ethical concepts discussed here are pertinent to most all professionals. In that context I recommend the book 'Conflict of Interest in the Professions (edited by Michael Davis & Andrew Stark - Oxford University Press 20011).
I am a physician, or doctor, or provider if you prefer, but I am not familiar with the stances of the ACP (not my specialty). I wonder if the ACP is as vocal and worried about other forces that threaten to make doctors primarily economic agents – insurance companies, health system consolidation and the fact that most physicians are now employees, not independent. The influence of these factors dwarfs the effect of labels.
I went into Pre-Med way back in 1956 because medicine was a respected profession and a good way to make a living. You acquire a body of knowledge that people value. They come to you for advice and management and they pay you in return. There is a longstanding ethical component to what we do related to the type of service we provide but there are very few Albert Schweitzer's among us. Hopefully we learn about this aspect of the profession in med school but there is considerable variation in how much physicians incorporate these attitudes into their daily practice.
The medical social media is filled with doctor complaints about inadequate salaries and excessive work. I think the worst aspect of modern medical practice is the abandonment of physician autonomy over to large medical conglomerates and the progressively impersonal nature of medical practice. Back in the "good old days" when patients paid doctors directly there was a heck of a lot more personal attention and charity involved. Kudos to the guys and gals who are doing what they can to get back to that arrangement.
As far as being called a "provider", it never bothered me. I earned my respect by always doing the best job I could for the people who chose to come to me and pay me for the knowledge and help I gave them. What did we think was going to happen when we gave over payment for our services to insurance companies and government bureaucracies?
Only skimmed the article, so FWIW: I believe calling doctors “providers” is purposeful to minimize the differences and lower patient expectations. I fully support mid-level providers, but not sure I like what could be the end goal…
A few thoughts :
I always thought physicians didn't like the word "provider" because it lumped them in with NPs and PAs.
As a nurse, we have had the fact that it is a "calling" used against us economically - such as, you went into nursing because it is a calling, you shouldn't be concerned with how much you get paid. When a service is provided, one should expect to get paid a living wage for it, unless you willingly volunteer your service. It doesn't matter whether it is a calling or not. I
There is nothing wrong with making money at your calling, your job, your profession. The problem comes when someone in your profession takes advantage of their position and causes economic or physical harm to their client so that they may profit.