In this blog post, 乌鸦传媒mines a vast network of physician sources to explore why so many physicians object to being called "providers."
Should doctors be called providers? A provocative blog by , also answered that question this week with a resounding "no." It is a sentiment I can understand. When I was a producer for the ABC News program "20/20" in the mid-1980s, if management had said I was now a "video information provider" I would have taken offense. I would have said, "That describes what I do, but is not what I am."
I knew this wasn't a new issue. But how long have doctors been called providers? I asked some of my sources in health policy for the historical beginnings. , emeritus professor of risk, insurance, and health management at Temple University in Philadelphia, said the term was used in the 1980s, "with the enthusiasm for 'Supermeds' (i.e., major consolidations of hospitals, physicians, therapists, etc.) and the desire to transfer responsibility to PAs, Nurse Practitioners, CRNAs, etc. brought on in part by the restrictions on the training of an adequate number of MDs."
, assistant professor of health policy and management at the State University of New York-Downstate Medical Center in Brooklyn, could date it even earlier. He cited titled "Health Care Service Use in Orange County, California" that he said "apparently makes reference to 'preferred health care provider[s]'."
, professor of health policy and management at Boston University, said doctors started being called "providers" around the same time patients began being called "consumers," and noted that both terms were enshrined in federal law in 1974.
"P.L. 93-641, The Health Planning and Resources Development Act of 1974, did explicitly use both words. It used 'consumer(s)' four times and 'provider(s)' 19 times."
"Blurring the lines"
So the label has been around for a long time. Yet, as Dhand made clear in his blog, it rankles today as much as it must have 40 years ago. And Dhand doesn't just mildly object. He said "forces" are pushing the doctor "towards the periphery of health care." He expressed outrage at pharmacy messages telling "prescribers (not doctors) to press 2." He says many of his colleagues are "sleeping with the enemy" by asking, "How many providers are on call this weekend?"
I honestly didn't know whether Dhand's views would stir up a social-media wave or be met with a collective shrug. So I invited 20 physicians in 20 different specialty areas to respond via email to the subject line: "Do you mind being called a provider?" I got a lot of responses.
"I too resent the term provider and I have since it first became popular," said , chairman of neurology at Cedars-Sinai Health System in Los Angeles. Lyden said he doesn't like it because, while there are many skilled and highly trained providers in healthcare serving patients medically and legally, "the buck stops at only one desk, mine."
There is also dislike for the term as "one more example of the dumbing down of the language and blurring the lines between those caring for the patient," says , of Mercy Medical Center in Baltimore.
Not so bad?
But I heard from number of doctors who did not mind the term. , a professor of community and family medicine at Wake Forest Baptist Health in Winston-Salem, N.C., agreed with Dhand that "clinician" was a better word than "provider," which he said connotes someone "providing internet service."
Spangler said, however, that he wasn't put off by the term because of the need to recognize that physicians aren't "better" than other members of the healthcare team. Spangler said of the skill of those who are not physicans, " In some instances the level of differential diagnostic thought and personal connection with the patient even seem inversely proportional to the number of years spent in training."
This theme of doctors not viewing themselves as above other members of the healthcare team was also voiced by , chairman of the department of medicine at the West Penn Allegheny Health Network, in Pittsburgh. She said provider was actually a better term than clinician because providers are positive figures. "I have no desire to be called something that makes me sound more scientific and distinguished or somehow insinuates that I am the most important member of the healthcare team."
And , an emergency medicine physician at the University of Chicago, doubts that calling physicians providers is "part of some sort of conspiracy to commoditize physicians." Trueger said, "Physicians are physicians, but there are other people who provide care too."
Non-physician views
In contacting physicians, I knew I was missing important voices -- other professionals who weren't physicians. So I contacted several nurses. And I again found resentment over terms.
Nurse practitioner from Staten Island, N.Y., said NPs "have been called "mid-level providers," and "of course there is nothing 'mid-level' about us, our profession, or the care we provide." Nelson called that title "misleading and frankly insulting," and said Dhand's suggestion of "clinician" was a good one.
She added, "Why not call us what we actually are -- a collective group of 'medical professionals'!"
But , an RN from Wakefield, R.I., thought the term provider was "very appropriate." She proudly ticked off how providers care for healthcare consumers: "We provide a listening ear and expertise in assessment and diagnosis. We provide care, comfort, and a treatment plan."
"Ship has sailed"
I was struck by one counterpoint. , dean of the School of Medicine at the University of Nevada in Reno, argued that the term provider is "a reflection of how medical care has become commoditized."
He continued: "The covenant between physician and patient is sacred and transcends cultures and time. We should be aggressive in protecting that covenant and the word that names our part of that covenant. In a similar way, nurse practitioners and physicians assistants should be equally protective of their role and fight the same lumping."
Yet while agreeing with the sentiment, Patrick Lyden suggested that "provider" is probably here to stay whether physicians like it or not.
"This ship has sailed many years ago," he said, "and while I applaud the blogger's sentiments, his ... proposed solutions are naive and likely to produce only frustration and wasted time."