ARE YOU A PROVIDER? DARN RIGHT YOU ARE!
If you have been involved in health care in any way shape or form, consider yourself part of the “Provider Club.” If you really think about it, you will likely be mortified to learn some things about the word that are disturbing. Not only does being a provider imply a loss of identity for physicians by grouping everyone together (nurses, PAs, respiratory therapists, pharmacists, etc.), it reduces us to providing transactions when we interact with patients. Since when did our work with patients become one in which we are considered simple conveyers of health—there to provide a service, however that is defined, and obtain compensation as payment? That is hardly what physicians do when we establish relationships with our patients. That sacred relationship that is so unique to medicine is significantly blunted when we are referred to as “providers.”
Medicine is not a simple transaction. It is not like going to the grocery store and buying a loaf of bread. But the word “provider” certainly makes it sound like that. We provide a service and patients (or their insurance company) pay for it. It also lumps us together with many others in the health care field. And that is most problematic as it says nothing about the education, thought, time, reflection, empathy, kindness, and more that goes into the honor of being a physician. This is not to denounce others involved in this work, but do we really want to be lumped with speech therapists, dieticians, housekeepers, phlebotomists, and others? They are all providing patient care services and are thus “providers,” as well. And don’t get me wrong, without these folks the team is lessened in its full capacity to give total care. But can you see how a name can deflate our status among patients? Not only that, it serves as a significant area of confusion to the many who think of the health care industry as a group of people with the same goals in mind-to render care that helps get patients better. “Provider” says nothing of the training that is required by physicians to be the true captains of the team. And it leads patients to assume that they can receive the same kind of care from any on the health care team as all may have interchangeable skills and training.1, 2
If we look back, we learn that the word “provider” may have had its beginnings in the early fifteenth century. Providen, "make provision for the future; arrange, plan; take care, relieve of needs, supply the needs of," from Latin providere "look ahead, prepare, supply, act with foresight.”3 This all sounds good, but even then the word smacked of a business venture or transaction in large degree. In 1965, Medicare was created and “provider” appears to have been used to refer to those qualified to receive Medicare payments. But perhaps what is not realized is the dark side implied by “provider.” This horrific underbelly is never mentioned by insurance companies, hospital systems, CEOs, administrators, and others. Specifically, the Nazis and their eugenics campaign in the 1930s initially targeted Jewish pediatricians.2 Half of these physicians at the time were Jewish.4 Beginning with female pediatricians, Jewish physicians were redesignated as Behandler (provider) instead of Arzt (doctor).2 Behandler is actually a shortened version of a longer term, “Krankenbehandler.”5 Mangione, for example, notes they were demoted to “Krankenbehandler,” that is, “practitioners” or “health care providers.”6 The term “Krankenbehandler” ultimately was applied to all German physicians of Jewish descent.2-4 As noted in an editorial by Jonathan Scarff, “This is the first documented demeaning of physicians as providers in modern history.”2 With this historical information taken just by itself, it is hard to reason how the word become so ingrained in the lexicon. How have we been so blind about this? How offensive and inappropriate and downright unconscionable that a word with such a background has been ingrained in the field of health care.
What is even more confusing and hard to reconcile is the term “mid-level provider.” This has often referred to “a person with a professional designation in the following categories, or any other professionally equivalent license: Nurse Practitioner, Physician Assistant, Licensed Therapist (physical, occupational, speech, respiratory, marriage/family, massage, etc.), Nurse Midwife, Registered Dietician, Mental Health Counselor, or Social Worker.”7 If this is the case, then is a physician a “high-level provider” occupying the penthouse? If so, who falls in the “low-level provider” group? Who would want to be in that group? Writing in Forbes, Lee notes mid-level providers, like nurse practitioners, makes it sound like they are confined to floors 10 to 20 in a 50-plus-floor-high-rise building. He also notes nurses, therapists, and others who have gone through more training and education than the average person should not be considered low-level or mid-level.8 As you can see, the terms are very problematic.
At the end of the day, language and labels matter and they can hurt. Some find an inappropriate label as offensive. Both nurse practitioners and physician assistants dislike the term “provider” and have found it incorrect and offensive. Both groups have put out position statements about it.9, 10 The American Academy of Pediatrics has advised the terms should cease to be used in describing board-certified pediatricians.11 Similarly, the American Academy of Family Physicians has noted “provider” is not interchangeable among health care professionals.12 The American College of Physicians13 and the American Academy of Emergency Physicians14 have similar statements. For physicians that have spent years and many hours learning about how to diagnose and treat various disease states and establishing strong patient relationships, the word is demoralizing. One can assume this has not helped in regard to physician wellness and resiliency.15, 16
So where do we go from here? Clearly we need to educate and bring awareness into the forefront. This involves patients, hospitals, insurance companies, legislators, lawyers, state and federal governments, and more. The AMA at its Annual Meeting in June 2022, saw Resolution 245 introduced by six states. The resolution supports the development and implementation of “a sustained and wide-reaching public relations campaign to utilize the term “physician” and discontinue use of the term “provider.” I would argue this does not go far enough. We need physicians to educate their patients and gain their support. We need to get our state legislators on board. We need to talk with those in the C-suite and those in the insurance industry. We need resolutions in all the states to strongly support the elimination of the word in regard to referencing physicians. Enough is enough and the time is now to act. This is especially important concerning scope of care. We must get ahead of this issue now! If we don’t, we’ll never be able to differentiate ourselves from everyone else who encounters and cares for patients. We’ll be stuck in the building with the doors closed and no way to escape.
Matthew J. Burday, DO
Goroll AH. Eliminating the term primary care “provider”: consequences of language for the future of primary care. JAMA. 2016;315(17):1833–1834. doi: 10.1001/jama.2016.2329.
Scarff JR. What's in a Name? The Problematic Term "Provider". Fed Pract. 2021;38(10):446-448. doi:10.12788/fp.0188
- provider | Etymology, origin and meaning of provider by etymonline
Saenger P. Jewish pediatricians in Nazi Germany: victims of persecution. Isr Med Assoc J. 2006;8(5):324–328.
- Taking a Courageous Stand … Where Nobody Can See Me | Ricochet
Mangione S, Mandell BF, Post SG. The Language Game: We Are Physicians, Not Providers. Am J Med. 2021 Dec;134(12):1444-1446. doi: 10.1016/j.amjmed.2021.06.031. Epub 2021 Jul 21. PMID: 34297975.
- Mid-Level Provider Definition | Law Insider
- Time To Stop Labeling Physicians As Providers (forbes.com)
American Association of Nurse Practitioners. Use of terms such as mid-level provider and physician extender. Published 2009. Updated 2015. Accessed June 12, 2022 https://www.aanp.org/advocacy/advocacy-resource/position-statements/use-of-terms-such-as-mid-level-provider-and-physician-extender.
A Guide for Writing and Talking About PAs, December 2018.pdf (aapa.org).
- Defining our identity does not include the ‘P word’ | ACP Internist
- Position Statement on the Term “Provider” | AAEM - American Academy of Emergency Medicine
Beasley JW, Roberts RG, Goroll AH. Promoting trust and morale by changing how the word provider is used: encouraging specificity and transparency. JAMA. 2021;325(23):2343–2344. doi: 10.1001/jama.2021.6046.
- Commentary: Hey Texas, Time to Stop Using the Word Provider! (texmed.org)