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Dr. Gregory Weiss weighs in on the ongoing debate over using the term provider to refer to doctors, which has recently been reignited on social media.
I have been practicing in healthcare in one capacity or another for over twenty years. My first job in the hospital was moping the floor in the operating room (OR) at an academic medical center. From there I became an anesthesia technician in the same OR. Being surrounded by ambitious and knowledgeable people I choose to take things a bit further and applied for a second bachelor’s degree in nursing at the same university where I worked.
I practiced nursing for a few years and progressed into nursing graduate school at which time I decided to apply for medical training. I was accepted, attended medical school, completed residency, two fellowships, and here I am today. But what am I? It has become increasingly clear that healthcare practitioners and physicians, in particular, are experiencing a rather serious identity crisis. But is it really a crisis or simply sour grapes?
Over the last couple of decades, the term “provider” has infiltrated the medical community much to the chagrin of many physicians. On the one hand, the insurance companies and health systems have sought and found a term that they can use to convey a broader concept to their patients, that concept being that many different people may “provide” you with services and care. On the other hand, many physicians consider this term a marginalization or even an insult to their lofty stance in the hierarchy of clinical care. I can clearly see both sides of this debate, however, I have a different take on the motivation behind the controversy. But first, let’s look at some definitions.
The definition of provider is a person or thing that provides something, a breadwinner. At first glance, that definition isn’t helpful. A deeper dive into the word provide reveals that a provider gives someone else something that they need. In the case of a healthcare provider, this “thing” that is given is literally “health” “care”.
Now, this care can consist of putting a cold compress on a forehead or performing quadruple heart bypass surgery but at the core is the concept of providing care at some level. As a former nurse and a contemporary physician, I can identify with providing something for my patients. I personally don’t feel the slight. So, why all the wounded egos? I believe this issue is merely a spinoff from much larger movement within the medical community, one of identity, priority, and entitlement.
Perhaps owing to the long path I took to medicine I considered it the deepest honor to be selected to literally carry the lives of thousands of other humans in my hands. Not for one instant did I ponder the lofty nomenclature that would be granted to me upon completion of my training. I guess I was too preoccupied with learning to be a physician to be proud of the moniker.
This brings up a really interesting point. Why is it that physicians are so desperate to be called doctors by everyone they encounter? Is it because we have studied so much more than everyone else? Is it because we are deserving of more respect than those not achieving such a high level of education? Would it surprise you to know that we are only one type of doctor in a giant sea of non-medical doctors?
Recently, the First Lady made some headlines because some not-so-well-informed pundit took issue with her calling herself a doctor. That pundit was mistaken of course because the first lady had earned a doctorate in education. The word doctor itself comes from the Latin docēre which means to teach. So, doctors are teachers, not necessarily medical practitioners. The type of doctor that practices medicine is called a physician. This fact in itself serves to dilute the narrow conception most physicians have about being called “doctor”. So why then are so many physicians possessive of the title?
I mentioned earlier that the basis for the backlash against being called providers comes from a larger more tenacious movement within the medical community. Physician doctors (a more apt description akin to calling lawyers juris doctors) have long felt the sting of their profession being marginalized by the exponential rise in non-physician providers performing care traditionally administered solely by physicians.
The most poignant example of this can be found in my profession where a concerted campaign exists on the part of the nurse anesthetist lobby aimed at convincing state and federal government agencies as well as the general public that physician anesthesiologists are generally obsolete. Outside of the OR nurse practitioners and physician’s assistants practice medicine with increasing autonomy. The truth is that many physicians feel at best that no one knows the difference these days and at worst they fear for their jobs. On a more personal note, many physicians feel that they have earned the title and that they are due the respect that comes with it.
The truth is that the objection to being lumped in with other healthcare providers is hypocritical and completely unnecessary. Physicians who express woe over the increasing responsibility quite frankly given to practitioners by them were the very people who started the name game in the first place.
The term midlevel provider is seen by nurse practitioners, doctors of nursing practice, nurse anesthetists, and physician assistants as an insult to their training and abilities. The fact is that all of these non-physician advanced clinicians came to be out of physicians’ desire to possess extensions of themselves in an effort to see more patients and yes, realize greater revenues. History has taught us that, over time, one should be careful what one wishes for.
My take is simple. I am what I am. Maybe my perspective is owed to my long path to medicine or possibly my deep connections to nursing as a profession, but I don’t see any problem with being called a provider. After all, I provide high-quality medical care to every patient I see.
Frankly, if a patient thought I was a jockey or a valet I wouldn’t think twice of it. I know what I am and if my patients are comfortable with me, as their valet, anesthetizing them and keeping them safe during surgery far be it from me to argue the point. I know that seems trite but aren’t I there for them rather than I or them for me? We shouldn’t need validation. We have degrees and certificates, a paycheck, privileges, and affiliations. Where did the “I’m honored to be chosen to have patients put their lives in my hands” go to?
I think, at the core, physicians ultimately endeavor to impress each other more than garner respect and admiration from advanced practice nurses and physicians’ assistants or even from patients. Are advanced practice non-physician providers eating into our market share? Yes, they are but they are also improving access to care for many rural and inner-city at-risk patients. Am I a provider? Well yes, I am.
This column represents the views and opinions of the author and may not necessarily represent those of the publication.