It feels dystopian to write, but I have I recently worked for a health system that discourages the use of the word doctor when referring to physicians. Instead, everyone from the freshest interns to the program director of neurology is called a provider. Unlike many young doctors, being providered was a new experience to me; the word provider was not applied to physicians where I trained.
Here, I could not escape the term. Our practice manager never veered from using the word provider in all her communications with me, verbal and written. Our electronic health record system allocated patient visits to each provider, not physician. In all internal meetings to discuss appointments, patient communication with physicians, the term was always provider. And yet members of our neurology team were all doctors, MD and DO.
I have found the term provider insulting, unnecessary, and a little confusing. On the other hand, my residents hardly notice the term and use it frequently themselves. I find this latter habit unnerving and sinister, given the purpose of the term. It is not a coincidence that this new word has overtaken medical parlance; it is perfectly intentional.
Let’s be clear: physicians are diminished by the word provider. Language matters in communication; using a term that creates interchangeability between members of a health care team is calculated to make them fungible. Provider is a generic term that blurs the lines between clinicians. When everyone is a provider, how does one distinguish between a doctor with years of training and board certification and a newly graduated physician’s assistant? That question presupposes the importance of education and credentials, which matter in many fields, but most particularly in medicine.
The Rise of “Provider” in Medical Parlance
When did people start saying provider? And where did this term come from?
Tracing the origin of the term provider as it is used now is not simple. The term was used infrequently if ever in papers in the 1980s but became ubiquitous by the 2000s. I found a paper from the American Journal of Nursing, first published in the 1980s, that explored the challenges faced by nurse practitioners in assimilating into physician practices.[1] The word provider was not mentioned at all.
Since its rise, physician voices opposed to the term provider have been published sporadically through the last decade. In 2011, two physicians wrote in The New England Journal of Medicine that
The term “provider” is deliberately and strikingly generic, designating no specific role or type or level of expertise. Each medical professional — doctor, nurse, physical therapist, social worker, and more — has specialized training and skills that are not recognized by the all-purpose term “provider,” which carries no resonance of professionalism. There is no hint of the role of doctor as teacher with special knowledge to help the patient understand the reasons for his or her malady and the possible ways of remedying it, no honoring of the work of the nurse as a nurturer with unique expertise whose close care is essential to healing. Rather, the generic term “provider” suggests that doctors and nurses and all other medical professionals are interchangeable.[3]
In 2015, two physicians wrote an open letter calling for the American Medical Association and all state medical boards to discourage the use of the term provider in place of physician in all administrative communication.[4]
And AMA answered! In a report of the Board of Trustees published in 2019, AMA affirmed the policy opposing the use of the term provider:
“Our AMA: (a) considers the generic terms “health care providers” or “providers” as inadequate to describe the extensive education and qualifications of physicians licensed to practice medicine in all its branches; (b) will institute an editorial policy prohibiting the use of the term “provider” in lieu of “physician” or other health professionals for all AMA publications not otherwise covered by the existing JAMA Editorial Governance Plan, which protects editorial independence of the Editor in Chief of JAMA and The JAMA Network journals; and (c) will forward to the editorial board of JAMA the recommendation that the term “physician” be used in lieu of “provider” when referring to MDs and DOs.”[5]
What’s more, some professional physician organizations have active positions that agree with this proposition. The American Academy of Family Practice (AAFP) and the American Academy of Emergency Medicine (AAEM) both have positions that oppose the use of the word provider for physicians. It is AAFP’s position that
“the term “provider” levels distinctions and implies a uniformity of expertise and knowledge among health care professionals. The term diminishes those distinctions worthy of differentiation such as education, scope and range of ability. Generic terminology implies an interchangeability of skills that is inappropriate and erroneous, as well as conferring legitimacy on the provision of health services by non-physician providers that are best performed by, or under the supervision of, physicians.”[6]
And AAEM goes further and calls credential transparency a moral obligation. In their position paper, AAEM argues that the term provider “removes the ability to distinguish the unique contribution of the physician not only in the clinical setting, but also for the purposes of policy and research that directly impact patient care.” Furthermore, AAEM acknowledges that physicians have “more education and maintain higher standards than any other healthcare professionals, and patients rightfully hold higher expectations for physicians than any other clinician.”[7]
Untitling physicians as a form of moral injury
In more personal paper penned by an orthopedic surgeon, Dr. Jennifer Weiss writes about an experience in which she was called a provider by a patient’s mother. I was struck by her description of this name-calling as moral injury, which is the first time I have had the language to describe my own reaction to this word. She notes that calling doctors providers “reduces morale, worth, purpose, and results in already overworked doctors finding less meaning in the work that they do. The word ‘provider’ comes between doctors and their patients, thus chipping away the joy in practice.”[8]
I am not surprised at the ascent of the word provider has transpired concomitant to the rise of physician burnout. I know I am not alone in finding the term insulting, just another demonstration of the disempowerment of physicians in our workplaces. If this mislabeling, in its kindest interpretation, is contributing to physician burnout, then it needs to stop.
Those institutions that propose to work against burnout, pay attention: language matters. Start by calling us doctors again.
References
[1] Little, Marilyn. “Nurse Practitioner/Physician Relationships.” The American Journal of Nursing, vol. 80, no. 9, 1980, pp. 1642–45. JSTOR, https://doi.org/10.2307/3462619. Accessed 22 Aug. 2022.
https://www.jstor.org/stable/3462619
[2] LII Electronic Code of Federal Regulations (e-CFR) Title 29 – Labor Subtitle B – Regulations Relating to Labor CHAPTER V – WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR SUBCHAPTER C – OTHER LAWS PART 825 – THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Subpart A – Coverage Under the Family and Medical Leave Act § 825.125 Definition of health care provider. 29 CFR § 825.125 – Definition of health care provider.
https://www.law.cornell.edu/cfr/text/29/825.125
[3] Hartzband, P and Jerome Groopman. The New Language of Medicine. N Engl J Med 2011; 365:1372-1373.
https://www.nejm.org/doi/full/10.1056/NEJMp1107278
[4] Dhand, Suneel and William Carbone. Physicians are not providers: An open letter to the AMA and medical boards. 2015. KevinMD.com
[5] Report of the Board of Trustees. American Medical Association.
https://www.ama-assn.org/system/files/2019-04/a19-bot09.pdf
[6] Provider, Use of Term. AAFP.com.
https://www.aafp.org/about/policies/all/provider.html
[7] Position Statement on the term “Provider. AAEM.org.
https://www.aaem.org/resources/statements/position/term-provider
[8] Weiss, Jennifer. ‘Physician’ not ‘provider’ is better for doctor and patient. 2019. Permanente Medicine.
https://permanente.org/physician-not-provider-is-better-for-doctor-and-patient/
