Why You Should Not Refer to Your Physician as a Provider
The value of the physician is derived far more from what may be called his general qualities than from his special knowledge. A sound knowledge of the aetiology, pathology, and natural history of the commoner diseases is a necessary attribute of any competent clinician. But such qualities as good judgement, the ability to see the patient as a whole, the ability to see all aspects of a problem in the right perspective, and the ability to weigh up evidence are far more important than the detailed knowledge of some rare syndrome, or even the possession of an excellent memory and a profound desire for learning.
Dr. John W. Todd, The Lancet, 1951
In recent years, a new term has entered the lexicon of corporate medicine. The term Provider is broadly and indiscriminately applied to any individual who plays a role in administering direct health care services. In fact, the term has become so ubiquitous that it has become necessary to create further stratifications amongst various “providers.” Thus terms such as Advanced Practice Providers (APPs) have now been ushered into existence. As a Physician, this leaves me wondering exactly what am I? I’m certainly not an APP — as one of my colleagues quipped, perhaps we are VAPPs or Very Advanced Practice Providers (pers. comm. Dr. Michael Champney, MD FACS).
The practice of heaping all professionals into a collective group without distinction in training or qualifications appears to be an insidious attempt by the health care industrial complex to create a false equivalency amongst health care professionals. For example, if a cardiac surgeon, who competed, excelled, and completed almost two decades of intense education and training, is labeled a provider, how is one to distinguish this sublime and elevated expertise from a Physician Assistant in the same practice — also a provider.
It appears the term “Provider” is being applied to marginalize, substitute and even degrade, the highly trained physicians in the US Healthcare system. When everyone who is involved in patient care is simply a provider, then it follows that there should be no distinction in compensation or privilege. The privilege I reference is that of participating in advanced specialized health care to patients in need.
No degree I have ever earned labels me a Provider. Like my colleague Physicians, I hold a Doctorate in Medicine which qualifies me to practice medicine as a Physician. Therefore, the proper appellation that I will accept is either Doctor or Physician.
In a curious twist, other “providers” seem to be appropriating titles meant for Physicians. One recent example is that of a nurse anesthetist who decided they should be known as an Anesthesiologist to distinguish themselves from the Physician Assistant anesthetist but blur the distinction between the nurse and physicians. This has prompted the Florida State Legislature to propose House Bill 309 designed to make it unlawful for non-physician health care providers to identify themselves with nomenclature traditionally associated and reserved for Physicians and Doctors. So now we need a law to ensure the proper and correct use of professional nomenclature!
In reviewing the origin or the practice of labelling Physicians as providers, a disturbing and forgotten piece of history emerges. It appears that the earliest practice of substituting Physician or Doctor with Provider can be traced to those masters of labeling, humiliating, and ostracizing groups — none other than the Nazis.
In pre-world War II Germany, the practice of exercising prejudices against Jewish professionals was gaining momentum. One singular group that was targeted were Physicians of the German Jewish community who accounted for approximately 15% of all German physicians despite Jews representing only 0.01% of the German population. Many of these Jewish Physicians were Pediatricians. It is estimated that almost half (47%) of German Pediatricians in pre-World War II were of Jewish descent. In 1933 the German Society of Pediatrics asked all Pediatricians of Jewish descent to either voluntarily resign their membership or be forcibly removed. Those brave Physicians that refused to comply were stigmatized with the application of a colon before their name and title. By 1938, the medical licenses of all Jewish doctors within the borders of the Third Reich were revoked and they were prohibited from using the title of Doctor or Antz in German. Instead, they were relegated to using the German word Behandler — the literal translation of which is Provider or Treater. By 1940, all Jewish doctors were prohibited from accepting private health insurance and could no longer make a living from their chosen profession (the German health care system was a hybrid of both Private and Government programs that guaranteed near Universal coverage to all Germans).
Many Jewish Pediatricians continued caring for children despite being thoroughly degraded, humiliated, and limited in their scope of practice. In fact, some even accompanied their young charges into the gas chambers rather than allowing them to face this horrible fate without some measure of comfort.
I present this important history on the application of the word Provider for your consideration. After all, if we are not aware of history, then we are doomed to repeat it. Proper terminology and nomenclature are important since words are an expression of our thoughts and we will ultimately do what we think. I am not comparing administrators or business people in modern American healthcare to Nazi’s — although I do question why a perfectly descriptive, earned, and distinguished title such as Doctor needs to be replaced at all? I simply ask that one consider the origins and past usage of the term Provider before applying it to modern day Physicians. In light of the history revealed in this blog, is it appropriate that we are reviving and applying the term Provider to Doctors/Physicians? That is why I respectfully ask that I and my colleagues be referred to as Doctors or Physicians — and not Providers.
P. Pravin Reddy, MD is a Board Certified Plastic & Reconstructive Surgeon and a member of the American Society of Plastic Surgeons.