The Term Provider – more than meets the eye?
Debra Faulk MD
Language and the precision of language matters. I (MY) am a doctor, not a provider. Indeed, it makes my skin crawl when I’m called “a health care provider” and not “a doctor”. Further, my patients are “patients” and not “clients”! Indeed, you may recall we recently had a PAAD discussion about the importance of language and why we should be addressed as ‘doctor’ and not by our first names (“It’s King Charles not Charlie”).
When I was a first-year fellow, one of my attendings, Dr. A. Michael (“Mike”) Broennle asked me (and I’m sure every other fellow he ever trained) “are you a doctor”? “Are you ashamed of being a doctor”? I said, “of course I’m a doctor and proud of it and the privilege of caring for patients”. He then asked “why did you sign your name on the chart, ‘Myron Yaster’, without listing your credentials ‘MD’ after it”? Lesson learned. Today’s PAAD by my friend, colleague and mentee, Dr. Debra Faulk, reviews a recent article discussing the history of the term “provider”. I had never heard this story before and was shocked. You may be too. Myron Yaster MD
Original article
Scarff JR. What's in a Name? The Problematic Term "Provider". Fed Pract. 2021 Oct;38(10):446-448. doi: 10.12788/fp.0188. PMID: 34733063; PMCID: PMC8560107.
How easily does the term “provider” roll off your lips? As the Medical Director of Medical Staff Affairs at Children’s Hospital Colorado, the article discussed in today’s PAAD was forwarded to me with the question, “Have you seen this before?”. As I began to read, I wondered how I could have NOT known about this. I have certainly noted many a colleague bristle at the use of this term in the past. As Scarff1 points out in today’s article, using the term “provider” to encompass all individuals comprising the pervasive multidisciplinary care team model is harmful in a number of ways:
· It changes the treatment relationship to be of a transactional nature ‘…a business, a commoditization of care, reinforced by referring to patients as consumers, clients or customers”.
· It is inaccurate, disrespectful and potentially harmful - changing or ignoring the true nature of the physician-patient relationship, failing to recognize or acknowledge the specialized education and training of multi-disciplinary treatment team members, and potentially misleading patients to believe all team members can deliver the same level of care by eliminating titles, training and scope of practice.
· Physicians are more than “providers”. Physicians “seek to know patients as people, putting their needs ahead of our own. We serve as confidants and advocates and not merely providers of medications, tests, or procedures. This personalized nature of health care depends on trust and professionalism rather than dispassionate delivery of commoditized services”.1
· ‘Doctor’ “is derived from Latin doctus or docere, meaning to teach or instruct—a valued function in our interactions with patients, families, students, and colleagues. In contrast, provider refers to commercial transactions or the provision of shelter, food, and love within families and communities”.1
· “Last, use of the term provider can mislead patients. By law, a health care provider is defined as “a doctor of medicine or osteopathy who is authorized to practice medicine or surgery… or any other person determined by the Secretary [of Labor] to be capable of providing health care services,” which includes podiatrists, dentists, clinical psychologists, optometrists, chiropractors, nurse practitioners, nurse-midwives, clinical social workers, and physician assistants”.1
Scarff points out that using the term provider instead of doctor may cause moral injury, and reduces self-worth, purpose and meaning in our daily work as it excludes our professional values. However, Scarff raises the concern that there may be deeper moral and psychological injury derived from the history of this word. According to Scarff,1 the term provider is reported to have its origins in Nazi Germany when Jewish doctors and the entire field of pediatrics which was a predominately Jewish field, were degraded and devalued by being stripped of the title “Artz” or “doktor” and referred to using the term “Krankenbehandler” or “Behandler” which has been said to freely translate to the word “provider”. 2
Scarff states, “Knowing this background, what health care organization would use a term once associated with Nazi ideology?”.1 Within a week of receiving this article, I became aware of 3 separate instances of medical staff members concerned with the use of this term and requesting discontinuation of the use of the word “provider” as a derogatory title to those of Jewish faith.
(From Myron: To be honest, I’m pretty sure that no one involved in coining the term “provider” was aware of this possible connection to Nazis nor is this history universally accepted. 3 Indeed, as a child of holocaust survivors, without more evidence, I found this connection to Nazis morally flawed and offensive. Indeed, because of pushback by many3, Scarff retracted much of his original assertions.4 )
The primary reason to avoid the use of “provider” is it confuses patients. It is well known that in the UK, surgeons were called Mr. or Miss, while non-surgical physicians were called Doctor. This practice had its origin in the middle ages because the practice of surgery evolved from barbering (think the red and white barber pole), requiring only an apprenticeship and was not treated with the same respect as non-surgical physicians, who had a university degrees and were ‘doctors of medicine’. In 2005, Hugh Phillips, then president of the Royal College of Surgeons, wrote “The important thing [is] that the patient knows who is treating them. Titles are confusing to patients; perhaps there is a good case for surgeons returning to the title of ‘doctor’ as in the rest of the world.”5 Even though, surgeons were also required to graduate from university since the 1850’s, they continued to be referred to as Mr. or Miss. Mr. Phillips remarks were prompted by the introduction of non-physician surgical assistants into surgical practice, and concern for the possibility of confusion between these individuals and surgeons.
Is this really a representation of concern about scope of practice expansion (otherwise known as scope creep), with a desire to distinguish physicians from mid-level practitioners rather than an argument based in moral concern/history? Many institutions provide ID badges where the patient care role is shown in large, impossible to miss, letters. Is it more important for our patients to understand our role and call us by our hard-earned professional title. Whether the literal translation of the word “Krankenbehandler” can be equated with the term “provider” is uncertain. In Schaff’s (4) clarification he states the extent to which the word “behandler” can be translated to “provider” is unclear, but suggests alternatives including “clincians, practitioners or health care professionals” as over-arching terms for the health care team (not “provider”). What is clear, however, is the use of the term “provider” blurs the line between the roles, training and expertise of each care team member for the layperson.
Let us know your thoughts about all of this and Myron will post in the regular Friday Reader Response.
References
1. Scarff JR. What's in a Name? The Problematic Term "Provider". Fed Pract. Oct 2021;38(10):446-448. doi:10.12788/fp.0188
2. Saenger P. Jewish pediatricians in Nazi Germany: victims of persecution. Isr Med Assoc J. May 2006;8(5):324-8.
3. Raz M, Freedman D, Roelcke V. Physicians or "Providers?" Inventing Nazi Origins Undermines Debates on Medical Professionalism. Journal of general internal medicine. Oct 2022;37(13):3479-3481. doi:10.1007/s11606-022-07725-9
4. Scarff JR. "Provider" Etymology is Unclear, but Still Wrong for Health Care. Fed Pract. Apr 2022;39(4):153.