Bernie Short, MD, FAAFP, BCUCM, FCUCM
According to my mother, since I was five years old, all I ever wanted was to be a doctor. Admittedly, there was some confusion about whether I wanted to be an animal doctor or a people doctor. I just knew that I grew up with an urge to help others who were ill or in pain. Shows like Ben Casey (1961) and Marcus Welby, M.D. (1969) fueled my passion and guided me to the MD path, a career in which I have thrived for over 40 years. I did not go to medical school to become a provider.
All MDs, DOs, NPs, DNPs, and PAs have a special relationship with their patients. The relationship between a patient and their doctor is different and more historical. A physician only achieves the designation after years of rigorous training with tremendous sacrifice and commitment. That path typically takes 11-15 years to become a fully licensed doctor (MD/DO). In contrast, there is no doctorate PA program, and a NP can receive their doctorate degree (DNP) completely online. So where is the equivalency?
In the 1930s the Nazi Party devalued the role of Jewish doctors in German society. Beginning with female pediatricians, all Jewish physicians were redesignated as ehandler (provider) instead of Arzt (doctor), the first documented demeaning of physicians as providers in modern history.
The term “provider” became more pervasive after the U.S. government first used the term in the 1965 Social Security Amendments that established Medicare and Medicaid. This resulted in the contagion of the term and the adaptation of “provider.” This ultimately led to medicine being thought of as a business and implies that the relationship between a patient and physician is a commercial transaction.
A provider is someone who supports a family, while a doctor is considered a person skilled in the healing arts and is licensed to practice medicine because they have an advanced degree. PAs and NPs also have advanced degrees and are skilled in practicing medicine. They are also demeaned by being called providers. None of us are providers.
When it comes to patient care, being called a doctor, NP, or PA rather than a provider is a sign of respect and acknowledges a certain level of expertise. Being called a provider confuses everyone and dehumanizes every NP, DNP, PA and physician. The term insidiously and innocuously erodes our professional identity.
In 2006, the Southern California Permanente Medical Group passed a resolution that prohibits the use of the word “provider” to describe physicians. The AAFP and the AMA House of Delegates have similarly published position statements that view the term provider as not being equivalent to a physician. CUCM has also recently chosen to discourage using provider, instead opting to use “Urgent Care clinician.”
We are not providers. We are NPs, DNPs, PAs and physicians. The term “provider” demeans all of us and fails to reflect the different paths taken, all of which are honorable and deserve proper terminology, otherwise we are all diminished. Our title is powerful. It is important. It is time for all healthcare professionals to reclaim our titles and our power.