Back when I was in business school, I interviewed for a job at a health care consulting firm. During one of the interviews, a partner there told me that there isn’t too much difference between running a hospital and running a fast food restaurant. This person said that in the first case you provide health care and in the second case you provide hamburgers and fries. Of note, the partner was relatively new to health care and had never directly taken care of patients. Take a wild guess which industry the partner used to be in before moving into health care.
Yeah, the moment your doctor tries to put ketchup on you, it’s time to switch clinics or hospitals. But has healthcare been moving the fast food direction since then? Sarah G. Candler, MD, MPH, an Assistant Professor of Medicine at the Baylor College of Medicine, wrote in the Annals of Internal Medicine Fresh Look blog, “Sometimes I feel like I work at a burger joint instead of a primary care clinic.”
Take, for example, the term “health care provider.” How many other professionals do you call providers? Are lawyers “legal service providers” or “document providers”? How about CEO’s as “paycheck providers” or “rah-rah speech providers”? Actor Chris Helmsworth is a pretty decent “smoldering look provider”? How long do you think quarterback Tom Brady will be able to be a “pass provider”? The word provider makes it seem like a physician is just there to pass something out to others and thus greatly simplifies his or her role. As Jeffrey Linder, MD, MPH, Chief of General Internal Medicine and Geriatrics at Northwestern University, recently told me, “being called a provider makes it seems like I am shoveling something.” Yep, using the term provider to describe physicians is certainly shoveling a pile of something.
This previous tweet from Linder further elaborates:
Corollary of why the term “provider” grates. Our job is not to shovel healthcare.
We provide our patients expertise, advice, and care. https://t.co/PSqoE2kxnk
— Jeff Linder (@jeffreylinder) March 2, 2018
Healthcare should not be shoveled. Fries may be, but not health care. You may go to a fast food restaurant specifically to get certain food items. If the person at the counter says, “instead of providing you with a burger and fries, I would like to really get to know you and discuss your hunger,” you may get upset. However, health care should be different. The main objective should never be to just get medications, tests, or procedures. Instead, you want your doctor to get to know you as a person, to discuss things, to serve as a confidant, and to serve as an advocate. The value of the doctor is the person and not simply what he or she can”provide.”
The term can be quite demoralizing for doctors too, and you don’t want a demoralized doctor, which unfortunately is becoming increasingly common, as I have written previously for Forbes. That would be like wanting a demoralized pilot steering your plane, a demoralized CEO running your company, or a lawyer defending you in court and saying “whatever, I don’t care, I’m tired.”
In a Viewpoint article in JAMA, Allan Goroll, MD, a Professor of Medicine at Harvard Medical School, wrote that ”Assigning the ‘provider’ designation to primary care health professionals also risks deprofessionalizing them.” How many physicians really considered themselves “pre-provider” before going to medical school? Or should medical schools be renamed provider schools? The word “provider” belies many of the reasons why doctors went into the profession in the first place. People spend considerable time and money to go to medical school and then undergo years of often unpleasant training because they want something more than a job. They want a calling. They want a profession. They want an opportunity to change lives. Not just to provide stuff.
Then there is the term “mid-level providers,” which has been used to describe nurse practitioners (NPs) and sounds like NPs are confined to floors 10 to 20 in a 50-plus-floor-high-rise building. If they are mid-level, then who are the low-level providers? Imagine introducing yourself by saying, “Hi, I am Bill, a low level provider. Please, don’t use words with more than one syllable because I’m just too low level. And don’t expect too much, because, after all, I am low level. Mistakes will happen” No nurse, therapist, or other health professional who has gone through much more training and education than the average person and deals with complex medical issues should be considered low-level or even mid-level for that matter.
The term “provider” reflects what seems to be an increasing commoditization of medicine and health care. In his article, Goroll said, “The term ‘provider’ makes no reference to professional values or professionalism; its use can lead to the inference that such values do not matter, potentially fostering an unprofessional work environment.” He added, “Using the ‘provider’ designation in primary care also suggests that primary care is simple care that can be commoditized and delivered piecemeal in a variety of settings by less well-trained personnel operating interchangeably at low cost.”
Indeed, a number of physicians have told me that they feel like they are working on assembly lines with their productivity being measured by relative value units (RVUs). They have said that they do not feel valued as individuals by their workplaces but instead are viewed as interchangeable and replaceable. For example, Leah Houston, MD, President and Founder of a healthcare blockchain company called HPEC, started the hashtag #RVUfactory and has used it in tweets such as the following:
An administrator of a health system to a prospective employed physician “I don’t need you… I need your license…” when you are employed in an #RVUFactory they do not care about you or your patients! Step away. It is unsafe #PatientsFirstAlways @PPPcares @PhysForPatients
— Leah Houston MD (@LeahHoustonMD) April 25, 2019
Health care is not a commodity and neither are doctors. Different doctors are not the same and not interchangeable. There are major differences between good doctors and bad ones just as there are major differences between good lawyers versus bad ones, strong CEOs versus weak ones, and Tom Brady versus the quarterback on your high school team or even Blaine Gabbert. Also, finding the right physician is about finding the right fit. Different patients may need different things, which different doctors may or may not be able to offer. Having the wrong doctor for a given patient would be like having Adam Sandler playing Thor. Can you imagine Thor saying, “Now that’s what I call a high quality hammer“?
Labels do make a difference. That’s why people use and change them. In a “Open Letter” on KevinMD.com, Suneel Dhand, MD and William J. Carbone wrote, “The word ‘doctor’ is over 2,000 years old, aptly derived from the Latin doctus, meaning to teach or instruct. ‘Physician’ was used traditionally to describe a medical doctor.” By contrast, “health care provider” hasn’t really been around longer than the term “Happy Meal.” Dhand and Carbone further emphasized that “The word ‘provider’ is a non-specific and nondescript term that confers little meaning.” It doesn’t really tell patients or anyone what specifically they will be getting. Besides, is the word physician or medical doctor really that difficult to say?