Provider, Use of Term (Position Paper)

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.

The term "provider" is one of bureaucratic origin and has no significance or relevance beyond that created by regulators and insurers. The effect of the term is to create confusion among individuals seeking care, especially those seeking care within a managed care environment. The implication is that "providers" are interchangeable and patients can expect to receive the same level of care from any "provider." Use of the term is especially inappropriate if it is employed as a tactic to confuse and thereby encourage use of health care professionals of less cost to the insurer.

Patients should be free to make personal decisions concerning their selection of health care professionals, including their personal physician. This right is restricted by the use of the term "provider" which, as indicated, implies uniformity of skills and conceals by failing to differentiate. Although the AAFP recognizes that non-physician personnel are valuable resources and may be able to assist in providing many aspects of patient care, the AAFP continues to support a patient's right to have a personal physician. That right is eroded when the several categories of health care professionals are aggregated into a generic cluster.

Academy policy clearly delineates different organizational roles for physicians and non-physician providers. Academy policy states that non-physician providers, "…should always function under the direction and responsible supervision of a practicing, licensed physician."1 Accordingly, any attempt to imply an interchangeability of expertise is derogatory to the profession, misleading to the consumer, and usurps the legitimate role and responsibility of the physician to oversee the activities of non-physician providers.

Academy policy also states that nurse practitioners and physician assistants, "…should only function in a collaborative practice environment under the direction and responsible supervision of a practicing, licensed physician."2,3 AAFP policy also states that payment for the services of non-physician professionals should be limited to those environments "…where services are provided in a collaborative practice arrangement."2

The term "provider" implies that the relationship between the patient and physician is a commercial transaction. The underlying premise of the "provider" based environment is that health care delivery is essentially a market-based enterprise based on a market ethic. This contradicts the Academy's position that the core of the family medicine specialty lies in "…the patient-physician relationship with the patient viewed in the context of the family." The Academy further maintains that the degree to which this relationship is developed and fostered is what distinguishes family medicine from other physician specialties.

References

  1. 2000-2001 AAFP Policies on Health Issues. "NON-PHYSICIAN PROVIDERS (NPPs) Guidelines on the Supervision of Certified Nurse Midwives, Nurse Practitioners and Physician Assistants."
  2. 2000-2001 AAFP Policies on Health Issues. "NURSE PRACTITIONERS"
  3. 2000-2001 AAFP Policies on Health Issues. "PHYSICIAN ASSISTANTS"

(2002) (2013 COD)