Recently I received a memo: “Provider Meeting: All PCPs should attend.” I don't know about you, but I am fed up with being called a “provider.” Yes, I know, I provide medical care to my patients. And “provider” is part of “primary care provider,” or PCP.
Let's look at how these terms came into use. The word “primary” used in regard to physicians appeared in the 1966 Millis Report, which called for “physicians who can put medicine together again.”1 The report proposed a “primary physician” who “would, by assuming primary responsibility for the patient's welfare in sickness and health, provide continuing and comprehensive care to the citizens of the United States.”2 In describing health care, we came to use the phrase “primary care” to distinguish first contact, continuing and comprehensive care from secondary care (still in debate) and tertiary care provided in large medical centers. Over the years, “primary physician” and “primary care” were melded into “primary care physician” as government and others sought a comprehensive term to refer to family physicians, general internists and general pediatricians. The “provider” term arose with insurance companies as they have invaded health care over the past two decades. Thus “provider” (or “primary care provider/PCP”) can be considered to be the brainchild of federal bureaucrats and the managed care industry. Certainly no physician ever woke up one morning and stated, “From now on, I want to be called a PCP.”
I am a physician and proud of it. I worked hard to obtain my degree, and I continue to work hard to keep my medical knowledge and skills up to date. I am also a medical doctor, in the sense that the word “doctor” comes from the Latin “docere,” meaning to teach. I highly value my role as educator for patients, students, residents and sometimes colleagues.
Calling me a “provider” lumps my physician colleagues and me with individuals who are frankly less qualified and yet aspire to do the same work we do. Although I believe that physicians respect the work of physician assistants and nurse practitioners, such respect does not justify the use of terms that, although “politically correct,” diminish us as professionals. Some pundits have even predicted that these other “providers” will replace fully trained physicians, but this seems highly unlikely given the increased complexity of generalist physician care today.3 Nevertheless, grouping generalist physicians with less trained “providers” lends credibility to their claims.
The word “provider” also encourages us to consider health care a commodity and the physician-patient encounter a business transaction. Pellegrino4 describes the implications of this paradigm shift in writing about the commodification of medical and health care. If we, as physicians, move from a professional to a market ethic, then we surrender professionalism to a commercial mentality.
There are racial, ethnic and even gender insults, and we all know what they are. We protest when they occur. Well, I consider “provider” a professional insult; it is personally demeaning, and it devalues my education and my degree. Why should you and I be forced to suffer repeated use of a derogatory professional insult?
If you agree, I suggest that you photocopy this editorial. Keep copies in your desk and send one—with a short personal note—to anyone who calls you a “provider.”
editor's note: At American Family Physician, we have a policy of avoiding the term “provider” when referring to physicians. Parenthetically, I find it surprising how many of my physician colleagues have adopted the term when referring to themselves. I doubt that neurosurgeons refer to themselves as “providers.” Why do we?—jay siwek, m.d.