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[deleted765155]

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[deleted407021]

"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."

I think more than the simple use of the term "provider" contributes to this relationship, but it's certainly not helped by the use of such a vague blanket term.

Also this position paper is super old?

 

[MedicineZ0Z]

Provider: A term used by midlevels to claim (false) equivalency to physicians.

 

[7331poas]

meh, you need a quick term to describe a group of people who can place orders.

 

[Angus Avagadro]

Funny, doesn't say Provider anywhere on my diploma.

 

[Ho0v-man]

“Providers” sure don’t want to “collaborate” and be part of the “team” when the subpoenas show up.

 

[7331poas]

What flavor is the kool aid my friend ?

ill drink however much kool aid you want if I get to use the term "provider" instead of "physician or NP or PA or other qualified medical professional who can place orders"

 

[watermelon master]

I implore everyone in this thread to read about the origin of the word "provider" in medicine.

1938 Nazi Germany -

Jewish doctors were stripped of their medical licenses and instead of being referred to as doctors, they were demoted to the german word "behandler" translated to as "provider." Non-Jewish doctors married to Jews were forced to divorce their spouses or lose their medical licenses as well. In 1938 Jewish doctors in Germany were no longer allowed to treat everyone - they could only treat Jews.

1942 -

Dr. Lilli Jahn. Her non Jewish husband was forced to divorce her. She moved to another town and opened up shop. Her business card still read “Dr. med Lilli Jahn.” which was illegal at the time, since she was merely a "provider." The gestapo found out she was calling herself a doctor. They sent her to a labor camp, leaving her multiple kids alone without a father (since he was forced to divorce her). She was deported to Auschwitz in 1944 and was never heard from again.

https://pdfs.semanticscholar.org/9684/f277d886cac9f67784911df2c875186bf484.pdf

 

[7331poas]

I implore everyone in this thread to read about the origin of the word "provider" in medicine.

1938 Nazi Germany -

Jewish doctors were stripped of their medical licenses and instead of being referred to as doctors, they were demoted to the german word "behandler" translated to as "provider." Non-Jewish doctors married to Jews were forced to divorce their spouses or lose their medical licenses as well. In 1938 Jewish doctors in Germany were no longer allowed to treat everyone - they could only treat Jews.

1942 -

Dr. Lilli Jahn. Her non Jewish husband was forced to divorce her. She moved to another town and opened up shop. Her business card still read “Dr. med Lilli Jahn.” which was illegal at the time, since she was merely a "provider." The gestapo found out she was calling herself a doctor. They sent her to a labor camp, leaving her multiple kids alone without a father (since he was forced to divorce her). She was deported to Auschwitz in 1944 and was never heard from again.

https://pdfs.semanticscholar.org/9684/f277d886cac9f67784911df2c875186bf484.pdf

What does that have to do with anything? You cannot call someone a provider because in the past a country called physicians providers AND killed millions of Jews? What kind of logic is this.

 

[watermelon master]

What does that have to do with anything? You cannot call someone a provider because in the past a country called physicians providers AND killed millions of Jews? What kind of logic is this.

It's derogatory to an extremely large group of people who were murdered in the Holocaust. Just like you shouldn't be using the n-word or any other derogatory terms towards groups of people - you must consider the historical significance. I assume you didn't read the article.

 

[nowanmd]

"provider" is a very intentional designation by the medical bureaucracy (insurance companies, the governement, even hospitals) to decrease the importance and power of physicians in the health care system. They want us to know "our place". We should all be apalled at this.

 

[longhaul3]

I didn't read more than a few sentences of the article, but "behandler" in German does not translate to "provider" with any sort of fidelity. I'm not sure what the author means by "freely translated as," but to claim that a common word in English is so historically charged because it's a translation of an epithet from another language in my mind requires an accurate translation. This seems like a politically expedient criticism of the rise of "provider" in American medicine.

I agree with the line of reasoning that it's detrimental (and frankly offensive) to our profession to intentionally call everyone "provider," but this is a stretch.

 

[VA Hopeful Dr]

It's derogatory to an extremely large group of people who were murdered in the Holocaust. Just like you shouldn't be using the n-word or any other derogatory terms towards groups of people - you must consider the historical significance. I assume you didn't read the article.

No it's not

 

[watermelon master]

No it's not

Really? I've provided peer-reviewed evidence that it is derogatory. The onus is now on you to prove it isn't

 

[Rekt]

Really? I've provided peer-reviewed evidence that it is derogatory. The onus is now on you to prove it isn't

I'd just ignore him. He's always extremely pro MLP independent practice. Against anything that might hurt Non-Physician Providers feelings.

 

[VA Hopeful Dr]

Really? I've provided peer-reviewed evidence that it is derogatory. The onus is now on you to prove it isn't

No, you've provided peer reviewed evidence that Jewish doctors were called "behandlers" as a way to discriminate against them.

So first, behandler is more closely translated to practitioner or treater not provider (someone else already mentioned an issue with that articles translation).

Second, using a common word in the English language isn't derogatory to Jewish doctors who were persecuted by the Nazis. Context matters. Is calling us providers meant in negative ways? Yes, frequently. Is it meant to delegitimize us? No, it isn't.

 

[VA Hopeful Dr]

I'd just ignore him. He's always extremely pro MLP independent practice. Against anything that might hurt Non-Physician Providers feelings.

Hardly. In fact I have testified at my statehouse before to the contrary, but don't let facts get in the way of your character assassination.

 

[allantois]

What term would you suggest to encompass all MDs, DOs, PAs, and NPs?

 

[sunshinefl]

What term would you suggest to encompass all MDs, DOs, PAs, and NPs?

Why does there need to be one?

 

[allantois]

Why does there need to be one?

Well if I want to tell the patient to see their primary care provider who may or may not be a physician or for insurance companies/hospitals to indicate the need to have an order placed by a medical provider

 

[allantois]

“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."

Two very different competing paradigms, hence why our medical system is broken.

Meh, what about internists who don't treat the whole family?

 

[allantois]

Because it's such a time burden to say "primary care np or pa." Damn, the angst.

"Please talk to your primary care doc/NP/or PA".

I've heard some specialists say talk to your GP, but that's a pretty outdated term

 

[allantois]

it was a position paper authored by FM. Extrapolate

It's an odd tirade on the semantics of a term that has its place in the medical system

 

[Winged Scapula]

Moving to TIH

 

[VA Hopeful Dr]

It's an odd tirade on the semantics of a term that has its place in the medical system

Not as much as you'd think, the AAFP is very physician-centric. This is pretty standard for them.

 

[WedgeDawg]

Please keep comments professional and respectful. Disagree with the idea without attacking the user. Thanks.

 

[NicMouse64]

Well if I want to tell the patient to see their primary care provider who may or may not be a physician or for insurance companies/hospitals to indicate the need to have an order placed by a medical provider

If they need a physician then you tell them to go see a primary care physician. If they have an established diagnosis and simply need a simple follow up then tell them to see a primary care PA/NP that is supervised. Problem solved.

 

[VA Hopeful Dr]

Interesting statement. I would think all specialties of medicine are physician centric.

do you think other specialties are on board with “the patient-physician relationship with the patient viewed in the context of the family" or are some specialties “essentially a market-based enterprise based on a market ethic” ?

What to do?

Great discussion by the way. Thanks for the thread, OP

The AAFP is more open about it. They have had firm positions on midlevels for years while lots of others either haven't or have had them but don't publicize them heavily.

I think it helps that we aren't CMG funded to the same extent that the ACEP and ASA are.

 

[TheRealCookieMonster]

 

[VA Hopeful Dr]

If they need a physician then you tell them to go see a primary care physician. If they have an established diagnosis and simply need a simple follow up then tell them to see a primary care PA/NP that is supervised. Problem solved.

That seems needlessly complicated.

Around here it's "follow up with your family doctor" and trust patients to know if that means their FP, internist, or mid-level.

 

[VA Hopeful Dr]

Complicated? Can't be serious.

Did you even read what you wrote?

If they need a physician then you tell them to go see a primary care physician. If they have an established diagnosis and simply need a simple follow up then tell them to see a primary care PA/NP that is supervised. Problem solved.

So first, we have to decide what level of post discharge care they require. That requires you know what takes a physician's level of care and what doesn't in a field not your own.

Second, you're assuming that having an established diagnosis that needs follow up doesn't need a physician.

Third, why are you even trying to stratify people on their post-discharge outpatient primary care needs?

You're adding a whole other level of decision making just to avoid saying provider. Do you not see how that's needlessly complicated?

Edit: if you really care that much, just tell people to see their primary care physician and let them sort it out. It's not hard.

 

[NicMouse64]

Did you even read what you wrote?



So first, we have to decide what level of post discharge care they require. That requires you know what takes a physician's level of care and what doesn't in a field not your own.

Second, you're assuming that having an established diagnosis that needs follow up doesn't need a physician.

Third, why are you even trying to stratify people on their post-discharge outpatient primary care needs?

You're adding a whole other level of decision making just to avoid saying provider. Do you not see how that's needlessly complicated?

Edit: if you really care that much, just tell people to see their primary care physician and let them sort it out. It's not hard.

You make good points. Who do you think is better to decide if they need a physician or not? The patient or a physician that is not primary care? My argument is that patients don't have the relevant knowledge to know which to see. I don't have the answers and you bring up good points about triaging. I just don't think that lumping NPs PAs and Physicians all under the same word is respectful to the training that physicians must go through to become physicians.

 

[VA Hopeful Dr]

You make good points. Who do you think is better to decide if they need a physician or not? The patient or a physician that is not primary care? My argument is that patients don't have the relevant knowledge to know which to see. I don't have the answers and you bring up good points about triaging. I just don't think that lumping NPs PAs and Physicians all under the same word is respectful to the training that physicians must go through to become physicians.

I don't love the term, but it doesn't even break my top 10 things that bug me on a daily basis. I really do think that most of the time it's a shorthand for "people who can write prescriptions", not ideal but a big ole meh most of the time.

 

[NicMouse64]

I don't love the term, but it doesn't even break my top 10 things that bug me on a daily basis. I really do think that most of the time it's a shorthand for "people who can write prescriptions", not ideal but a big ole meh most of the time.

Yeah there are a ton of other things that are headaches in medicine I am sure. I am just a young ole medical student so I understand my perspective on the issue is lacking in a practical sense. Maybe I am just paranoid but I see the logic for a large corporation to hire NP/PAs instead of physicians so that more revenue is generated for the hospital through increased orders of imaging and testing, and they get to pay them less. The first step towards replacing physicians is to confuse patients by using the word "provider" so that patients think the training is equal.

 

[762513]

Provider: A term used by midlevels to claim (false) equivalency to physicians.

As a NP I wouldn't mind if you mistook me for the janitor and used that as my title as long as my patients do well and I'm providing high quality, evidence based care. That being said, many non physician providers take offense to being called a midlevel, and I know many physicians specifically do not use the term around me, which I do appreciate, even if I'm not offended if they forget. The NP/PA's who dislike the term believe, as the article states "The term "provider" is one of bureaucratic origin and has no significance or relevance beyond that created by regulators and insurers." Which is exactly what the term midlevel is, as it was created by the DEA to signify a group of people who prescribe medications yet do not have a medical license. Med students love to throw it at people as a sideways insult, kind of like some physicians feel insulted by the word provider. Just food for thought that if you don't like being called a specific word, you probably shouldn't call other people words they also don't like being called, when there are other words that would work just as well. One of those kindergarten things.

 

[VA Hopeful Dr]

Yeah there are a ton of other things that are headaches in medicine I am sure. I am just a young ole medical student so I understand my perspective on the issue is lacking in a practical sense. Maybe I am just paranoid but I see the logic for a large corporation to hire NP/PAs instead of physicians so that more revenue is generated for the hospital through increased orders of imaging and testing, and they get to pay them less. The first step towards replacing physicians is to confuse patients by using the word "provider" so that patients think the training is equal.

Patients still want to see a doctor nine times out of ten. Maybe that'll change, but I kinda doubt it. People either know or eventually realize that we're superior.

Right @Goro ?

 

[Spodermin]

As a NP I wouldn't mind if you mistook me for the janitor and used that as my title as long as my patients do well and I'm providing high quality, evidence based care. That being said, many non physician providers take offense to being called a midlevel, and I know many physicians specifically do not use the term around me, which I do appreciate, even if I'm not offended if they forget. The midlevels who dislike the term believe, as the article states "The term "provider" is one of bureaucratic origin and has no significance or relevance beyond that created by regulators and insurers." Which is exactly what the term midlevel is, as it was created by the DEA. Med students love to throw it at people as a sideways insult, kind of like some physicians feel insulted by the word provider. Just food for thought that if you don't like being called a specific word or title, you probably shouldn't go out of your way to call other people words they also don't appreciate being called, when there are other words that would work just as well. One of those kindergarten things.

One thing you should keep in mind, midlevels do not provide "high quality evidence based care"
Midlevels in a nutshell use the "monkey see, monkey do" approach. They don't know why they're doing what they're doing. They've just seen it done a couple of times so they do it. I'm pretty sure you can find a thread where doctors share all the incompetence they've witnessed being done by midlevels, but I'm not gonna go into that here.
Now that that's out of the way. Physicians do feel insulted by the term provider because we didn't bust our a$$e$ going through med school for us to be equated with someone who, on all objective measures, is not quite up to our standards intellectually. If you can't handle that then maybe you should've gone into med school so that, oh wait (please refer to text in bold)

 

[762513]

One thing you should keep in mind, midlevels do not provide "high quality evidence based care"
Midlevels in a nutshell use the "monkey see, monkey do" approach. They don't know why they're doing what they're doing. They've just seen it done a couple of times so they do it. I'm pretty sure you can find a thread where doctors share all the incompetence they've witnessed being done by midlevels, but I'm not gonna go into that here.
Now that that's out of the way. Physicians do feel insulted by the term provider because we didn't bust our a$$e$ going through med school for us to be equated with someone who, on all objective measures, is not quite up to our standards intellectually. If you can't handle that then maybe you should've gone into med school so that, oh wait (please refer to text in bold)

Yawn. Nicely offensive post. I'll just repeat myself since what I'm trying to say isn't really very controversial.

Just food for thought that if you don't like being called a specific word, you probably shouldn't call other people words they also don't like being called, when there are other words that would work just as well. One of those kindergarten things.

 

[Spodermin]

Yawn.

Just food for thought that if you don't like being called a specific word, you probably shouldn't call other people words they also don't like being called, when there are other words that would work just as well. One of those kindergarten things.

You obviously don't understand hierarchy.
The difference between us and you is that when we call you midlevels, its your actual title. When you call us provider, you do it to blur the lines between who is and isn't a doctor. You feel offended by it because somewhere deep inside, you have a burning desire to be something more than what you are, just a midlevel.

 

[MedicineZ0Z]

As a NP I wouldn't mind if you mistook me for the janitor and used that as my title as long as my patients do well and I'm providing high quality, evidence based care. That being said, many non physician providers take offense to being called a midlevel, and I know many physicians specifically do not use the term around me, which I do appreciate, even if I'm not offended if they forget. The NP/PA's who dislike the term believe, as the article states "The term "provider" is one of bureaucratic origin and has no significance or relevance beyond that created by regulators and insurers." Which is exactly what the term midlevel is, as it was created by the DEA to signify a group of people who prescribe medications yet do not have a medical license. Med students love to throw it at people as a sideways insult, kind of like some physicians feel insulted by the word provider. Just food for thought that if you don't like being called a specific word, you probably shouldn't call other people words they also don't like being called, when there are other words that would work just as well. One of those kindergarten things.

ok... but you're still a midlevel. The physician is at the top. You're below, in the midlevel category.

 

[762513]

ok... but you're still a midlevel. The physician is at the top. You're below, in the midlevel category.

We're ALL providers here, except you, who's still a medical student. Have a nice Saturday.

 

[Goro]

Patients still want to see a doctor nine times out of ten. Maybe that'll change, but I kinda doubt it. People either know or eventually realize that we're superior.

Right @Goro ?

I think that they may have to learn the hard way to stick with a doctor. Shots and sniffles? A midlevel will be OK then.

 

[Spodermin]

Now that I think of it. Why are they called midlevels? Top is doctors, midlevel is nurses and PA, who's at the bottom? The janitors?Administrators?

 

[762513]

You obviously don't understand hierarchy.
The difference between us and you is that when we call you midlevels, its your actual title. When you call us provider, you do it to blur the lines between who is and isn't a doctor. You feel offended by it because somewhere deep inside, you have a burning desire to be something more than what you are, just a midlevel.

Show me where midlevel is my title. It's not on my diploma, its not listed on my state license, it's not put after my name in the EHR, it's not on my business card, and my job doesn't refer to me as such.

 

[MedicineZ0Z]

We're ALL providers here, except you, who's still a medical student. Have a nice Saturday.

So? I'll be a "provider" (lolol) in a couple of months. You're still a nurse and years and years away from being a doctor or real provider of healthcare.

 

[Spodermin]

Show me where midlevel is my title.

It's what doctors call anyone who pretends to be a doctor

 

[allantois]

You obviously don't understand hierarchy.
The difference between us and you is that when we call you midlevels, its your actual title. When you call us provider, you do it to blur the lines between who is and isn't a doctor. You feel offended by it because somewhere deep inside, you have a burning desire to be something more than what you are, just a midlevel.

Medical student talking about hierarchy

 

[Nurse2MD2018]

What’s up with

One thing you should keep in mind, midlevels do not provide "high quality evidence based care"
Midlevels in a nutshell use the "monkey see, monkey do" approach. They don't know why they're doing what they're doing. They've just seen it done a couple of times so they do it. I'm pretty sure you can find a thread where doctors share all the incompetence they've witnessed being done by midlevels, but I'm not gonna go into that here.
Now that that's out of the way. Physicians do feel insulted by the term provider because we didn't bust our a$$e$ going through med school for us to be equated with someone who, on all objective measures, is not quite up to our standards intellectually. If you can't handle that then maybe you should've gone into med school so that, oh wait (please refer to text in bold)

Nurses can also share countless stories of the errors we witness at the hand of the physicians. Does that make every physician incompetent? I’m not sure what’s up with SDNers constantly bashing of midlevels.

 

[MedicineZ0Z]

Medical student talking about hierarchy

You're below med students in the hierarchy of life. An NP is still a nurse, a PA is a doctor's assistant by title (literally). My role is finite, in fact just for another month or so. Your role is permanent.

 

[allantois]

It's what doctors call anyone who pretends to be a doctor

Sure you can choose to be a prick to other providers, nursing, and ancillary stuff. The only thing you will accomplish is complicating your own job as no one likes to work with a prick