Supervising NP- does it normally take this long?

[drresident8288]

I signed a contract last year with a company that is affiliated with one of the places that I work to supervise a nurse practicitoner. I knew they had not yet hired one and I would be involved in the hiring process. This was last July.

I interviewed one candidate who made it to the “final interview”, but they never told me what happened with her and I guess it didn’t work out. I am now getting emails to interview 3 new candidates, one of which her bio says won’t be credentialed fully until November. Is this a normal timeline? I knew it would be slow and I liked the idea of interviewing the NP I would be working with, however I’m starting to feel like I’m getting the run around. It’s been over 7 months, I’ve spent time interviewing candidates, completing tons and tons of onboarding paperwork, and have yet to be paid anything since I haven’t actually started supervision yet and it’s a monthly stipend. Just trying to see others’ experiences with something like this, and if it is not the norm- what can I say to pretty much say “hey, I signed a contract with you 7 months ago and haven’t made any money yet?” 😅

This is not my full time job or anything, but I would probably be planning to look for another side gig later this year if this one doesn’t work out.

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[Sushirolls]

1) ARNPs are also in demand and have ability to be picky in some markets for compensation level.
2) Some ARNP applicants truly have no experience, interview poorly, and have CV issues that all culminate in a pass.
3) Some get picky about job details, either because they can or they think they can, and drop out before contract sign time.
4) Some employers really are just that bad, that even the ARNPs know its a scat place, and avoid it.

One or several of the above.

 

[comp1]

Yep, NPs are in HIGH demand, just like psychiatrists. The one you interviewed might have dropped out during the process because they got a better offer elsewhere. Hiring all mental health providers is extremely challenging pretty much everywhere because it's such an employee's market. You definitely have to grab the upcoming graduates ASAP.

 

[drresident8288]

Thank you for the insight! I know there were a couple candidates who did not make it to the interview with me (I’m the last interview) because their expected salary range was not in line with what the company wanted to pay them, but I have no idea what happened to the candidate I interviewed (unless they were just taking so long with her credentialing as well). I am a new practitioner too, so while I don’t want to be terribly picky given it’s difficult to find NPs, I do want someone who has some experience in the mental health field and whose treatment of patients aligns with what I would do in a situation. I guess the company will need to fork out more money to the NPs or I’ll have to take a different route!

 

[drresident8288]

Thank you for the insight! I know there were a couple who did not make it to the interview with me (I’m the last interview) because their expected salary range was not in line with what the company wanted to pay them, but I have no idea what happened to the candidate I interviewed (unless they were just taking so long with her credentialing as well). I am a new practitioner too, so while I don’t want to be terribly picky given it’s difficult to find NPs, I do want someone who has some experience. I guess the company will need to fork out more money to the NPs if they’re wanting me to

 

[littlefred]

Please don't call yourself a provider/practitioner if you are an MD.

 

[clausewitz2]

Please don't call yourself a provider/practitioner if you are an MD.

When I am dictator of the world I will forbid this and also the phrase "med check".

 

[drresident8288]

Please don't call yourself a provider/practitioner if you are an MD.

I am an MD and have always heard other MDs call themselves providers/practitioners (though of course to my patients I introduce myself as doctor). I’ll think about this from now on 🤣

 

[splik]

When I am dictator of the world I will forbid this and also the phrase "med check".

and don't forget "prescriber" and "behavioral health"

 

[splik]

I am an MD and have always heard other MDs call themselves providers/practitioners (though of course to my patients I introduce myself as doctor). I’ll think about this from now on 🤣

The issue is NPs love to use the term "provider" to obfuscate the fact they aren't doctors. Big box shops also love using the term "provider" to dupe patients re: the qualifications of who they are seeing. I don't get riled up about this like some people but it does bother me when I see patients who think their NP is a psychiatrist. These are fairly savvy, medically complex, cash-paying, intelligent patients and they are always shocked when I tell them that they don't have a psychiatrist, and they are seeing an NP.

In my states, NPs are legally required to tell patients that they are not physicians and clearly introduce themselves as NPs or "enferma especialista". They are also not allowed to call themselves "Dr." and are supposed to list their supervising physician on their websites. Unfortunately, most of them don't adhere to any of this, and I've only heard of one NP who got fined and faced disciplinary action for calling herself "dr." We do need to educate patients, but in a way where we aren't shîtting on NPs but emphasizing the benefits of physician-led care. The problem is whenever these things come up it often looks like petty turf wars rather than issues like truth in advertising, patient choice, and patient safety. It also doesn't help that there are a lot of bad psychiatrists out there too.

 

[comp1]

I'm not sure doctor should be a protected term. There's a heck of a lot of doctors around, including DNPs. I think the protected term really is just physician. And since there's such massive variety in what a "supervising physician" means from state to state, what's even the point of requiring that to be listed? And yes, it looks like a turf war. We need to show the benefits of either type of provider in the literature.

 

[splik]

I'm not sure doctor should be a protected term. There's a heck of a lot of doctors around, including DNPs. I think the protected term really is just physician. And since there's such massive variety in what a "supervising physician" means from state to state, what's even the point of requiring that to be listed? And yes, it looks like a turf war. We need to show the benefits of either type of provider in the literature.

I dont agree with this at all. most people think of a medical doctor when they are thinking of a doctor in a healthcare setting (or even out of a setting). No one ever asks if there is a physician on board a plane, they ask for a doctor. When I was in academics, a lot of my med students had PhDs. It would be misleading if they introduced themselves as "dr" to the patients instead of as medical students. There was a move a few years ago amongst a small group of NPs to rebrand themselves as "cathopathic physicians" whatever tf that means. Most people don't use the term physician. The DNP is not a real doctorate and the move towards it was specifically so they could call themselves pts. I've also noticed only the bad NPs seem to call themselves "doctor." The good ones seem comfortable with their role in the healthcare team. I've mentioned before one of the NPs I worked used to sign their notes "neurology attending." Technically lawyers have JDs but everyone would consider it ridiculous if lawyers called themselves "dr."

There isn't a massive variation in the term supervising physician from state to state. Some states don't require it, others have collaborative practice agreements rather than supervision (which is different), but the concept of supervision is pretty consistent in states that have those laws, and I'm only talking about the law in my state. If they are practicing in states or a system where they aren't independent, patients have the right to know and to request to see the physician should they wish. That's the law.

 

[Sushirolls]

I got a PhD professor friend. I used to try to call the person Dr at times when first started working their professor job.

Person gets pissed like "shut up" "I ain't a doctor." Guess only Jill Biden wants to be the PhD doctor.

 

[calvinhobbes]

DNP is not a doctor lol it’s a fake ass degree

 

[TexasPhysician]

It is incredibly easy to become a psych NP. NP’s can become psych NP’s part-time while working a FT job. There isn’t a big shortage. Your company is trying to find a cheap option that accepts their terms. I can credential new staff in 1-5 months typically depending on the plan. Big companies don’t like gradually introducing new staff, because it requires work to train scheduling staff on which insurances they’ve been approved for as it changes. They’d rather just wait until all major plans are ready.

In the past, I agreed to be medical director. My terms were that I was paid a monthly amount before the facility even opened to review paperwork, interview, etc. Then when staff were hired, there were graduated increased payments based on certain terms.

You should be being paid months ago.

 

[PsyDr]

I got a PhD professor friend. I used to try to call the person Dr at times when first started working their professor job.

Person gets pissed like "shut up" "I ain't a doctor." Guess only Jill Biden wants to be the PhD doctor.

The difference between "doctor" and "physician" was already well established in 1387 when Chaucer wrote about the doctor of physic. It’s not the same thing.

 

[psycho-matic]

The issue is NPs love to use the term "provider" to obfuscate the fact they aren't doctors. Big box shops also love using the term "provider" to dupe patients re: the qualifications of who they are seeing. I don't get riled up about this like some people but it does bother me when I see patients who think their NP is a psychiatrist. These are fairly savvy, medically complex, cash-paying, intelligent patients and they are always shocked when I tell them that they don't have a psychiatrist, and they are seeing an NP.

In my states, NPs are legally required to tell patients that they are not physicians and clearly introduce themselves as NPs or "enferma especialista". They are also not allowed to call themselves "Dr." and are supposed to list their supervising physician on their websites. Unfortunately, most of them don't adhere to any of this, and I've only heard of one NP who got fined and faced disciplinary action for calling herself "dr." We do need to educate patients, but in a way where we aren't shîtting on NPs but emphasizing the benefits of physician-led care. The problem is whenever these things come up it often looks like petty turf wars rather than issues like truth in advertising, patient choice, and patient safety. It also doesn't help that there are a lot of bad psychiatrists out there too.

Why wouldn't a NP introduce themselves as an NP? That's their license and they should say their name and title upfront, as any healthcare professional should. I'm an NP and I don't get it. It bugs me when NPs will a DNP introduce themselves as Dr. Smith, but I hope they are at least ending the sentence with stating they're a nurse practitioner. Just middies the water. I have some patients that choose to informally call me doctor but I make it clear I'm not a physician. I don't even have a DNP. Don't need it. No clinical benefit and thousands more $$$.

 

[psycho-matic]

DNP is not a doctor lol it’s a fake ass degree

I wouldn't call it fake but it's a glorified, watered down MPH degree.

 

[psycho-matic]

The difference between "doctor" and "physician" was already well established in 1387 when Chaucer wrote about the doctor of physic. It’s not the same thing.

This problem isn't limited to NPs. I know of a pharmacist with a PharmD who insists on being called Doctor Smith in the retail setting. What a douche. Appropriate in an academic setting, maybe in a clinical setting, but that would still confuse patients IMO. Talking about an inferiority complex.

and don't forget "prescriber" and "behavioral health"

"Prescriber" always irritated me. We aren't just pill pushers. But I never understood the sensitivity some physicians on these forums have to being called a provider. It's a generic, catch-all word that is convenient to use and appropriate in some contexts, in my opinion, e.g. "PCP" means primary care provider which could be an MD, DO, PA or NP. I may tell the patient to go back to their PCP for this or that, and I don't have to stop and think about which type of provider they are seeing as their PCP. I refer patients to a particularly gifted endocrinologist but they often end up getting seen by her NP. I find that a bit irritating but what can you do? I don't think "provider" is purposely used to obfuscate or blur the roles of various healthcare professionals so patients think they are all the same. I see physicians use the word "provider" all the time. If you want to always refer to yourself as "physician" or "doctor" to your patients, more power to you. Nothing wrong with that. You're entitled to feel how you feel but I think it's a bit silly that some of you physicians get your panties in a wad over being called a provider. It isn't personal and it isn't meant to insult you.

 

[PsyDr]

This problem isn't limited to NPs. I know of a pharmacist with a PharmD who insists on being called Doctor Smith in the retail setting. What a douche. Appropriate in an academic setting, maybe in a clinical setting, but that would still confuse patients IMO. Talking about an inferiority complex.

Help me out with the bounds of this logic. One profession doesn’t like to use their legally protected title. Instead they prefer an honorific that is not legally protected. Because of the avoidance of the legally protected title, no one else can? And you’re saying anyone who uses the honorific has an inferiority complex? Can men not call themselves “Mr” because surgeons like the title? What about telling nuns that they can’t call themselves “Sister” because nurses used to use that title?
What about those with MBBS degrees? They are not doctors, but they are physicians.

 

[psycho-matic]

Help me out with the bounds of this logic. One profession doesn’t like to use their legally protected title. Instead they prefer an honorific that is not legally protected. Because of the avoidance of the legally protected title, no one else can? And you’re saying anyone who uses the honorific has an inferiority complex? Can men not call themselves “Mr” because surgeons like the title? What about telling nuns that they can’t call themselves “Sister” because nurses used to use that title?
What about those with MBBS degrees? They are not doctors, but they are physicians.

Whoa dude. Talk about overthinking. I said specifically that that pharmacist had and if here we are the complex, and that it makes Physicians look a little insecure if they get worked up over being called a provided when it's not meant to be personal. That's my opinion. As a whole, I don't think my profession purposely avoids using their legal leave protected title. I haven't seen it happen often. When I was in the hospital recently, the cardiologist's APRN saw me first and he introduced himself as such. That's been my experience as a patient almost every time I've seen a nurse practitioner.

Now when I had a C6-7 posterior discectomy, I woke up in terrible pain. The PACU nurse said they gave me all they can. I asked they call the anesthesiologist or surgeon to get an order for something stronger. They said Dr. Smith (who was the surgeons APRN ) was with a patient and wasn't available. I called them out on it that she was a nurse practitioner, not a doctor, and it ticked me off. I talked to the surgeon about it at my followup appt about how I felt it was inappropriate to allow his APRN to call herself doctor to patients.

Nowhere in my post did I say that a physician, regardless of which terminal degree they have, should not call themselves a doctor. I think that's entirely appropriate. I think only physicians, podiatrists, dentists, psychologists and veterinarians should use the term "doctor" in the clinical setting.

 

[PsyDr]

Nowhere in my post did I say that a physician, regardless of which terminal degree they have, should not call themselves a doctor. I think that's entirely appropriate. I think only physicians, podiatrists, dentists, psychologists and veterinarians should use the term "doctor" in the clinical setting.

In general, I'm trying to understand the logic you are setting up .

1) If the issue is about being misleading, then why should non-doctoral physicians be allowed to use the title "doctor"? They don't have a doctorate. Why is that not misleading?

2) You're creating a position where:
a. Physicians prefer to use the title "Dr", as a stand-in for their actual title in a manner that is not historically supported.
b. Because of the avoidance of protected titles, others should not be allowed to use this honorific.

I'm simply asking where the limits of this logic go. Should the American Bar Association send a cease and desist to Esquire magazine? How should a male address himself around surgical wards, to avoid misleading anyone into thinking he is a surgeon?

 

[psycho-matic]

In general, I'm trying to understand the logic you are setting up .

1) If the issue is about being misleading, then why should non-doctoral physicians be allowed to use the title "doctor"? They don't have a doctorate. Why is that not misleading?

2) You're creating a position where:
a. Physicians prefer to use the title "Dr", as a stand-in for their actual title in a manner that is not historically supported.
b. Because of the avoidance of protected titles, others should not be allowed to use this honorific.

I'm simply asking where the limits of this logic go. Should the American Bar Association send a cease and desist to Esquire magazine? How should a male address himself around surgical wards, to avoid misleading anyone into thinking he is a surgeon?

In general, I'm trying to understand the logic you are setting up .

1) If the issue is about being misleading, then why should non-doctoral physicians be allowed to use the title "doctor"? They don't have a doctorate. Why is that not misleading?

2) You're creating a position where:
a. Physicians prefer to use the title "Dr", as a stand-in for their actual title in a manner that is not historically supported.
b. Because of the avoidance of protected titles, others should not be allowed to use this honorific.

I'm simply asking where the limits of this logic go. Should the American Bar Association send a cease and desist to Esquire magazine? How should a male address himself around surgical wards, to avoid misleading anyone into thinking he is a surgeon?

First of all, physicians in an MBBS are an outlier in the US, but they're still physicians. In the US, physicians are traditionally called doctor. So regardless of their terminal degree, they completed med school and should be called doctor to avoid confusion with patients.

I don't support APRNs with DNPs calling themselves doctor, so I don't know why you have a problem with that.

2. I don't know a thing about Esquire Magazine, but this is a preposterous example. Lawyers have a doctor but they don't call themselves a doctor. Maybe they do in academics, I don't know. What that has to do with the use of the title "doctor" in the clinical setting is beyond me.

 

[PsyDr]

First of all, physicians in an MBBS are an outlier in the US, but they're still physicians. In the US, physicians are traditionally called doctor. So regardless of their terminal degree, they completed med school and should be called doctor to avoid confusion with patients.

I don't support APRNs with DNPs calling themselves doctor, so I don't know why you have a problem with that.

2. I don't know a thing about Esquire Magazine, but this is a preposterous example. Lawyers have a doctor but they don't call themselves a doctor. Maybe they do in academics, I don't know. What that has to do with the use of the title "doctor" in the clinical setting is beyond me.

1) but they are do not have a doctorate. You are concerned with misleading someone. Should these individuals stop calling themselves “doctor”? What about unlicensed MDs?

2) the argument is essentially just saying, “eh, we preferred to use a generic honorific instead of our actual title, and everyone sorta went along with it, so no one else should use that honorI fix.” This idea has already been litigated, and determined to be wrong. When you consider the idea of surgeon and Mr, the argument falls apart entirely.

3) If you wanna go deeper, we can discuss why academic regalia ranks PhDs higher than MDs, JDs, and PsyDs.

3) I’m asking for an internally consistent argument.

 

[splik]

What about those with MBBS degrees? They are not doctors, but they are physicians.

This is not correct. The MBBS degree (and other similar degrees e.g. MBChB, BM, MBBChir, MB BS) are not doctorate degrees but those who hold them are doctors, and not physicians. Certainly in the countries where these degrees are bestowed, they are for medical doctors. The term physician is not interchangeable with doctor in countries influenced by the British system. Only physicians are physicians. Surgeons (especially surgeons), psychiatrists, general practitioners/family doctors, obstetricians, anesthetists etc. are not physicians in countries which offer the bachelor of medicine degrees. It is a North American peculiarity to use the terms physician and medical doctor interchangeably. This is not the case in the UK, Australia, New Zealand, India etc. Surgeons might be insulted to be called a physician in such countries.

When I described myself as a physician, I was pilloried by a british colleague for using this term despite not specializing in physic. They weren't aware that the term physician is used interchangeably with doctor in the US when referring to medical doctors.

 

[PsyDr]

This is not correct. The MBBS degree (and other similar degrees e.g. MBChB, BM, MBBChir, MB BS) are not doctorate degrees but those who hold them are doctors, and not physicians. Certainly in the countries where these degrees are bestowed, they are for medical doctors. The term physician is not interchangeable with doctor in countries influenced by the British system. Only physicians are physicians. Surgeons (especially surgeons), psychiatrists, general practitioners/family doctors, obstetricians, anesthetists etc. are not physicians in countries which offer the bachelor of medicine degrees. It is a North American peculiarity to use the terms physician and medical doctor interchangeably. This is not the case in the UK, Australia, New Zealand, India etc. Surgeons might be insulted to be called a physician in such countries.

When I described myself as a physician, I was pilloried by a british colleague for using this term despite not specializing in physic. They weren't aware that the term physician is used interchangeably with doctor in the US when referring to medical doctors.

explain where the doctorate occurs. Cite the Bologna process and hood lengths. Then reconcile the state laws that allow MBBS holders to use MD on their name badges, and explain why this isn’t misleading. Then reconcile that behavior with case law that prevents unlicensed MD holders from listing that credential, citing the first amendment.

There’s either a title or an honorific. If misleading is the concern, then everyone should be up in arms about case law, and the MBBs/MD badge, or the Mr/surgeon issue. They aren’t. Instead the debate is going to ignore the fundamentals, and insist that the issue is something everyone does, while ignoring the hypocrisy of the converse.

Hint: there is legal precedents in all of that.

 

[clausewitz2]

explain where the doctorate occurs. Cite the Bologna process and hood lengths. Then reconcile the state laws that allow MBBS holders to use MD on their name badges, and explain why this isn’t misleading. Then reconcile that behavior with case law that prevents unlicensed MD holders from listing that credential, citing the first amendment.

There’s either a title or an honorific. If misleading is the concern, then everyone should be up in arms about case law, and the MBBs/MD badge, or the Mr/surgeon issue. They aren’t. Instead the debate is going to ignore the fundamentals, and insist that the issue is something everyone does, while ignoring the hypocrisy of the converse.

Hint: there is legal precedents in all of that.

I appreciate a historical and etymological argument as much as anyone, but when it comes to arguments about what is, in fact, misleading to patients, the empirical distributional realities of who, in fact, is typically called what are much more relevant. Misleading is about manipulating the expectations of people as they exist, not as they would exist if everyone was more familiar than they are with academic minutiae.

A state of war theoretically exists between the United Nations and North Korea but to argue that there is in fact an armed conflict going on actively as a result would be to fail to grasp the reality of the situation.

 

[FlowRate]

When I am dictator of the world I will forbid this and also the phrase "med check".

Least favorite thing about local clinic culture is that intake appointments are called "med evals" and follow-ups are called "med returns." And sometimes that language leaks to patients rather than just reflecting specific slot/encounter types in Epic.

Runner-up to that is that some of the therapists and therpists' managers have taken to calling therapists "providers." Which makes things REALLY confusing.

and don't forget "prescriber" and "behavioral health"

TBH I don't particularly mind either of those too much.

The one that really gets me is national KP wants everyone to start calling our department "Mental health and wellness." I'd actually say I'm not an expert in "wellness," as much as I'm an expert in treatment of the opposite--"mental sickness and unwellness." I don't think that one is going to fly as a department title, though. But something about it does seem Orwellian.

As for prescriber, I like that at least it explicitly refers to the specific commonality of midlevels and physicians and sometimes it is useful to have a word to use instead of having to say "Doctors, PA's, and NP's" repeatedly when doing things like writing clinic policy that affects all three.

I appreciate a historical and etymological argument as much as anyone, but when it comes to arguments about what is, in fact, misleading to patients, the empirical distributional realities of who, in fact, is typically called what are much more relevant. Misleading is about manipulating the expectations of people as they exist, not as they would exist if everyone was more familiar than they are with academic minutiae.

A state of war theoretically exists between the United Nations and North Korea but to argue that there is in fact an armed conflict going on actively as a result would be to fail to grasp the reality of the situation.

Tangential but relating to misleading patients, I still wonder what goes on in all of the independent practice NP offices that leads to patients I see calling their former-NP's their "psychiatrist" or "Dr. lastname." Do they just not correct them? Do they introduce themselves that way?

 

[clausewitz2]

Least favorite thing about local clinic culture is that intake appointments are called "med evals" and follow-ups are called "med returns." And sometimes that language leaks to patients rather than just reflecting specific slot/encounter types in Epic.

A patient of mine who is at a group home has a stupid form I am required to fill out about their visit every time they see me. This form requires me to specify the reason for the visit and wants me to circle one of 3. One is med eval, and one is "90-day med check". I make a point of crossing out the latter and just writing "f/u appointment" over it every single time.

 

[calvnandhobbs68]

A patient of mine who is at a group home has a stupid form I am required to fill out about their visit every time they see me. This form requires me to specify the reason for the visit and wants me to circle one of 3. One is med eval, and one is "90-day med check". I make a point of crossing out the latter and just writing "f/u appointment" over it every single time.

I've found therapists in some situations perpetuate this language as well, almost as if they're conveying to patients they're just seeing us for a "med check" and seeing them for the real therapy or something.

I don't even know where this language came from, why isn't "new patient appointment" and "followup appointment" fine enough....

 

[nexus73]

I've found therapists in some situations perpetuate this language as well, almost as if they're conveying to patients they're just seeing us for a "med check" and seeing them for the real therapy or something.

I don't even know where this language came from, why isn't "new patient appointment" and "followup appointment" fine enough....

I always assumed the prescriber term originated in community mental health centers largely run by masters level therapists. Likely not thought of as derogatory initially, but it certainly does imply the therapist can do everything the MD can do, just not the prescribing part

 

[michaelrack]

The one that really gets me is national KP wants everyone to start calling our department "Mental health and wellness."

At least that name is better than "Department of Behavioral Medicine and Psychiatry". Any use of "behavioral medicine" in a department name leads to the misconception that we are using medications to make people (especially C and A patients) behave.

 

[Merovinge]

At least that name is better than "Department of Behavioral Medicine and Psychiatry". Any use of "behavioral medicine" in a department name leads to the misconception that we are using medications to make people (especially C and A patients) behave.

What's really tone deaf is that the current generation is all about mental health and using that specific term for it. I can't tell you how often I hear "for my mental health..." or "xyz impacts my mental health". Calling it behavioral health to avoid saying mental health is just seen as hand-wavy weird adult thing by current teens.

 

[Stagg737]

"Prescriber" always irritated me. We aren't just pill pushers. But I never understood the sensitivity some physicians on these forums have to being called a provider. It's a generic, catch-all word that is convenient to use and appropriate in some contexts, in my opinion, e.g. "PCP" means primary care provider which could be an MD, DO, PA or NP. I may tell the patient to go back to their PCP for this or that, and I don't have to stop and think about which type of provider they are seeing as their PCP. I refer patients to a particularly gifted endocrinologist but they often end up getting seen by her NP. I find that a bit irritating but what can you do? I don't think "provider" is purposely used to obfuscate or blur the roles of various healthcare professionals so patients think they are all the same. I see physicians use the word "provider" all the time. If you want to always refer to yourself as "physician" or "doctor" to your patients, more power to you. Nothing wrong with that. You're entitled to feel how you feel but I think it's a bit silly that some of you physicians get your panties in a wad over being called a provider. It isn't personal and it isn't meant to insult you.

Saw that this wasn't addressed the but the origin of the issue with the term "provider" is that it was a form of anti-semitism utilized by Nazi Germany. Most pediatricians in Germany at the time were Jewish and at some point (I believe in the late 1930's) Jewish pediatricians (and later all Jewish doctors) were referred to as the German word for "provider" and were not allowed to be referred to as "doctors" to distinguish between Jews and non-Jews. Regular use of the term "provider" in healthcare nomenclature in the US didn't occur until much later, and was initially used to describe larger organizations. Modern use of the term was not meant to be discriminatory and was generalized to physicians, mid-levels, etc after being an identifier for larger entities, but the supposed** origin of the term is still explicitly derogatory in nature.

**ETA

 

[clausewitz2]

Saw that this wasn't addressed the but the origin of the issue with the term "provider" is that it was a form of anti-semitism utilized by Nazi Germany. Most pediatricians in Germany at the time were Jewish and at some point (I believe in the late 1930's) Jewish pediatricians (and later all Jewish doctors) were referred to as the German word for "provider" and were not allowed to be referred to as "doctors" to distinguish between Jews and non-Jews. Regular use of the term "provider" in healthcare nomenclature in the US didn't occur until much later, and was initially used to describe larger organizations. Modern use of the term was not meant to be discriminatory and was generalized to physicians, mid-levels, etc after being an identifier for larger entities, but the origin of the term is still explicitly derogatory in nature.

This turns out to be spurious, although it doesn't make me like the term any more:

Physicians or “Providers?” Inventing Nazi Origins Undermines Debates on Medical Professionalism - Journal of General Internal Medicine

link.springer.com

 

[comp1]

I mean, everyone had to know that sort of thing was spurious, right? Honestly. You can be upset about something, but bringing Nazis into a discussion is rarely helpful.

 

[Stagg737]

This turns out to be spurious, although it doesn't make me like the term any more:

Physicians or “Providers?” Inventing Nazi Origins Undermines Debates on Medical Professionalism - Journal of General Internal Medicine

link.springer.com

Partially? Here's a PubMed link to the original article referencing this: Jewish pediatricians in Nazi Germany: victims of persecution - PubMed

I had originally heard about this from Jewish attending while I was in medical school (2017) before the blog post the authors in the article you posted cited. I also agree that the comparison the article posted brings up is pretty ridiculous (ie, if you say "provider" you're a Nazi) give the source article, but I'd heard of this before 2019 given the rant I recall from an attending about it. The translation may not be completely baseless, even if the blog post was sensationalist and disingenuous (though idk why my attending would have been so angry if that blog post was really the original source...). I googled several translation apps/services for "krankenbehandler/behandler" and there's a lot of variability... Examples:

Google translate: medical practitioner
Cambridge Dictionary: nurse
Translate.com: nurse
DeepL: health care provider (health care practitioner is an alternative translation)

Most translate "behandler" as just "handler" or sometimes "practitioner" or "treater" and "kranken behandler" (with a space) as "sick practitioner" or "sick handler". Seems like "practitioner" was actually a more common translation, so idk. The article I posted (original article considered the source of the translation) was a general translation of "behandler" to "provider" and that the author wasn't implying that the English term "provider" was problematic, just offering the (non-definitive) English translation of the offensive term ("behandler"). Either way, like I said the modern use wasn't based on a translation of a German term, it was the result of a defined legal term being expanded to be applied to individuals. Could be a weird coincidental (or dubiously intentional) example of a convergent evolution of language. You're the language expert though, so I'd defer actual knowledge on linguistics, lol.

 

[clausewitz2]

Partially? Here's a PubMed link to the original article referencing this: Jewish pediatricians in Nazi Germany: victims of persecution - PubMed

I had originally heard about this from Jewish attending while I was in medical school (2017) before the blog post the authors in the article you posted cited. I also agree that the comparison the article posted brings up is pretty ridiculous (ie, if you say "provider" you're a Nazi) give the source article, but I'd heard of this before 2019 given the rant I recall from an attending about it. The translation may not be completely baseless, even if the blog post was sensationalist and disingenuous (though idk why my attending would have been so angry if that blog post was really the original source...). I googled several translation apps/services for "krankenbehandler/behandler" and there's a lot of variability... Examples:

Google translate: medical practitioner
Cambridge Dictionary: nurse
Translate.com: nurse
DeepL: health care provider (health care practitioner is an alternative translation)

Most translate "behandler" as just "handler" or sometimes "practitioner" or "treater" and "kranken behandler" (with a space) as "sick practitioner" or "sick handler". Seems like "practitioner" was actually a more common translation, so idk. The article I posted (original article considered the source of the translation) was a general translation of "behandler" to "provider" and that the author wasn't implying that the English term "provider" was problematic, just offering the (non-definitive) English translation of the offensive term ("behandler"). Either way, like I said the modern use wasn't based on a translation of a German term, it was the result of a defined legal term being expanded to be applied to individuals. Could be a weird coincidental (or dubiously intentional) example of a convergent evolution of language. You're the language expert though, so I'd defer actual knowledge on linguistics, lol.

I think the telling part is that (and the person who posts on here who is a resident in a German-speaking country can absolutely weigh in) it does appear that German speakers don't perceive this term as equivalent to provider, that would be Anbieter.

The real stretch is trying to link a thing the Nazis did in the 30s with the mindset of people writing the Medicare bill in the 60s. Given it's clearly not a borrowing directly from German but a calque at best, you need to demonstrate that these authors were in some way aware of this term. 'provider' existed as an English word in other non-healthcare contexts well before this, like since the 15th century. Given the lack of equivalent usage, phonological similarity and the fact they are not etymologically related, why is there any reason to believe the existence of this German term influenced a new usage of a centuries-old English word?

 

[comp1]

Any time you reference the Nazis for your point, you need to be on the firmest of ground because the chance of becoming offensive is massive. This, most certainly, is not even resembling that standard.

 

[nexus73]

To OP's original issue, I'd want to change whatever supervision contract you have to allow for some type of compensation, like hourly billing, for onboarding and other logistical time required to facilitate the NP starting work. You're working for free with all these interviews and paperwork.

 

[Stagg737]

The real stretch is trying to link a thing the Nazis did in the 30s with the mindset of people writing the Medicare bill in the 60s. Given it's clearly not a borrowing directly from German but a calque at best, you need to demonstrate that these authors were in some way aware of this term. 'provider' existed as an English word in other non-healthcare contexts well before this, like since the 15th century. Given the lack of equivalent usage, phonological similarity and the fact they are not etymologically related, why is there any reason to believe the existence of this German term influenced a new usage of a centuries-old English word?

Right, I'm not saying it did. That was my point about it being like convergent evolution in language. Same/similar term ("provider") being found offensive by different groups (Jews and physicians, with overlap obviously) for different reasons. To the bolded, because of the 2006 article which "freely" translated "behandler" to "provider". I'm not saying that what actually happened or true, but that appears to be the source the early arguments utilized.

I mean, everyone had to know that sort of thing was spurious, right? Honestly. You can be upset about something, but bringing Nazis into a discussion is rarely helpful.

Any time you reference the Nazis for your point, you need to be on the firmest of ground because the chance of becoming offensive is massive. This, most certainly, is not even resembling that standard.

I don't disagree, but I've heard quite a few physicians (Jewish and otherwise) make the statement of provider having Nazi origins as a matter of fact, one even before the 2019 article clausewitz posted which appears to be where that idea gained traction. I brought it up because I had heard this so many times and there was an actual historical reference, though I also clarified in my post that while some docs find "provider" offensive d/t the supposed connection to Nazi Germany that this was not how the term became pervasive in the US health system.

 

[ObsequiousAplomb]

Right, I'm not saying it did. That was my point about it being like convergent evolution in language. Same/similar term ("provider") being found offensive by different groups (Jews and physicians, with overlap obviously) for different reasons. To the bolded, because of the 2006 article which "freely" translated "behandler" to "provider". I'm not saying that what actually happened or true, but that appears to be the source the early arguments utilized.




I don't disagree, but I've heard quite a few physicians (Jewish and otherwise) make the statement of provider having Nazi origins as a matter of fact, one even before the 2019 article clausewitz posted which appears to be where that idea gained traction. I brought it up because I had heard this so many times and there was an actual historical reference, though I also clarified in my post that while some docs find "provider" offensive d/t the supposed connection to Nazi Germany that this was not how the term became pervasive in the US health system.

I also had the experience of elderly Jewish attendings saying emphatically and before 2019 that they felt the term had Nazi origins. I've definitely heard a number of rants on the topic.

 

[clausewitz2]

I also had the experience of elderly Jewish attendings saying emphatically and before 2019 that they felt the term had Nazi origins. I've definitely heard a number of rants on the topic.

Well, sad to say, they had no idea what they were talking about.

 

[ObsequiousAplomb]

Well, sad to say, they had no idea what they were talking about.

I mean, I knew that based on what they said about psychiatry too