Avoiding the ‘P-word’: Why these physicians are taking the ‘no provider pledge’

“Please stand, raise your right hand and repeat after me: I pledge not to use the word provider when referring to physicians and, further, to encourage my colleagues to do so. You may be seated.”

So began rheumatologist Dr. Robert McLean’s inaugural address as 2019 president of the American College of Physicians (ACP) — and with it, his mission to eliminate the “P-word,” provider, as a term for physicians.

“People stood, smiled, I got some claps, and several came up afterward to thank me,” McLean recalls. “It kind of became my moniker. For the rest of the year, at every committee meeting, I would start with the ‘no provider pledge.’ If somebody slipped up and used the word provider, they had to throw a dollar in the kitty.”

More than six years later, McLean is still widely recognized among recent ACP physician leaders as the standard-bearer against the term. “At a recent AMA [American Medical Association] meeting, when the word ‘provider’ slipped into speeches by CMS Director Dr. [Mehmet] Oz and AMA CEO Dr. [John] Whyte, people sitting nearby would turn around and look at me and shake their heads,” he said. McLean notes that the AMA and other major physician organizations have a long-standing policy opposing the use of the term.

Although some may argue that fighting a word isn’t worth the effort, McLean and others believe replacing physician with provider represents far more than semantics. It reflects a deeper erosion of professional identity, clarity and trust in American medicine.

How ‘provider’ entered medicine — and why it stuck

The term provider gained traction in the late 1980s and 1990s alongside the rise of managed care and changes in Medicare payment structures.

“As insurers and health care systems sought to streamline contracts and reduce costs, it became convenient to group physicians, nurse practitioners, physician assistants and other clinicians under a single, interchangeable label,” McLean explains. “Medicare also began using the term ‘provider’ in statutes and regulations, when referring to health systems and delivery networks rather than just individual physicians.”

From an administrative standpoint, the umbrella term simplifies language. From a clinical and ethical standpoint, it obscures critical differences in education, training and responsibility.

“It effectively brought everyone to one level — elevating nurse practitioners and physician assistants,” McLean says. “But it fails to recognize the significant differences in physician training, and that leads to patient confusion.”

That confusion is no longer theoretical.

“In my interactions with patients, patients often believe they’ve seen a physician in different clinical settings,” McLean says. “When I explain that it was actually a PA or an APRN after I see the visit note, sometimes they’re surprised. Other times, they ask me to explain the difference.”

When titles blur, patients lose informed consent

Radiation oncologist Marsha Haley, M.D., MPH, a board member of Physicians for Patient Protection, sees this confusion daily.

“Just because someone calls themselves doctor doesn’t mean they’re a physician,” Haley says, noting that health systems may benefit financially from this ambiguity. “Clinics and emergency [rooms] can be staffed at lower cost without patients fully understanding who is providing their medical care.”

Pediatrician, author and columnist Niran Al-Agba, M.D., has also been a vocal critic of the term provider. She emphasizes that the issue is not ego — it’s honesty. “When you strip away titles, people assume we’re all the same,” she says. “But the training is not the same, and the sacrifice is not the same.”

Combining the word provider, white coats and marketing imagery can further obscure credentials rather than clarify them. Al-Agba points to a hospital social media post thanking “clinic providers” on National Doctors’ Day that featured a group of individuals in white coats.

“When you look at it, it’s striking,” she says. “You have six people with very different letters after their names, but they all look the same. They’re all described as ‘doctors,’ and patients are led to believe they can see any of them interchangeably.”

What the image doesn’t show, she argues, is the reality of training.

“It doesn’t say M.D./D.O.: 15,000 to 20,000 hours. ARNP: 500 hours,” Al-Agba says. “That’s the most insidious thing about the word provider. It was created to make everyone look the same.”

Training is not interchangeable

Drs. McLean, Haley and Al-Agba all agree that well-trained nurse practitioners and physician assistants can provide high-quality care in defined settings. But only physician training prepares clinicians to manage undifferentiated, complex or life-threatening conditions across the full spectrum of illness.

Physician education is highly standardized, rigorous and immersive: Four years of medical school are followed by residency training that often exceeds 20,000 hours of supervised clinical experience. By contrast, nurse practitioner education varies widely, with many programs now largely online and requiring far fewer clinical hours, often self-arranged.

“What makes physician training different is exposure to seriously ill patients, both inpatient and outpatient,” McLean explains. “The best way to recognize when someone is truly sick is by having seen a lot of sick people and following them through the course of illness. That typically happens in the hospital. If your experience is limited to wellness care and walk-in complaints, the exposure simply isn’t the same.”

For Al-Agba, that training came at a personal cost.

“Why would anyone want to become a primary care doctor anymore,” she asks, “when you give up your 20s — and then you don’t even get to be called a doctor?”

She believes the failure to acknowledge the sacrifice required to become a physician contributes to widespread moral injury.

Burnout, moral injury and the cost of erasure

Physicians today face declining autonomy, increasing corporatization and growing administrative burdens. Many are now employees of large systems that prioritize efficiency and margins over relationships and continuity. Against this backdrop, being reduced to a generic provider is more than demoralizing — it directly affects physician well-being.

“Language matters,” Haley says. “When institutions fail to recognize physicians distinctly, it sends a message that their training and sacrifice don’t matter.” With physician suicide rates roughly twice that of the general population, she argues, support and recognition are not optional — they are essential.

McLean believes reinforcing professional identity must start early. “When I hear medical students say ‘provider,’ I stop them immediately,” he says. “‘You’re not going to provider school,’ I tell them. The fact that it’s become part of their vernacular is gut-wrenching.”

What physicians can do

McLean urges physicians to speak up, consistently and respectfully. “This matters,” he says. “I am not a provider.”

When he hears the term used, he asks for clarification. “I’ll say, ‘Who are you referring to? The health system? The physicians? The PAs? The APRNs?’ I give them a menu of choices.”

Often, he says, people acknowledge the point, only to revert to the term later. “And then I remind them again,” McLean says. “You have to become the thorn in their side.” Over time, it starts to work. “Now, when the word comes up in meetings, people joke, ‘Robert probably doesn’t like that word,’ or ‘Robert, I see you making a face.’ It becomes an inside joke, but it also starts to stick.”

More than a word

At the heart of McLean’s objection is the idea that medicine is not a business transaction, but a covenantal relationship grounded in trust, responsibility and professional judgment.

“Marketplace terms must not be applied to the essence of what we do,” he says. “We help people who are suffering. We manage complex problems. We counsel patients on how to live — and how to die. Our work is relational, not transactional.”

He argues that the commoditization of health care — of which the word provider is a symptom — has enriched middlemen while weakening the physician-patient relationship that patients value most.

“Meaningful, trusting relationships take time and effort,” McLean says. “Physicians need to be at the forefront of taking that back.”

One simple place to start: take the “no provider pledge.”

Listen to the full episode of Physicians Taking Back Medicine, a podcast by Medical Economics, for an in-depth conversation on why language matters and how physicians can take back control of their profession.

Rebekah Bernard, M.D., is a family physician in Fort Myers, Florida, and the author of four books on health care topics.

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Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction to the "Provider" Problem (00:00:13) Overview of the episode’s focus on the term "provider" and its impact on physicians’ roles and identity.

The "No Provider Pledge" and Its Reception (00:00:36) Dr. McLean introduces the "no provider pledge" and describes physicians’ reactions to it.

Origins and Spread of the Term "Provider" (00:02:34) Historical background of the term, its use by insurance companies, and its effect on health care roles.

Confusion in Clinical Titles and Patient Perception (00:04:06) How patients are confused by titles, and the implications for care and professional identity.

Declining Standards in Nurse Practitioner Education (00:06:18) Concerns about the quality and rigor of nurse practitioner training and its consequences.

Legislative Changes and Nurse Practitioner Autonomy (00:07:36) Dr. McLean’s advocacy experience and the evolution of laws allowing nurse practitioners more independence.

Differences in Training: Physicians vs. Non-Physicians (00:10:10) Discussion of the rigorous, standardized training for physicians compared with other practitioners.

Personal Sacrifice and Physician Burnout (00:13:07) Dr. Al-Agba shares the personal costs of becoming a physician and the emotional impact of being called "provider."

Corporate Medicine and Physician Demoralization (00:15:14) How corporate health care, loss of autonomy, and generic titles contribute to physician burnout and suicide.

Propaganda and the Visual Blurring of Roles (00:17:12) Analysis of social media posts that visually equate physicians and nonphysicians, reinforcing the "provider" label.

Physician Reactions to Lack of Recognition (00:18:22) Doctors’ emotional responses to being grouped with nonphysicians and the importance of proper recognition.

Strategies to Reclaim Physician Identity (00:19:33) Dr. McLean discusses ways to push back against the "provider" term and reclaim professional identity.

Relational versus Transactional Care (00:21:22) Emphasis on the unique physician-patient relationship and the dangers of commoditizing health care.

Market Forces and Commoditization of Medicine (00:22:32) Discussion of how insurance and private equity treat health care as a commodity, harming the profession.

Comparison to Legal Profession and Final Thoughts (00:23:25) Comparison to law, concluding with a call for physicians to reclaim their identity and resist being called "providers."