Physicians are confidants, advocates, leaders — but not providers, ACP says

Using the term “provider” for physicians turns medicine into a transaction that erodes the responsibilities, integrity and professionalism of doctors, according to the American College of Physicians.

The words used in health care have ethical and practical implications and should uphold, no undermine, the physician-patient relationship, according to ACP’s position paper, “Physicians are not Providers: The Ethical Significance of Names in Health Care.”

"The term provider is derogatory because it diminishes the physician-patient relationship,” ACP President Jason M. Goldman, MD, MACP, said in an accompanying news release. “Physicians are not providers, they are confidants, health advocates, and partners with patients, especially in times of medical need, bound by deep and longstanding ethical responsibilities.

“And patients are not merely consumers. They are individuals with dignity and unique needs,” he said. “This paper serves as an important reminder that words have meaning and should be used carefully and thoughtfully."

‘The P-word’

The position paper is not the first time ACP members and other physicians have advocated about terminology for doctors and other clinicians.

At the start of his ACP presidential term, Robert McLean, MD, created the “P-word” pledge, asking physicians to not use the word provider when referring to themselves and their peers.

“People stood, smiled, I got some claps, and several came up afterward to thank me,” McLean recounted for the Physicians Taking Back Medicine commentary and podcast, created by Rebekah Bernard, MD, with Medical Economics. “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.”

The term gained traction in the late 1980s and 1990s when insurers, health systems, and other care managers began grouping physicians with nurse practitioners, physician assistants, and other clinicians under a single, interchangeable label, McLean said. The latest position paper also outlined some history of the term in the rise of the “medical-industrial complex.”

Since then, physicians have bristled under the appellation that degrades their training and place of leadership in health care. Patients at times have been confused about who exactly is guiding their care.

“The current use of provider in reference to institutions, insurers, physicians, nurses, physician assistants, and other clinicians lumps impersonal entities in with humans and obscures differences in clinical training and expertise,” the paper said. “For patients, who need to be aware of the important and different roles of health care team members, such distinctions may not be transparent.”

Duties to patients, not commerce

Physicians have duties to patients that are different from the duties of other individuals and entities that deliver health care services. Meanwhile, “patients are not mere consumers; they have dignity and individual needs,” so doctors must act in patients’ best interests, even when the patients’ interest run counter to their own, according to ACP.

“The patient-physician interaction focuses on maintaining or improving the health of the patient,” the paper said. “This partnership is not transactional but rather relational, with the patient seeking care from a physician who is trained to help and bound by ethical duties to do so.”

Apart from the expanding use of the term, Authors Lois Snyder Sulmasy, JD, and Jan K. Carney, MD, MPH, noted the current environment. Commerce and economic concerns now outweigh professionalism, or the ethical duties of physicians and the needs of patients, in the U.S. health care system.

The position paper makes a formal recommendation: “Language in health care has ethical and practical. implications. Physicians should be referred to as physicians, not providers. Also, when describing professionals with varied credentials who care for patients, the terms clinicians or health care professionals, not providers, should be used.”