I Am Not a Provider.

jordan shlainThis is the fourth in a never ending series of screeds that attempts to crack open words that are misused, misguided misnomers in the healthcare arena.

“Provider” is a substantial, material word that will require a medical sledgehammer to crack open…and what we find inside this 8-letter facade will turn your stomach and give a new sense of appreciation for it’s history.

First, before the healthcare system adopted and mangled this well-meaning word, it was not a healthcare word. It had real meaning rooted in family life; the head of a household provided for their family. It was rooted in substance and survival. There was an aura of pride and dedication in being that family

Sadly, healthcare has an clumsy tendency to mangle and maim its lexicon….and has rendered provider a hollow noun, a shell of its former self.

As physicians and clinicians we provide a service to people who are sick, worried or dying….as we have since the days of shamans, medical men and healers. So, why and how did the word provider rise so rapidly? If you look at any historical literature or descriptions of healthcare, there are sparse references to medical professionals as providers.

I recall my father, a surgeon, telling me when I was seven years old,

Son, they are trying to de-professionalize medicine. These HMOs and large insurance companies are using language to relegate us to a generic noun from a professional noun. By stripping doctors of our laurels, they will own the narrative…and he who owns the narrative, owns the future”

At the time, I had no idea what he was talking about…but he was prescient.

Shoe, meet other foot:

Do we call executives healthcare insurance companies or hospitals chief supervisors or Vice Managers ? No, we don’t. We call them chief executives or vice presidents; there is respect for the nomenclature of their station in the hierarchy. We honor their professional noun.

Hospital v Hospitality

Is healthcare a product or a service? It is a service that is often productized…but let’s be honest, healthcare is a service at its core.

Sadly, however, it’s a one-star service industry in an economy where most strive to be at least 3-4 stars and only the fanatical few earn the right to project the 5-star service label.

It’s interesting that the word hospital and hospitality are separated etymologically by the suffix ‘ity’; yet the difference between hospitals and hotels is really anything but‘ity’. The delta is huge! A three-star Holiday Inn crushes the service level of a hospital.

In fact, there couldn’t be a bigger gulf from market-driven, hospitality-oriented service business (that, succeeds or fails, based on their ability to deliver on the service) and the hospitals that wish they could add the ‘ity’ to their last name.

Sorry for the digression. Back to provider….

Providers in healthcare provide services, right? (Grabbing my word cracker now J)

Human v Non-Human

The first whack will crack provider into two distinct pieces; human providers andnon-human providers.

Human providers, are those that you see when you’re sick; a doctor, nurse, allied healthcare professional or caregiver. In business parlance, these types of providers cannot scale themselves. That is, they can really only do one thing at once. Most importantly, human providers have the capacity and a proclivity for empathy.

Non-human providers are generally large actors in the medical industrial complex; hospital systems, radiology facilities, dialysis centers and laboratories just to name a few. Non-human providers can scale, and as a result they make a lot of money. Non-human providers cannot possess empathy themselves.

Here is the problem: if we use provider to mean both human and non-human providers, we are immediately conflating two very distinct groups with very different attributes and goals.

Large, multi-billion dollar hospital systems are labeled providers.

Solo doctors are labeled providers.

A family member can be a provider.

Can we really use one word to describe the rich contours of multiple different actors?

Repeat after me (again)

When referring to a human provider, I will use doctor, physician, nurse, allied health professional or caregiver. If I want to refer to human providers en bloc, then call them clinicians or medical professionals.

When referring to a non-human provider, we should use Hospitals and other descriptive terms. In aggregate, call them healthcare institutions.

To expose the absurdity of this word, allow me shatter the remaining shell of that word:

M.D. or M.P. ~ R.N or R.P.

Last time I checked Georgetown Medical School didn’t give me a Medical Provider degree, did they?

I received an MD – Medical Doctorate. Nurses earn an RN (registered nurse), not an RP (registered provider).

It really only takes a few extra syllables to be precise. Collectively, we need to stop the subversive attempt by the medical-industrial-complex to own the narrative by professionalizing the physician and clinician class. We have become linguistically lazy and intellectually negligent which is preventing us from having legitimate conversations about how healthcare can evolve and what it is at its core: people helping people.

Do you want to be generic?

If we call doctors and nurses providers, we should call anyone in the service of anyone or anything providers also…and that, my friends, would be almost everyone, including you~

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11 replies »

  1. Actually, Jordan, you start to get it right at the end. “Provider,” in context, means provider of health care services, not provider of any services. (Context, remember? It has no ideological/ethical/professional implications whatsoever except as the invention of a collective noun. Much as docs like to get on their high horse about it — which I understand, but, hey, if you promise never to use the term “content provider” or any other collective noun any other group doesn’t like — we’ll think about it. 🙂

    Yes, people, you still choose a “doctor,” not a provider. It’s a convenience word. Here to stay.

  2. In my experience, if your an independent doctor with your own practice your called doctor or physician. If you are part of an entity like an HMO / IPA / Hospital, or a Hospital/Physician system, and if you interact with the insurance companies through that entity then your referred to as a provider.

    I think this is because these “entities” have financial teams, CEO’s, non-medical staff, etc. Once you are in that group, you as a whole provide healthcare services. But individually, doctor or physician is better suited.

  3. It is worse than that. We are doing windows and floors for hospital administrators and insurance cos. Calculate your hourly wage after you finish all of the clicks and check boxes and then look at the SEC filings for Aetna and others and review the compensation packages of the CEO. When you are done, take a look at the 529’s for the charitable hospitals at which you work and read of the compensation and perks of your CEO.

  4. There may be other doctors who could address this contentious topic with Dr. Schlain’s wit & elan, but I know I have not met them – and having met the good Doctor S, I would have expected nothing less.

    He can doctor circles around most doctors, and write circles around most writers – you have to ask yourself, what CAN’T the man do?


  5. “isn’t your doctor, its the system”

    john, your comment could have been duplicated to Dr. Shlain, tell him “it’s the system”.

    What does he want, more respect, more money, better patient care, change the “system”? If I call him anything but a provider will I have to pay him more?

    If he wants a better way to serve patients he can stop fighting the “last war” and get off the grid and go cash only. More time with patients, less billing/admin/manager staff to chase insurance, lower cost to patients and as much or more “reimbursement”, oh sorry, “payment”, oh wait, maybe “compensation”, no it’s got to be “gratification bucks”, that’s it.

  6. The administrator at the hospital where my wife worked about 10 years ago was not aware that a cardiologist was not the same as a cardiac surgeon, so yeah a provider is a provider, period.

    And, Peter1, I agree with you, the drive to move patients through like cattle has eroded the nature of the patient-physician relationship, further encouraging the “provider” title. However, there are many of us who choose not to practice that way.

  7. @Peter1 it sounds like you deserve a provider …

    or possibly a practitioner

    or better yet a prompt

    another in a long series of anti-doc comments

    dude, you’re fighting the last war – maybe even the war BEFORE the last war

    the reason you get 15 minutes or 10 – or 5 – isn’t your doctor, its the system

  8. I’m no longer a “writer,” I’m a “content provider.” Conversely, your garbageman is now an “environmental professional.”

  9. Thank you DOCTOR Shlain!!!

    I repeatedly reinforce (in vain, no doubt) your observation that I went to “DOCTOR school,” and not “provider school.”

    Like you, my degree says “DOCTOR” and not “provider.”

    However, you failed to mention the number one driver of this “lowest common denominator” terminology – it is the mid-level “provider.” It is precisely because insurance companies, the US government, the states, healthcare entities, hospitals, and the like that they all view physicians, podiatrists, mid-levels, herbologists, acupuncturists, etc. as synonymous, fungible, and interchangeable.

    It matters not to them whether I went to school for 26 years (12+5+4+5) or 13. It only matters what I charge (or what they will pay) for my “provider services.” Until this changes, we will continue to be addressed by all of the entities I noted (and more) as “providers.”

  10. Doc, you’ll stop being a “provider” when you stop trying to get me out of the office in 15 minutes or less to get “effective” billing.