JORDAN SHLAIN, MD

This 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~