Discussions

Do you say “Physicians” or “Providers”?

Posted by Matthew Rehrl @matthewrehrl, Dec 18, 2019

"Providers" or "Physicians"?

Does your organization use the term providers or physicians? Why?

I am bringing this up because there is a fairly sizable percentage of physicians who are deeply offended by being called a provider, and you may want to be prepared when you run across them.

Roughly the argument goes something like this:.

"I spent 8-10 years in training and went $130,000 in debt to earn my right to practice medicine as a physician. I carry significant liability with every patient I see, and my scope of practice is vastly more complicated than other 'providers.' I have earned the right to be called a physician."

Large medical groups, such as the American Academy of Family Practice, also have formal statements against using the term providers for physicians. https://www.aafp.org/about/policies/all/provider-term-position.html

Roughly I would say that of about the 30-40% of the physicians who have thought about our imposed name change – it upsets about 95% of them.

How much does it upset them? Well, if you ever read a physician social media site such as Doximity, it probably elicits more negative reaction than any other single topic.

Is this an over-reaction? Perhaps. But consider this: if it's your child who has a subdural hemorrhage and needs immediate surgery – do you want them to see a "provider" or a "surgeon"? (Surgeons are particularly offended by being called "HCPs" :o))

Why organizations have chosen to use this term is interesting to consider. Superficially, the argument may be is it simplifies brochures, websites, social media, insurance firms, etc, and therefore it's simply part of the org Style Guide to make documentation easier.

At a slightly deeper level the term "provider" may have a more "democratizing" feel, and I think most leadership tend to justify the use of the term with words like "team" and camaderie, and everyone – nurse practitioners, physician assistants and physicians have equal value. Arguments which are reasonable as far as they go. ( As an aside, for certain things Nurse Practioners and PAs are indeed more profitable than physicians).

Anyway, I personally think there is something much deeper going on. I believe that along with the growth of technology and organizational size, there is an inevitable drift towards dehumanization, and the change of vocabulary from physician to provider has the same source as changing patients into "customers" (or even worse healthcare "consumers").

Incidentally, because I, myself, believe this drift is inevitable, I tend not to worry too much about the term provider, just as I tend not to worry about it raining in Seattle. It simply cannot be changed.

But for people who are in marketing and who occasionally are in a position to consider word choice, just be aware of potential derogatory nature of this word to some of your staff.

And one area of particular attention? Take a look at the terms you use on your recruiting page. Are you recruiting physicians or providers?

We use the word providers because we have medical providers that are not just physicians. We have people with titles of PA-C, ARNP and other titles that are also considered medical providers.
This also deter someone less willing to get medical attention from that provider just because the word physician isn't attached to their name.

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We market to several audiences (patients, CEO's, MDs, PAs, NPs, etc.) so we use the term "providers" for a few reasons. 1. We don't have the space in all of our marketing materials to say "physicians and providers." 2. Simply saying "physicians" can make a NP or PA think we can't/won't work with them for treating patients. 3. With the doctor shortage, there seems to be a shift toward more mid-level providers to fill the gap.

But this really makes me wonder if we should customize some of our pieces more when targeting some specialties. No matter what you do in this situation, you're bound to frustrate someone.

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I think @lynkeren Brings up a great point.

Administrators know that-rightly or wrongly- some patients would prefer seeing physicians rather than nurse practitioners. Isn’t this the reason to clearly differentiate them?

Keeping in mind there is an organizational incentive for patients to see NPs and PAs rather than physicians, at what point does this border on a bait and switch scheme?

(Again, I Personally am neutral, but I think it’s important for marketing folks to be aware that some vocal physicians will attack the use of the term “provider“ on ethical grounds).

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@bethdavidson brings up the physician shortage and she is right too – up to 122,000 physicians over the next 12 years:
https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage
With this in mind, take a look at how your website, LinkedIn and social media efforts recruit different groups uniquely. Personally I think each Group warrants their own unique approach.

You may get a surprise. I recall seeing job postings for neurosurgeons next to receptionists without even an attempt to approach their recruitment differently.

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@matthewrehrl

I think @lynkeren Brings up a great point.

Administrators know that-rightly or wrongly- some patients would prefer seeing physicians rather than nurse practitioners. Isn’t this the reason to clearly differentiate them?

Keeping in mind there is an organizational incentive for patients to see NPs and PAs rather than physicians, at what point does this border on a bait and switch scheme?

(Again, I Personally am neutral, but I think it’s important for marketing folks to be aware that some vocal physicians will attack the use of the term “provider“ on ethical grounds).

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I think it depends on each organization really. We prioritize and treat our physicians and mid-levels with the same respect in marketing, even if they are just part time. I don't believe (from my perspective) we have any physicians or mid levels that don't like the word provider. We provide trusted, quality medical care. I don't believe they see it as they are providing a service, as if they were a robot.

And even if someone is not trying to create that bait and switch scheme, it sometimes is just easier marketing and organization wide. Like @bethdavidson said, having to create pieces that had physicians, then ARNP, then PA-C, then other mid-levels would be a lot of time not only for the marketing team but even the patients. This is one less step for them and us.

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Here's a link to one of the local organizations in Seattle (Virginia Mason) which makes a specific effort to recruit physicians as physicians. https://www.virginiamason.org

Notice how easy it is to find physician openings on a single web page that is devoted strictly to physicians.

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I'm sending this thread to our Marketing and Internal team. Apparently, there was a very heated debate between our doctors over this very topic a few weeks ago. Some took great offense at "providers," while others had a "lighten up Francis mentality." I had no idea. I've never used provider in what I write for our newsroom.

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Whoops. I must be dating myself ( that is, I am old!) because I low-balled the average physician medical school debt, which is now about $196,000.

The challenge superimposed on this debt is the average residency salary is <$60,000 per year, which means most of that student debt gets deferred ( ie larger) over the ensuing 3-5 years).

Personally I don't think this is a valid argument (I am more concerned about over-digitalizing every facet of both providers and patients and in a sense representing people as data-sets) but financial stress, and other factors such as work hours (80+/week for residents) and delaying life events such as marriage and children can stoke the fire over what is a seemingly small vocabulary change.
https://www.nerdwallet.com/blog/loans/student-loans/average-medical-school-debt/
Oddly, I've seen another subtle change in some organizations, now referring to "healthcare" as "health care" ( See United Health/Optum). I haven't quite sorted out the why of this – perhaps it's a way to market oneself as more prevention-focused rather than treatment/disease-focused?

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Interesting topic, @matthewrehrl I am only a patient/customer/user/seeker/etc. As such I think it would be interesting to know what your audience prefers.

In a recent job I was a fundraiser. All too often the organization would decide we needed a different title. Fundraiser, development, resource advocate, etc. When I'd go on the road to see our donors everyone one of them just called me a fundraiser.

Our son just went through a cardiac trauma and believe me, while the parade of people came through talking to us about his several options we cared a TON about who they were in terms of a surgeon, nurse practitioner, RN, cardiologist, qualifications, length of service, etc. They each carried their own weight and interest. I loved when one surgeon came in and referred to herself as a 'provider'. Our son asked 'What do you provide? My lunch?' To all of us 'provider' stinks of industrial healthcare. Likewise calling my son a customer or consumer tells me the same thing, especially after he was an inpatient…Corporate is running the show from somewhere.

Just my two cents, plain.

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Thank you Scott for your thoughtful response. And I am “only” a provider. However, I think there is another thing we (as in the very delicate interaction between physician and patient) are at risk of becoming, and that is the product.

Very recently Amazon released Transcribe Medical ( https://aws.amazon.com/transcribe/medical/) which is a conversation transcribing service which links with their EHR data-mining service, effectively allowing all conversations between pt/provider to be uploaded to the cloud and analyzed.

Although this could offer some benefit to the patient, I think the bigger question for this service is who is the real customer? If it is the corporation, then I suspect it’s going to be driven by words like efficiency, maximizing revenue, throughput, etc.

I also am concerned that ubiquitous monitoring and storage of conversations between physician and patient which change the fundamental nature of the conversation.

Anyway, this is somewhat far afield from the original topic, but this is what I mean about a subtle drift in healthcare to digitize people and their interactions. Lots of potential, but lots of downside, too.

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Good day, @matthewrehrl I agree this issue is related and I harbor significant concerns over digitized patients. Just wait until the insurance companies begin buying all this data to catalog each of us as to what they will cover, what they won’t, and with our DNA, what they will consider unacceptable, potential uninsurable risk.

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We distinguish "physicians, providers, and staff." It's not for the benefit of the physicians, but because in the perception of some patients, "physicians" has more weight than "providers." Our communications colleagues for our physicians also prefer "physicians" to "doctors." I assume it's to emphasize that they are MDs (and other clinical degrees) and not just PhDs.

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I'm surprised nobody has brought up "doctor" vs. "physician." If we're talking about people with an MD, our style is to use the word "doctor" in patient-facing materials, because it's shorter, easier to read, and lay people use it more in Google searches (although I haven't seen recent research about this.) I recently went to a session on health literacy and it was pretty eye-opening. I would encourage everyone to do the same and to involve a health literacy expert in style guide decisions for patient-facing materials.

Our site navigation says "Find a Doctor." But in copy, if we need a broad term to apply to anyone who sees patients, we tend to use "providers." I've never heard an MD complain about it, and we have a very vocal contingent of nurse practitioners and others who would throw a fit if we simply said "doctor." Our leadership prefers "team" over "employees," but I also try to avoid that in external communications so nobody thinks we're talking about a sports team.

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Megan – I think you are dead on to having a nuanced approach to these terms, especially for patient-facing materials. What I find curious, however, is the lack of this nuance on many provider/physician recruiting web pages.

when I have discussed this with COOs and Chief Medical Officers ( who usually are the deciders in this), I remind them that from a strictly financial perspective a typical New Patient capture might be worth $30,000 of RVUs over 10 years, whereas a typical New Physician Capture may be worth $10,000,000 of RVU generation over 10 years, so it is essential, especially considering how few people visit the Physician and Provider recruiting page relative to the homepage, to put your very best website design people on this page, and to track this page at least monthly.

I cannot imagine a physician or NP hiring on to an organization without going to the recruiting page at least once ( and more likely 5-6 times).
Put simply from a revenue perspective, the physician recruitng page is, far and away, the second most valauble digital real-estate on most healthcare orgqanizations entire website.

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@matthewrehrl

Here's a link to one of the local organizations in Seattle (Virginia Mason) which makes a specific effort to recruit physicians as physicians. https://www.virginiamason.org

Notice how easy it is to find physician openings on a single web page that is devoted strictly to physicians.

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I like what Virginia Mason has done with their careers page. We've done something similar on ours at https://www.lmh.org/careers. We're clear that you can find jobs for physicians in one dedicated section and for other opportunities by clicking in our callout.

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