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Commentary

PA

Provider or professional?

Phillips, William R. MD, MPH

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doi: 10.1097/01.JAA.0000892744.97285.d3
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During this COVID-19 pandemic, I have been careful and lucky to avoid infection. I did have a bout of upper respiratory infection symptoms that led me to the urgent care clinic for a COVID-19 test. I was seen by a clinician dressed in scrubs wearing an ID tag showing his name and the title “Medical Staff.” He introduced himself by name only. I offered that I was grateful they could work me into the day's busy schedule and asked what kind of clinician he was. He replied that he was a “medical care provider.”

I asked him “what kind of medical care provider,” and he replied, “I'm a member of the medical staff.” So, I pushed a bit further and asked what his qualifications were. Only then did he tell me he was a certified physician associate/assistant (PA).

“Great,” I replied, and our brief clinic visit unfolded with expertise, professionalism, and excellent communication.

As a profession, PAs refused, early and wisely, to be labeled midlevel practitioners. Now they need to refuse the degrading label provider.

The P-word is a threat to our practices, our professions, and our patients. Growing numbers of professionals share concerns about the pernicious use of the term provider.1,2 It may be most common among physicians, but all caring professionals should be alarmed at its use. The term is not inclusive; it's dismissive.

Embrace a better term, more accurate, descriptive, and personal. The term clinician almost always fits best. Sometimes prescriber, operator, or therapist works. Professional is always appropriate.

The term provider is a tool of the corporate machine—the medical-insurance-industrial complex—to commoditize both professionals and patients.3 We are all familiar with providers of internet or telecommunication services, oxygen, durable medical equipment, and commercial goods and services. Providers transact business with customers. Professional take care of patients. A provider is more impersonal than a PA, NP, or physician. The impersonal becomes the interchangeable. It's easier to manage interchangeable widgets than caring clinicians on the schedule spreadsheet. It's easier to buy and sell contracts per patient per month than to provide patient-oriented care.

The power of the patient-clinician relationship scares managers to death. They can't measure, manage, and manipulate it with their MBAs and LEAN schemes.

The persistence of provider calls for action. Don't respond to memos addressed “To providers.” Avoid provider meetings. Explain that you are a PA, physician, or NP, not a provider; the notice doesn't apply to you. Push your professional organizations to take an official stance against the term provider, avoid using it in their communications, and alert members to the perils of the P-word.

At the end of my clinic visit, I asked why his nametag did not identify his profession, and he explained that was the policy of the clinic corporation. I gave him a brief spiel on how the term provider carried risks for both the patient and professional. I assured him that I was happy to be seen by a PA but that I would feel better if I was seen by someone who was proud to be a PA.

Then I explained a key clinical outcome of our visit.

“When I leave the office today, I'm going to go out and get in the car where my wife is waiting for me. She will ask, ‘How did your visit go?’ I'll tell her that I was seen promptly and got excellent care from a well-trained health professional who skillfully addressed my needs and made me feel confident and well cared for. If all I had to go on were your nametag, that would be the end of the story. Only if your name tag identifies you as a PA can I include that into my story and be able to say, ‘I saw a great PA who took good care of me and made it an excellent visit.’”

No professional credential—no credit for professional care. How can our patients and the public understand and appreciate our training, qualifications, and professionalism if they don't know who we are?

Insist on being identified with your profession and qualification. You earned it. Your patients deserve no less.

REFERENCES

1. Goroll AH. Eliminating the term primary care “provider”: consequences of language for the future of primary care. JAMA. 2016;315(17):1833–1834.
2. Beasley JW, Roberts RG, Goroll AH. Promoting trust and morale by changing how the word provider is used: encouraging specificity and transparency. JAMA. 2021;325(23):2343–2344.
3. Phillips WR. Watching our words. Washington Family Physician. 2021;(Spring):12.
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