Why I Never Use the Term “Provider”
Is medicine really a business?
When future doctors choose to go into medicine, very few of them see it as a business venture. If a person wanted to start a lucrative business, there are much better avenues to take in order to make money—avenues that require fewer years of training, less stress, and more sleep. It’s not the idea of owning a business—or working for Big Business—that attracts people to medicine. Most people pursue medicine because they want to help others. Some even see it as a calling, a way of life.
This is why it can be so disappointing and demoralizing to work in healthcare in the United States today. Our healthcare system is largely based on a fee-for-service model where clinicians and hospitals are reimbursed for the “things they do”—the tests ordered, the procedures done, the visits completed. As a result, a clinician’s time and energy is commodified, their productivity is calculated, and their success is measured in “relative value units” (RVUs) generated for the system. As healthcare writer and former Administrator of the Centers for Medicare and Medicaid Services Dr. Don Berwick wrote in a recent article in JAMA, “The grip of financial self-interest in US healthcare is becoming a stranglehold, with dangerous and pervasive consequences. No sector of US healthcare is immune from the immoderate pursuit of profit, neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices.”
Our fee-for-service model that renders our healers as “providers” and patients as “consumers,” dictating the time clinicians can spend with patients and how many patients they must see in a day, inevitably diminishes the kind of care clinicians can offer. Reducing relationships to market exchanges and limiting our responsibilities to others by conceiving of them only as contractual obligations defies the reasons why people go into medicine in the first place. When we see medical practice through the lens of market logic, it undermines healing, disincentivizes compassionate connection, and prevents both patients and clinicians from really seeing each other and the ways we all suffer. As Berwick puts it, “Professionals find themselves trapped in record keeping, coding behaviors, and productivity imperatives that belie the reasons many went into healthcare in the first place. ‘Moral injury’ is the harvest, with demoralization and disengagement to follow.”
It is this moral injury—knowing what care patients need but being unable to offer it due to constraints of a broken healthcare system—that is causing our clinicians so much pain. And, contrary to what many might say, the remedy is not helping our clinicians become “more resilient.” Derived from the Latin word resilio, meaning to rebound or bounce back, resiliency speaks to adaptation in the face of adversity and perhaps even returning stronger afterwards—something many clinicians do every day. In fact, a study in JAMA found that physicians have significantly higher resilience scores than the general employed US population. It is this resiliency that helped them endure the rigors of training to even become a physician. So, our already resilient clinicians do not need to become “more resilient” to the crushing environment of market-driven medicine; rather, we need to take a hard look at what we want from our healthcare system and what we really value in our shared society. Is it morally acceptable that medical debt is among the top two main causes of bankruptcy in the US? That 58% of all debt collections in the US are for medical bills? That not-for-profit hospitals are closing services in poor areas while opening new services in wealthy suburbs—all the while top executives of health systems are making multi-million dollar salaries off the backs of frontline healthcare workers and sick, vulnerable, and even dying patients?
These are not the reasons anyone chooses a life in medicine.
Caring for patients is not a market exchange, and clinicians are so much more than “providers” of healthcare goods. Clinicians are healers whose value can never be measured in dollars and cents.
