Stanley Feld takes exception:
The term healthcare provider, in my view, has been constructed to decrease the value of physicians. The goal is to decrease reimbursement and distribute reimbursement for medical care delivered by physicians to others. The physician is now in the same category as the nurse, nurse practitioner, physician assistant, pharmacist, physical therapist, occupational therapist and dietician, to name a few. We are all referred to as healthcare providers by secondary stakeholders.
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{ 17 comments }
The egos of the providers are rather inflated. It will take some time to reverse the deification process put in place and expanded since the mid-1800s.
Whatever happened to the term,
“Caretaker”?
For some reason, the word “Provider” sound less compassionate than “Caretaker”.
I don’t agree with all this baiting talk about ego inflation. Most patients when they are alarmed about their health ask to see a doctor, not just a “health care provider.” That suggests a higher level of expectations and extra value-added with a doctor.
But expecting good treatment from an insurance company is unrealistic. When you agree to take payment from insurers, as opposed to holding the patient responsible for the bill in full, the back stairs treatment becomes inevitable. The insurer isn’t beholden to anyone except those that pay premiums and choose their company over others. That person sure isn’t the doctor, and frequently isn’t even the patient. But between the two, the insurance company is more beholden to the patient.
That relationship ought to continue through the entire doctor-patient relationship. To get there, doctors have to insist their patients pay them in full and that patients deal with their insurance companies (including Medicare) themselves. To a profession so used to the process of chasing dollars from third parties, that requires a little willingness to change. But it is the only chance the medical profession has to avoid the inevitable abuse that comes from third-party payment arrangements.
To those that argue that patients would be helpless against their insurers, reread. Insurance companies that didn’t make filing easy, convenient and quick would find themselves quickly replaced by those that did. And the very people who are most likely to control who gets the premium check would be those who could judge whether the payment was worth the trouble. Funny thing is, this is exactly how doctors and patients and insurers used to do business, so it isn’t an impossibility. But it does take a willingness to say “no” to the patient who tries to make his custom conditional on taking payment directly from the insurer. We have the object lesson.
Healthcare provider? No, the term you are looking for is “employee”.
It’s time that MDs learned that their expertise and hard work are no more valued by their employers than are the expertise and hard work of other technical employees.
If you want respect and a good income, then get a liberal arts or business degree, learn to play golf, join a fraternity, dress like an executive, avoid any responsibility, learn to be a politician, and kiss the appropriate ass and stab the appropriate backs. Also, don’t get old (over 40). Otherwise, you are just an H1-B visa from unemployment.
Anon 2:02.. yes, it is ego that makes me not want to be on an equal par with PA’s and NP’s, not the extra years of schooling and murderous residency and incessant licensures and fees and exams. Obviously all of these “providers’ know the same information and have equal skills.
So make sure you see an NP or PA in the future. they’re just like doctors. Arent they???
Bravo to all the comments above. For those who have a negative comment read my blog entry carefully.
http://www.stan.feld.com
I believe physicians have to take the lead to Repair the Dysfunction in the healthcare system.
The AMA tried to define the diference between a medical doctor and a healthcare provide in 1990. They clearly failed. However, I bet when you are sick you want a doctor and not a healthcare provider.
Stanley Feld M.D.,FACP,MACE
Frankly, I just want to see a system that is opened to competition. Any system in which the financial benefits drawn by the existing group of providers serves as a concern to limit competition (e.g. the Illinois anti-competitive actions by the providers against the NPs) then we have a problem. If I want to see an NP and save money than the choice should be up to me. If I want to see an MD then the choice should be up to me. I shouldn’t be forced to see an MD simply because the healthcare market has been cornered by them. Providers it is. And Mike, remember, its just another job.
~Crminallopath~
Criminallopath…it is not “just another job”… to say that is to say that being a clergy or lawyer is also just another job. It is a profession. That is why it has a prefessional code of ethics. I call out my own when i see ethical violations and I expect the same of my peers. I do not expect clergy, lawyers or physicians to abuse the trust that their position is given. do not attempt to pull me down to your level just because you fail to hold yourself up to your profession’s ethical codes and expectations (assuming you are a lawyer and provide legal counsel).
doc tom
Doc Tom–
As an economist, who sees “professional ethics” as simply a way of justifying guild control of a highly information asymetric contract (that between physician and patient), I find your temper tantrum most unhelpful. Doctors will maximize their welfare–which includes financial rewards and, as is characteristic of professions, reputation and ego-benefits. That latter part (reputation/psychic rewards) distinguishes “professions” from other jobs. But, they are all jobs in that you wouldn’t do them if you weren’t paid.
Tom -
One hopes that your clinical skillset is of the variety that is superior to your psychic skillset as your assumption is neither correct nor valid. You have a job. No less important or more important than any other job in our society. The Professional Code of Ethics might work wonders for the credulous wide eyed masses but it won’t even get you out of the gate here. You are going to need to show some intellectual honesty in the discussion here. Show me a Professional Code of Ethics and I will show you a meaningless oath or piece of paper used to pull the wool over the eyes of the credulous and the mechanism for hiding (at times in plane site) unethical behavior.
~Criminallopath~
If a profession is “just a job,” Why aren’t “professionals” provided the same employee rights as those with other “jobs?”
Why is a professional exempt from overtime pay, for example, while a “non-proessional”, even if salaried, must be paid overtime rates if they work more than 40 hours/wk? Why do you vote and have your legislators pass laws that exempt “professionals” from these protections, and then run around claiming there is no difference?
Hyprocrisy.
Theoretically, exempt employees receive other benefits (such as greater flexibility in arranging their own work hours) than hourly employees who are more closely monitored.
I don’t see the connection between “exempt/non-exempt” and “professional/’just a job’”. In my business, graphic artists are kept on a time clock specifically so that marketing staff doesn’t abuse their time. It doesn’t make the artists any less professional, and they all have at least a B.A.
I’ve seen plenty of collateral materials from hospitals and clinics which refer to doctors as “providers”. Sometimes such general terms are used only out of a desire for efficiency. Seriously doubt anyone uses “health care provider” specifically to demean doctors, and I find it kind of funny that some physicians would take offense at such a triviality — surely you have better things to worry about.
anon 10:19 says “they are all jobs in that you wouldn’t do them if you weren’t paid”
here is a list of things that doctors do that DON’T get paid for
1-ER call, often involving caring for non-paying or medicaid patients in the middle of the night with NO hope for reimbursement
2-phone calls to patients to report labs /xrays or to follow-up on an acute condition
3-fielding calls from patients, nurses, pharmacists, homecare providers at all hours of the day & night
4-paperwork for referrals & communication with other doctors
5-reviewing labs & xrays/ct scans etc. after the patient is out of the office
6-discussing a patient’s care with the dozen family members who must each independently hear from the doctor
7-charting all of the above
Also PLENTY of doctors work for free in a voluntary capacity (retirees seeing clinic patients, doctors without borders, peace corps, etc)
On the other hand, lawyers bill by the minute from the minute the phone rings or pen hits the paper.
Happyman–You’re delusional. To use your second example, what patient would PAY YOU if you failed to call him with important lab results or failed to follow-up on a critical condition.
Run an experiment. Have two consulting fees: one for the consultation and the other fsor the consultation with follow-up. I’m sure you’ll get a lot ofs takes for the first option.
The services you cite are simply part of the consultation fee.
Finally, lawyers these days generally flat rate most routine services.
anon 3:22 –
you are the delusional one – patients don’t pay PERIOD (except the copay for the actual visit, sometimes). Otherwise as much care is sought before and after (and often without) an actual visit as possible. And all of that is unreimbursable (by their insurance company).
Ever wonder why, seemingly, some doctors make patients come back into the office to follow up on something so simple? Now you know. (I certainly don’t endorse that but understand its stemming from the lack of insurance reimbursement for work outside the office visit).
I have a busy practice and do not call each and every patient about each and every lab or study result. There are simply not enough hours in a workday for me to do that and see the patients who actually are there in person to be seen. Abnormal results and normal results that direct therapy or evaluation in a significant way are all I have time to field; the rest waits until the next scheduled visit unless the patient calls beforehand. And no, my “staff” don’t have time for that either; they are as busy as I am.
You had better believe I expect to be paid anyway.
The consultation fee–if in fact I am being consulted, which is usually not the case–does not include free phone calls to patients as a required element of the previous visit. Those services are courtesies only, not entitlements. Don’t believe me? Check any CPT manual. Consultation–as defined by Medicare and others– requires written communication from the referring physician and which requires written reply to the referring physician. No communication to the patient outside the visit in person is required. You may think you are entitled to that phone call, but in fact you really are not, and you aren’t “paying” for it either. If you receive a call, it is an act of goodwill and a courtesy (if you can appreciate that, which I doubt.)
anon 9:01-
well put!
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