Are We Doctors or Providers? Does it Matter?

October 23, 2007

The conversation started innocently enough; a member of Sermo--a wonderful doctors-only website--posed the question, "do kids still play doctor?" The conversation that followed was full...

The conversation started innocently enough; a member of Sermo—a wonderful doctors-only website—posed the question, “do kids still play doctor?” The conversation that followed was full of childhood memories. Then the zinger came: “They don’t play doctor. They play provider!” The laughter ensued and then abruptly stopped. So many changes have occurred over time, is it any wonder that there is a looming shortage of doctors?

According to a study conducted by Merritt Hawkins & Associates, over the next one to three years, 48% of physicians between ages 50 and 65 will either retire, take non-clinical jobs, see less patients, or greatly reduce their hours. When these doctors entered practice, they had control over how and when they practiced and the fees they charged. Not so anymore. The rules of practicing medicine have changed and many are looking for a way out. Worse, fewer young adults are going into medicine, and even less want to go into primary care.

At this point, I decided it was time to start my own thread on Sermo and open this topic up to the general community. I started by asking “Are patients patients, or consumers? Are we still doctors, or are we now providers?” The response I received was overwhelming.

The answers on the forum varied greatly. Even those who loved their jobs complained of lower reimbursements than several years ago for the same work and intense business pressures. Among the many comments posted were the following:

“The actual practice is fun. I teach at a university hospital and enjoy the interactions with the residents. But, running a business in this environment is stressful. New regulatory requirements in NY, rising malpractice, high rent, low reimbursement, and the fear of litigation all add to the stress. I get through the day, but it is getting harder to enjoy what I do.”

“I stopped being a true psychiatrist when 45-minute sessions went to 25-minute medical psychotherapy, which was replaced by 12.5-minute medical checks. I stopped seeing people get better. It’s not that they may not get better; I just don’t have the contact with them to see it. Interactions are quick, superficial, and one-dimensional.”

“The government and the VA system was the entity that dumbed us down from doctor to provider. That was to foster the environment in which registered nurses, nurse practitioners [NPs], etc would all be lumped into the category of ‘provider,’ and all would be considered ‘equals.’”

“We are going to have NPs taking over primary care, just watch. High-tech specialties will have more doctors and they will disproportionately fix primary care with more NPs.”

“It amazes me. People will pay for expensive dinners, pay $700 to get their hair straightened, but when they get sick, they don’t want to pay for it! They don’t want to pay for expertise that took years and years of study and training. Everyone assumes doctors are cleaning up, but the ones who are making out are the hospital administrators and the insurance companies.”

Many physicians complain about being bogged down by paperwork instead of caring for patients. One oncologist and internist I spoke with said physicians are paid less to perform exams and procedures than they were 10 years ago. Some patients are hiring healthcare advocates to help them with doctors and insurance companies and paying tremendous fees to them out-of-pocket. At the same time, most doctors are holding on with both fists to their identities and are dealing with the other issues as best they can.