By Kyle Sanniec, MA, MHA; and Michael Gellis, MD
BELLEVUE, Wash., – The senior author (M.G.) became insulted years back when insurance companies started referring to him as a “medical provider.” Indeed, our medical license does not read “Medical Provider,” it reads “Doctor of Medicine.” A provider is someone who supports a family or another person, while a doctor is primarily defined as a person skilled or specializing in healing arts, who holds an advanced degree, and who is licensed to practice medicine.1 Patients, in our opinion, want to call their doctor exactly that: their doctor, not their provider. We have heard patients say that they love their doctor, but can one really say they love their provider? Yet, the name has stuck, and younger generations of medical school graduates have become so accustomed to it that they do not know any other way to recognize themselves. What they do not realize is that nurses, physician assistants, and anyone else who is legally allowed to administer care bear the same name—medical care provider.
The terminology shift from doctor to provider has been gradual and is symptomatic of a larger problem in our medical system. Treatment of symptomatic disease has taken the place of a good medical workup. Perhaps this is what society seems to desire—instant gratification and treatment for a medical symptom. However, this desire for immediate satisfaction comes without the realization that a patient’s symptoms may be harbingers of a more severe medical condition. In medical school, we are instructed about the importance of the doctor-patient relationship and about treating the “whole” person. When we are thrust into practice, this altruistic and beneficent belief of the doctor can be replaced by patients’ priority on autonomy. Whatever the patient wants, the “provider” gives. The doctor-patient relationship is no longer a “higher calling,” and it is what has suffered most in the transition from doctor to provider.
Patients are already feeling the burden of the provider mentality. The financial dynamics of today’s health care system require physicians to cram as many patients into their clinics as possible, often allotting only 3 to 5 minutes per appointment. Patients who want a more doctor-patient focused relationship are forced to find alternative avenues. Accordingly, there has been an increase in the number of “concierge” medical practices, where physicians limit their patient volume and patients pay a membership fee.2 The benefits of this arrangement are obvious, with increased interaction between patient and doctor. However, many patients cannot afford these membership fees and must find access to health care through other medical centers, something that might become more difficult with the advent of the Patient Protection and Affordable Care Act (PPACA).
According to David Houle and Jonathan Fleece, 3 authors of The New Health Age: The Future of Health Care in America, one-third of all existing hospitals will close their doors by 2020. The hospitals that survive will operate under the PPACA, which may force more doctors, because of increasing financial burden, to leave their private practices to join hospital systems. The Accountable Care Organizations portion of the PPACA joins hospitals with local doctors and gives a financial incentive to doctors who reduce costly medical services.4 This “streamlined” care—consisting of following algorithms to treat a patient’s symptoms and finding ways to minimize the costs incurred by the hospital for each patient—is perfect for a provider, someone who is simply another cog in a well-oiled machine. However, it does not work for the tradition private practitioner; a “Marcus Welby, MD” cannot survive in an unsupported market.
In 2005, 67% of medical practices were doctor owned. By 2013, that number will probably drop to 40%, according to the Medical Group Management Association.5 Many specialists, having succumbed to being hired by a hospital because of declining reimbursement, overbooked call schedules, lack of vacation time, and costly overhead in private practice, will not realize that they can be easily replaced in a hospital system by a cheaper, “for-hire” specialist. To resist falling under the steamroller of modern medical practice and ideology is not easy for the private practice doctor, and middle-ground options may offer an alternative. For example, joining with a large private practice group to supply specialty services or combining with other specialists to lower overhead costs is an option. Larger groups have bargaining power with health maintenance organizations, insurance companies, and hospitals. Unfortunately, the odds of maintaining a financially successful, single-doctor private practice are small in this milieu.
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Mr. Sanniec is a medical student at the University of Arizona, College of Medicine, Phoenix, Arizona, Dr. Gellis us a plastic surgeon in private practice and is Chief Medical Officer at Sono Bello Body Contour Centers, headquartered in Scottsdale, Arizona.