The Death of Specialization

By NIRAN AL-AGBA, MD (20)

George Orwell undated BBC photo, via Wikimedia Commons / Penguin India

“If you control the language, you control the argument
If you control the argument, you control information, 
If you control information, you control history, 
If you control history, you control the past. 
He who controls the past controls the future.”
— Big Brother, 1984. (George Orwell)

Allow me to submit to you: a physician should be called a “physician.” A nurse practitioner should be identified as “nurse practitioner.” Please call a physician assistant, “physician assistant.” These are accurate titles, reflective of their specialized education, training, and expertise. They are all venerated professions which share a mutual goal of improving patient’s lives, yet the vocations are fundamentally different.

“But if thought corrupts language, language can also corrupt thought.”
   — George Orwell

A central message of 1984 is that language shapes thought by structuring ideals and limiting ideas. Imprecise syntax spreads by imitation and tradition, even among those people – like physicians–who should know better. Some young physicians do not realize that the word “provider” undermines their profession by devaluing their specialized education and training. 

My request:  Stop calling physicians “providers.” It is insulting, personally and professionally.

Language is a powerful tool.  It doesn’t just allow us to communicate; it is a way to change culture and control people. History has shown us that every oppressive regime to come into power, did so by shifting language and influencing thoughts in order to alter perception and then, form a new reality. There is a word for this weaponization of language.

Propaganda.

Behind today’s push to change the language of medicine, is the colossal “medical-industrial complex” –part government and part corporate medical machine — which stands to benefit fiscally by denying physicians their special expertise.  Disparaging physicians allows policymakers to surreptitiously advance the idea that a nationalized health system, administered and controlled by the government, is the fix-all solution to what ails the health of our people.  But first and foremost, physicians must be conscripted, and that is precisely what is happening. 

While mass generalization is expedient, convenient semantics is part of a larger societal trend best described as “the death of specialization.”  In reality, this deceptive linguistic creep obscures a 19,000-hour training difference that exists between a physician and nonphysician, a fact that should be of great material consequence to patients.  The control of healthcare is being relinquished through this ambiguous propaganda war as a first step, which will be followed by changed in medical culture that will corrupt the entire healthcare system. 

“War is peace, Freedom is slavery, and Ignorance is strength.”
   – George Orwell

Today, in healthcare, absolutely anyone can be anything.  Any patient can self-diagnose and treat their condition using the internet, Jenny McCarthy can be an expert on immunizations for children, and Nurse Practitioners and Physician Assistants are considered doctor “replacements.”  While non-physicians with graduate degrees –nurse practitioners, physician assistants and psychologists– are fighting for the title of “doctor,” physicians who have earned the designation through more than a decade of education are being shamed into avoiding its use.  Any physician daring to highlight their credentials is labelled as “egocentric”, “elitist” or “self-important.”  The perversity of this is utterly astounding. 

Though seemingly innocuous, “provider” has allowed substitution of lower paid personnel in place of physicians under the premise of lowering costs, despite the fact there is not a single shred of evidence to scientifically support this claim.  The mainstream, believing anyone can practice medicine, have turned a blind eye to the plight of physicians struggling against the odds to care for patients.  

“If liberty means anything at all it means the right to tell people what they do not want to hear.” -George Orwell

By insisting physicians accept the derogatory term “provider”, we are being forced to comply with the systematic demise of our profession, for the sake of political correctness. Countless physicians have shared their repugnance of this derogatory term, yet remain silent due to fear of losing employment, or worse, face character assassination. I write in support of marginalized physicians unable or unwilling to speak up.  

We must think about our word choices.  If we relinquish control of our language, we will lose our humanity.  The term “provider” applies to almost any type of clinician.  This growing unwillingness to highlight differences in training, education, and expertise constitutes an increasing danger to not only our profession, but also to patients, our healthcare system and society as a whole.  Patients deserve to know who is rendering their care.  

We are physicians, not providers.  It is insulting and I am asking for it to stop.

Niran Al-Agba, MD is a physician, not a provider.  She is based in Washington State.

20 thoughts on “The Death of Specialization

    1. Your welcome. Please do not give up this sacred profession. I think the best physicians are the ones getting discouraged. I truly believe we are at a tipping point and we need physicians like you to keep caring for patients until it becomes truly enjoyable again….. it will 🙂 I know it will.

  1. Also, can we please stop using the word “allopathic!?” It was created by the original homeopath (Samuel Hahnemann) as a derogatory term and is based in pseudoscience, yet somehow it became the default distinction between MDs and DOs. Let DOs call themselves whatever they want to (and homeopaths, for that matter.) But I’ll stick with MD, thanks.

  2. Overly dramatic but interesting parallel to 1984.

    I actually think your title ironically contains the solution to this problem.

    Physicians should become more specialized starting today. Going into general practice, IM, FM or peds is a waste of time. Mid level providers are unfortunately the perfect investment for health corporations and an inescapable future for all of us. They allow businesses to cover large swaths of territory and hospitals with primary care for a fraction of the MD cost.

    I’m not so sure about your claim that outcomes are worse for patients by midlevel vs NP. I would have to research, but based on my observations, it’s not significantly different.

    But no matter how many NP’s or PA’s are manufactured, none of them can independently perform surgeries, officially interpret images, deploy stents, etc.

    Being addressed as a “provider” should be the least of your concerns. You should be figuring out a way to get into a specialty or sub speciality STAT!

    1. Thanks for reading and commenting. Actually, as a pediatrician there is not much I can’t do. Pediatrics IS a specialist. Somehow, many forget this. Mid-levels may be a great $ investment but they are not great for the health of patients on the whole. There are no training requirements, experience threshold, and patients are really suffering out here in underserved areas like where I practice. 10 years ago I could not have imagined that adults would be asking (sometimes begging) a pediatrician to see them. Seriously, we don’t need more specialists. We need midlevels helping out the specialists so a child with a GI bleed can be seen earlier than 3 months from now. Its a protocol right? How hard can it be? Its the primary care where things aren’t working out for physician extenders…..its overburdening physicians, who are NOT providers. 🙂

  3. Latest in Florida is nurse anesthetist dare asking to be called ‘nurse anesthesiologists’; actual testimony before the Health Care Committee in the House by a representative of the FANA.

  4. That was rhe most pompous example of literary self assurance I have ever read. Coming from a patient perspective the reason the term providor is probably used is because the industry has mitigated medical liability from a few specialties to hundreds, complicating care for patients from both a scheduling and financial perspective. Instead of caring for patients needs you now hide behind your 2 years of fellowship and cast your patients off to another specialist, all while billing as many RDUs as you can to make that 400k salary. The medical field has become a game of tennis with the patients are being user as the tennis balls. You hold our health hostage for enormous sums of money.

    1. So I haven’t done a fellowship and I am not sure who you are addressing actually. Its RVU, not RDU and it is spelled provider and not providor. I don’t know what else to say because the $400K salary has me laughing so hard I might pee my pants. I would not see that much money in 4 years…. but I suppose we can all dream… thanks for reading and providing some humor in all this.

  5. It’s entirely dependent on context.

    In the context of one patient – or even all patients – the title’s you’ve identified are appropriate and useful.

    However, in the context of the healthcare industry, we need a general category for all those who “provide” clinical healthcare services – regardless of setting – so provider is not only acceptable, it’s preferred.

    Context is key.

    1. No, you don’t need a category. And NO its definitely NOT preferred. Look, its derogatory and it looks like you enjoy baiting physicians. That is fine. That won’t change. You don’t like us. You use propaganda. George Orwell was onto something. Thanks for being proof of that fact. A physician, a nurse and a physical therapist are all healthcare professionals. I SERVE patients and provide nothing.

  6. You are so correct. I have said this for years.
    We should also not call our patient care “products” That is horrible. These terms recuce us to working in a factory!!!
    Reginald Cooper M.D.
    Chairman Emeritus of Orthopaedics at the University of Iowa

  7. Thanks, Dr. Al Agba. Physicians must keep their hippocratic oath and push back on the confusing and dangerous use of the word ‘provider”

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