Physicians Are Not Providers: The Ethical Significance of Names in Health Care: A Policy Paper From the American College of PhysiciansFREE
Publication: Annals of Internal Medicine
Abstract
More than 25 years ago, Pellegrino and Relman noted the increasing commercialization of the learned professions, anticipating what many physicians are increasingly experiencing today: an impairment of their ability to practice in accordance with standards of medical ethics and professionalism. These hurdles to the physician’s ability to do right by the patient contribute to what leaders in medicine and the American College of Physicians have called deprofessionalization. An example is the use of the term provider to describe physicians and other health professionals. The use of this terminology has been reviewed in medical journal articles but has not been adequately explored as a matter of ethics and professionalism. Through that lens, this paper examines the trends, significance, and implications for patients, physicians, and health care of the use of the term provider.
What’s in a name? That which we call a roseBy any other name would smell as sweet…—William Shakespeare, Romeo and Juliet (1)
With apologies to Shakespeare, names are important. In health care, they can have ethical significance.
The American College of Physicians (ACP) is concerned about the use of the term provider to describe physicians. Medical journal articles have criticized the term as deemphasizing professional identity, with particular negative ramifications for primary care because differences in training and expertise among clinicians are not recognized; others have found it to be ambiguous and disrespectful (2–5). Yet the use of provider has not been adequately examined as an ethical matter.
The word provider represents one of many challenges to ethics and professionalism posed by corporatization, commercialization, and physician employment, among other aspects of today’s practice environment (6–8). The issues are not new. From Galen to Paracelsus to Sir William Osler, distinguishing the patient–physician relationship from commercial transactions has been critical. As Osler said, “The practice of medicine is an art, not a trade; a calling, not a business…” (9).
It is also essential to consider the use of the term provider given changes in health care delivery over time. Changing societal and cultural expectations are embedded in physicians’ roles and the context of care, such as challenges posed by electronic health records and technological advances. Civil rights and consumer movements (8) have stimulated greater patient engagement, especially in medical decision making, and led to increased self-management by patients.
In 1980, Relman described the rise of the “medical-industrial complex” (10); in 1999, Pellegrino and Relman examined the increasing commercialization of the learned professions (11). They anticipated what many clinicians experience today: deprofessionalization, an impairment of the ability to practice according to the precepts of ethics and professionalism (7, 11). Has language helped cause these shifts, is language a result of them, or are both true? This paper examines trends and implications for patients, physicians, and health care of the term provider from the perspective of medical ethics and professionalism.
Methods
This paper was developed on behalf of the ACP Ethics, Professionalism and Human Rights Committee (EPHRC). Committee members abide by the ACP’s conflict-of-interest policy and procedures; appointment to the EPHRC and its procedures are governed by the ACP’s bylaws. Following environmental assessment to determine the scope of issues and literature reviews, the EPHRC evaluated and discussed drafts of the paper; it was then reviewed by the ACP Board of Governors, Board of Regents, Council of Early Career Physicians, Council of Resident/Fellow Members, Council of Student Members, and other committees and experts and was revised to incorporate comments from these groups and individuals. The ACP Board of Regents approved the paper on 26 July 2025.
Origins of Words Associated With Care
Paydarfar and Schwartz trace the origin of the use of the word provider to Medicare and Medicaid law (1965), which refers to “any provider of services” (2). They found it to be a “peculiar descriptor” when applied to physicians given its common use to describe suppliers delivering products and services to markets. Goroll describes the use of provider for hospitals or networks referring to institutions or insurers (3) but not for human-to-human relationships and interactions. Use of provider before the 1960s has been historically contested (12), but the term has clearly evolved to encompass diverse types of clinicians.
Medical care is not a mere service. This is especially apparent in the origins of words associated with care. The Oxford English Dictionary defines the origins of the terms patient, physician, and medicine. Patient is from the Latin patiens, for one who suffers. This word refers to the vulnerability often brought on by illness. Doctor comes from the Latin docere (“to teach”). Physick originally meant medical treatment or remedy; one who practiced physick was a physician. By the 18th century, physic referred to the practice of medicine. Compassion comes from the Latin compassio, meaning “to suffer with.” Compassion is essential to the patient–physician relationship; it is not just empathy or kindness but refers to supporting the patient in need and acting with and for the patient. These words help convey the significance of what is at stake in medical care.
The Implications of Language for Care and for Ethics and Professionalism
Language has myriad implications for health care as well as for ethics and professionalism. First, the current use of provider in reference to institutions, insurers, physicians, nurses, physician assistants, and other clinicians lumps impersonal entities in with humans and obscures differences in clinical training and expertise (3). For patients, who need to be aware of the important and different roles of health care team members, such distinctions may not be transparent.
Second, the duties of physicians differ from those of individuals and entities who deliver commercial and other services. The physician’s ethical responsibilities are primary when delivering patient care—arising from the patient’s experience of illness—and inform the nature of medical decisions in the context of diagnosing and treating illness and preventing disease (13). The patient–physician interaction focuses on maintaining or improving the health of the patient. This partnership is not transactional but rather relational, with the patient seeking care from a physician who is trained to help and bound by ethical duties to do so.
Patients are not mere consumers; they have dignity and individual needs. The physician must act in the patient’s best interests (the ethical principle of beneficence, promoting the good of the patient), even when it is counter to the physician’s own interests or conflicts. The physician must avoid doing harm (the duty of nonmaleficence), such as unnecessary tests and procedures; respect patient autonomy; and consider issues of justice, such as equity and the responsible stewardship of resources (8).
Third, use of the term provider undermines ethics and professionalism. Medicine is dedicated to serving others whose trust must be earned. As quoted in the ACP Ethics Manual, Francis Peabody said that medicine is not “a trade to be learned, but a profession to be entered” (8), with publicly declared values (in Latin, the “profess” in “profession”) and ethical duties to uphold. The professional prerogatives and rights that society grants to physicians include expectations that physicians will use their role to benefit patients. Physicians are accountable to the public for their professional actions (8). The mission of hospitals was once aligned with and supported the ethical duties of physicians to serve the needs of patients first and to avoid commercialism (14), but that role has often been compromised. Admittedly, professionalism and commerce coexist in medicine to advance clinical practice and research; it becomes problematic when underlying motivations are economic and not ethical (14). Today, commerce and professionalism are imbalanced, with the forces of commercialism growing (7).
The term profession is often used loosely. But medicine is a learned profession, of which there are only a few (15); it requires “educational breadth,” dedication to service, and putting patient care above self-interest to fulfill a “fundamental human need.” Altruism and the desire to help people need to be fundamental motivators in this ethical endeavor that is committed to the welfare of patients (15).
A physician should be a trusted confidant, counselor, advocate, and partner in times of need. Since Hippocrates, physicians have committed to putting the interests of patients first, utilizing their extensive knowledge, training, and experience to benefit patients and help keep them from harm. In contrast, providers provide. Business transactions need not focus on values or consider the interests of consumers before those of stockholders and owners.
Fourth, language not only affects the perception and value attributed to what is being provided but can also alter one’s professional sense of self and influence behavior (2, 16). Communication and language are key. To quote Robert M. McLean, MD, former president of ACP, “Patients share things with us that they share with nobody else, including close family” (17). Language should focus on “health and not healthcare, on relationships and not transactions, and on people and not products” (18). Terms such as “covered lives,” patient “leakage,” and others that focus on the “healthcare industry” undermine the physician’s role and should be avoided. Health care should be 2 words: health (including the opportunity for its fulfillment for all [19]) and care (attending to patients).
Recommendation
Language in health care has ethical and practical implications. Physicians should be referred to as physicians, not providers. Also, when describing professionals with varied credentials who care for patients, the terms clinicians or health care professionals, not providers, should be used.
Conclusion
ACP supports transformative changes to promote quality and access to health care. This objective needs to uphold the ethics of the patient–physician relationship, which is fundamental to the practice of medicine. The words physician and provider are not interchangeable. Provider undermines the physician’s ethical obligations, clinical integrity, and accountability, as well as trust in the patient–physician relationship. The term should not be used to describe physicians, nor should physicians use it to describe themselves, their team members, or their trainees.
Patients still want trusted, compassionate relationships and care by humanistic physicians who exercise independent clinical judgment and profess to heal when possible and to comfort always. Physicians should strive to fulfill these expectations, and language should recognize and support their individual and collective ethical responsibilities to serve patients.
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