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August 2019

Autonomic Angst Conjured By The Word-Which-Must-Not-Be-Spoken to Physicians

If while speaking to a group of physicians you use the word “provider” before you come to your important point, you will never get your point across.  In fact, you may not even get another sentence in, such is the autonomic angst conjured by the word-which-must-not-be-spoken

Most physicians resent being called the word-which-must-not-be-spoken, and some are instantly enraged by it.  Protect your valuables should you let it slip out of your mouth.  It is felt by physicians to be demeaning and disrespectful.  There are many reasons given for this, but I think the root cause is that the word-which-must-not-be-spoken is intertwined with bureaucratic red tape that has increasingly constrained the practice of medicine, especially over the past decade.  For example, the CMS Meaningful Use, PQRS and MIPS payment programs are all written for “eligible providers”.   Literally thousands of pages of rules, regulations and policies that impact the day-to-day activities of those who are said to be a word-which-must-not-be-spoken.   

Who wouldn’t resent such a word?

This happened because the word-which-must-not-be-spoken was adopted by policy writers for the rules and regulations associated with Medicare and Medicaid, as well for private insurance payors, to lump together all of the clinicians they pay for providing health care services to their clients.  To make it easier to write such regulations and policies, a single word was chosen to describe all the people that this word intentionally lumps together--physicians (M.D.s and D.O.s), nurse practitioners, physician assistants, podiatrists, chiropractors, dentists, anesthesiology assistants, audiologists, certified nurse-midwives, certified registered nurse anesthetists, clinical nurse specialists, clinical social workers, occupational/physical therapists, psychologists, registered dieticians and speech language pathologists to name a few. 

It sounds reasonable to lump all those people in with one word when writing policy rather than writing the whole list every time, doesn’t it?  But the word-which-must-not-be-spoken has unfortunately spilled out of regulatory-speak into common vernacular.  Personally, I can verify that after reading a 400-page CMS rule where the word-which-must-not-be-spoken is used over a thousand times,  it gets imprinted on the brain and difficult to avoid using for several weeks afterward.  So now PCPs are not primary care physicians anymore, but instead are called primary care words-which-must-not-be-spoken

So, one may ask, why did the policy writers not call us clinicians instead?  That would be more palatable. 

Well, the issue is that CMS and private payors also pay “entities” such as acute care hospitals, long-term health care facilities, physician practices and other clinical facilities and practices.  All of these entities are also considered to be “providers”, but they are not clinicians. 

Since entities do not have independent thoughts or feelings, they are not offended by the word-which-must-not-be-spoken, so you can call them providers without fear for your valuables.  In my opinion, it would have been better for policy writers to differentiate clinicians (people providers) from entities (facility providers), but that boat left the dock more than a decade ago.

I admit to being rankled for many years by the word-which-must-not-be-spoken, but I've gotten over it.  If one ignores the connotation of the word due to its overuse in bureaucratic red tape, it is really not such a bad word.   In fact, look it up in the dictionary, and you will see it is actually a word one should be proud to be called. 

Although I understand the autonomic angst conjured by the word-which-must-not-to-be-spoken, as it has been thoroughly butchered by government policy writers, at the end of the day call me a "provider of quality healthcare" and I'll go home happy.

Or just call me "Matt".


Matt Murray, M.D.

Provider of Quality Healthcare

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