This article is republished from National Review with the permission of the author.

In recent years, the term “service provider” has been deployed widely as a descriptor for doctors and other medical professionals. That’s unfortunate, as the terminology de-professionalizes those who work and study for years to become expert at delivering medical treatments, interventions, diagnoses, and counseling. And it concomitantly threatens to transform patients into mere customers; doctors, essentially into so many order takers.

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Some physicians’ organizations have noticed the trend and are pushing back. A few months ago, an opinion article in the Annals of Internal Medicine argued that using the term “service provider” has negative ethical implications. From “Physicians are not Providers” (citations omitted):

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. . . .

Second, the duties of physicians differ from those of individuals and entities who deliver commercial and other services. . . . This partnership is not transactional but rather relational. . . .

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”, with publicly declared values (in Latin, the “profess” in “profession”) and ethical duties to uphold. . . .

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. 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.” Language should focus on “health and not healthcare, on relationships and not transactions, and on people and not products.”

That makes abundant sense to me.

Hierarchies as negative by definition

But in an essay in the Hastings Bioethics Forum, bioethicist Brandon Ambrosino reacts to the column and promotes the very de-professionalization that the original article decried. From “Physician or Provider? What’s in a Name?”:

The paper notes that provider “obscures differences in training and expertise,” which suggests that physicians are at the top of a knowledge hierarchy. This is true much of the time. But the term physician does not automatically tell us all we need to know about the person providing us with care. People should not uncritically accept that a physician is by default more knowledgeable or capable or informed than, say, a nurse practitioner with a university appointment. Some physicians, for instance, are skeptical of lifesaving vaccines, and they attempt to bolster their view by referring to their physician title.

The same could be said about doctor-assisted-suicide advocates. But that is irrelevant.

The idea that hierarchies are definitionally negative — particularly within the medical professions — or denigrating to nondoctors is just wrong. I might pay more attention to what my doctor recommends than I would to a nondoctor medical professional. But that is because my doctor has more education and depth of experience. And it does not mean that I don’t value the contributions of his physician assistant.

But that seems to be what the author thinks:

We should avoid cultivating a medical culture in which patients think that only the word of a physician is worth believing. There is a shortage of physicians in rural and under-resourced areas, but the number of nurse practitioners and physician assistants/associates is increasing. Surely the growing availability of these professionals is a good thing for individual and public health. Undercutting their expertise could have negative consequences for both.

It doesn’t undercut their expertise. Physician assistants and nurse practitioners are medical professionals, but they are not doctors. They have fewer years of medical education, for example. Of course they provide important functions in the medical system and should not be reduced to the status of mere “service providers,” either.

And here’s the nub of Ambrosino’s complaint:

Such a strict hierarchical approach, where the physician is seen to sit peerlessly at the top of Medicine, risks harming the foundation of shared decision-making. It also risks shoring up the medical clericalism that bioethicists have encouraged practitioners to be on guard against. Ensuring that physicians carry themselves at all times as members of a profession is a noble goal. But calling a physician a physician doesn’t magically cultivate professionalism in a practitioner.

Perhaps not, but it sure promotes it. Real service providers — plumbers, electricians, barbers, and the like — offer important services, but they are not fiduciaries to their customers in the same sense as are doctors, physician assistants, and nurse practitioners.

The risk of deprofessionalization

In the end, Ambrosino essentially admits the de-professionalizing effect of calling medical professionals “service providers”:

There is nothing inherently wrong with the word provider. Parents provide for their children. My husband provides for me. I try to provide for my students. My PA provides me with clinical judgment and reassurances. My physician, who sometimes collaborates with my PA, provides me with similar goods. People we are in relationships with provide us with care and kindness and pick-me-ups and friendship.

Sorry, but the myriad ways in which my wife “provides” for me are not professional activities. They are personal.

Bottom line: I do not go to a physician for kindness — although I do appreciate a good bedside manner — but for medical expertise. Indeed, I recently had a serious medical test, and the doctor who performed it was as gruff and non-empathetic as one could imagine. But he was very good at the intricate medical task at hand, for which I was very grateful. I would never not call him “Doctor.”

So, when I have a medical issue, I won’t be calling my SP but a licensed professional who deserves the respect and status that his many years of education, training, and experience have earned, in the reasonable expectation that I will receive the optimal care to which I, as a patient — not a customer — am entitled.