Job Titles Change as Healthcare Evolves

Physicians face innumerable stressors. There are dozens of new articles published every day with information we need to know. Patients' medical issues are increasingly complex as we develop a greater understanding of disease processes and have a wider variety of tools with which to treat them. The electronic health record (EHR) which was supposed to improve our ability to take care of patients often becomes a barrier. And, in the background are politicians choosing to wage partisan battles on the field of healthcare. However, I think an often unrecognized challenge is the sense of losing one's professional identity.

One of my colleagues, who is an excellent and well-respected family physician, shared her feelings about going from being a physician, to a healthcare provider, to a provider. The expertise and training, responsibility and sense of duty have distinguished us professionally. There is great pride in being a physician – it is a title designating years of training and sacrifice, a dedication to knowledge and the betterment of your fellow human beings.

Physicians are not interchangeable with other providers. For all kinds of reasons, it may be easier to lump all healthcare professions with a certain level of training into the broad category of "provider" – indeed I do this commonly. However, it can make a professional feel like a vendor.  

Physicians are not better than their other professional colleagues – chiropractors, podiatrists, dentists, advance practice clinicians – but physicians are better than their non-physician colleagues at certain things. As their skill set becomes marginalized and de-emphasized, physicians can feel lost. I was reviewing hospital by-laws and found that some podiatrists are able to admit patients and perform the history and physical exam (H&P) on their patients.

I respect my podiatry colleagues, but I would contend that their skill set is not the same as a physician when it comes to an admission H&Ps. All physicians, regardless of specialty, have logged numerous admission H&Ps as students and residents.

The medical hierarchy is on the decline. Gone are the sharply demarcated ranks indicated by the length of a lab coat. Many of us don't even have a lab coat anymore. Medical students and residents are protected in ways completely foreign to those of us who trained before work hour limitations. In some ways, this is better.

Hierarchy can lead to abuse of power, fear of speaking up, performance anxiety, and limited communication and collaboration. However, hierarchy also forms a scaffold upon which training experiences are layered to build a multi-dimensional professional. Hierarchy comes with responsibility – as an attending, you are responsible to share what you know with the residents and fellows, and they in turn have a responsibility to do the same with medical students.    

In the quest to eliminate hierarchy and figuratively assign everyone the same lab coat, we have missed something along the way. Multiple professions – each with a unique skill set and training background – become homogenized into an interchangeable group of "providers." This fails to respect the specific talents and expertise each brings to the patient. In the jumble of professional identity, we can be left wondering what our role is and how we are different than any other provider.