It’s Time to Retire the Term “Provider” from JABFM’s Pages

To the Editor: We write with a humble request that the American Board of Family Medicine develop a written editorial policy that explicitly rejects the word “provider” when referring to a physician/Diplomate in all its publications, and that use of the term be eliminated during its journal’s editorial process.

The most recent example¹ was published in JABFM in February 2023 but the use of the term in JABFM has been common: Search Results | American Board of Family Medicine (jabfm.org). Some of the published articles’ methodologies indicate only family physicians were part of the study yet the term “provider” was still substituted. Of note, the February 2023 issue published 17 articles (https://www.jabfm.org/search/clinician%20jcode%3Ajabfp%20volume%3A36%20issue%3A1%20numresults%3A25%20sort%3Arelevance-rank) that used the more professional term “clinician” and an editorial and other articles that specified “family physicians.” One article used both “provider” and “clinician” to ostensibly refer to the same group.

The American Board of Family Medicine (ABFM)’s own “Strategic Plan 2019 to 2025”² states a major goal is to “Promote Professionalism and the Social Contract.” Use of the term “provider” represents an assault on professionalism and a fraying of the social contract for economic reasons. This insurance-derived, transactional term has become widely adopted by the health care industrial complex for its own gain to the detriment of the medical profession and patients. The ABFM’s “strategic need” is stated as follows: “Commercial pressures, depersonalization through technology, commoditization of health care, and widening social inequities will erode the public’s trust in health care. In an environment in which health care is increasingly seen as a business, and professionalism is called into question, our commitment to patients’ needs, to the doctor-patient relationship, and to health equity needs to be a part of all we do. ABFM will promote professionalism and the social contract in all its activities, functions, and programs.” In this strategic plan document, the word “provider” is never used; the term “physicians” is used 28 times, the word “clinician” once. We believe the JABFM should demonstrate this same level of care when referring to Diplomates in its own journal.

Other journals^3,4 prohibit use of this deprofessionalizing term to describe physicians. The Journal of Graduate Medical Education specifically states in its “Instructions for Authors” “Do not use the word, ‘providers.’ Choose the specific term, or if a generic term is needed, consider, ‘clinicians.’” Family medicine organizations (including American Academy of Family Physicians (AAFP) since 2002, reaffirmed in 2018⁵, and Association of Family Medicine Residency Directors (AFMRD) in 2022⁶ have made this official policy in all communications. ABFM, with its leading role in promoting professionalism and valuing professionalism in a growingly difficult profit-driven health care milieu, clearly needs to do the same.

Last year the Accreditation Council for Graduate Medical Education (ACGME)'s Journal of Graduate Medical Education published our article⁷ in which we review in detail that calling physicians “providers” has a significant and disproportionately damaging impact on family physicians and family medicine residents, as well as the entire health care team and patients. If physicians are “providers,” then for consistency we should think of patients primarily as “consumers,” communities as “markets,” and our care as a commodity. Rejecting this label is a care quality and physician workforce wellness necessity, emanating from ABFM’s core values.

We believe in the importance of words and being precise when labeling human beings. Use “family physician” whenever possible and “clinician” when collectively referring to physicians and other professionals. If you agree, please consider this letter an action item rather than academic discourse. Even if you do not, our direct question is this: Will JABFM publish an official position on the ongoing use of this term?

Sincerely,