Dr. Richard Feldman: Let’s be clear about who is providing health care

Keywords Opinion / Viewpoint
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One in four Hoosiers are not sure if their regular provider is a physician.

It’s not uncommon for patients of mine returning to my office after a trip to, for example, a specialist’s office or urgent care clinic to be confused about specifically who provided their care.

I inquire, “So, did you see a physician? Or might it have been a physician assistant or nurse practitioner?”

“Well, doc, I’m not exactly sure. The person looked like a doctor.”

The above scenario is disturbing. It should be made perfectly clear to patients who is providing their medical care. Patients can make their best-informed health care decisions when this occurs. And as a family physician, I can better evaluate the care delivered and the medical decisions made when I know the credentials of the health professional.

I’m not saying that patients cannot get high-quality medical care from a variety of providers. But there is a difference among providers—especially compared to physicians—in experience, education and training, depth of knowledge, and amount of clinical experience.

Today, there exists a multiplicity of health professionals extending care to patients. And there are various clinical settings from which a patient can choose—retail and urgent care clinics, physician offices, health care centers, emergency departments, and now virtually through telemedicine. Ideally, health care should be delivered using a physician-led team maximizing the skills of every member, including physician assistants, nurse practitioners, nurses, pharmacists and psychologists. Each adds to the collective quality of care provided.

A recent study found only half of patients surveyed felt it’s easy to identify who is a physician and who is not by reading marketing materials regarding services offered, titles, licensing credentials and other qualifications.

In the clinical encounter, the same confusion is prevalent because clear disclosure of the type of health professional performing the service is not always adequately reached. One in four Hoosiers are not sure if their regular provider is a physician. Eighty-five percent believe it is important to know the training and education of their health care provider.

Indiana physician professional groups have formed the Indiana Physician Coalition coordinated by the Indiana State Medical Association to address this uncertainty through public engagement and education as well as legislatively with lawmakers.

The coalition seeks legislation this session of the General Assembly to ensure greater clarity and transparency in the identification of providers.

Marketing and advertising materials for medical services should clearly and prominently disclose the provider’s license type (physician, nurse practitioner, physician assistant, chiropractor, optometrist, dentist, podiatrist, etc.). All providers should also be identified by prominent posting in the office or clinic setting stating their license type. Providers engaged in direct patient care should wear a badge displaying their license type and if they are still in training. If the title “doctor” is used, it should be coupled with the license type.

Further changes in statute are necessary to reserve physician specialist designations such as dermatologist, cardiologist, endocrinologist or anesthesiologist only for physicians (doctors of medicine and doctors of osteopathic medicine).

Physician assistants and nurse practitioners can earn academic doctorate degrees. But they should be prohibited from simply using the title of “doctor” when they introduce themselves to patients during the clinical encounter. Patients particularly confuse nurse practitioners and physician assistants for physicians. As soon as patients hear the word “doctor,” they commonly assume the person is a physician.

This proposed legislation respects all members of the health care team and the vital roles they play in providing the best-quality care possible to Hoosiers while providing enhanced transparency to patients.•


Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon.

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3 thoughts on “Dr. Richard Feldman: Let’s be clear about who is providing health care

  1. Legislation is not necessary. it would be yet another waste of taxpayers dollars. Hospitals, clinics, and all licensed health care organizations should step up to the digital age to provide all patient medical information in an accessible database. Some health care organizations do a credible job of maintaining accurate medical records that are then made available to patients on a username/password protected basis via internet. Dates visited to specific providers with statistical information of vitals, a summary of the outcome of the visit, medications prescribed and/or medications to be discontinued, lab results, and many other details are available. The ‘clarity” Dr. Feldman speaks to could be provided in one or two additional tabs or columns of the database that would name all attending health care providers and their credentials during each visit. I am always amused when I go to the doctor and they ask me when I was there last, what medications have been prescribed, etc. as they sit in front of a computer console looking at my records. I don’t bring my laptop to the health care provider. They are the ones sitting in front of the computer. Time for health care providers … non-profits that have recently reported record profits … to get off the dime and invest in up-to-date IT resources as a means to making all patient data, including who provided their care and the credentials of the provider readily available to every patient. I’ll guarantee more legislation is the absolute wrong answer, but one not unexpected from a physician turned political bureaucrat like Dr. Feldman. All that is required is for the healthcare organizations that provide this transparent clarity to advertise and market the benefits to the patient of such transparency as a means to shame their lackluster competitors into providing the same transparency and clarity …, or lose significant volumes of business by not stepping up to the digital age. Most of us would not allow an anesthesiologist to hold a bag of ether over our mouth and nose to put us out for surgery. That’s yesterday’s approach. Patient customers demand up-to-date technology, including their health records and knowing who provides the care. For those with no access to the internet, the same information could be printed out for each visit when customers check out after seeing the provider. How about these health providers approach their healthcare businesses … as businesses rather than entitled mystery organizations conspiring with 3rd party insurance companies that further sow confusion with each transaction. It’s way past time to replace the label “patient” with the more accurate label “customer” and for healthcare providers to deliver world-class customer service. It’s tough enough for customers with serious health problems to deal with the physical, mental, and emotional stresses of those serious health problems … without experiencing the added stress of healthcare providers that shun customer service.

  2. Ignoramus… another myopic physician afraid of losing his job and prestige, and working against the patient in the process. Does the good doctor Feldman ask his patients how long the specialist/UC provider was in practice? Does he ask how many years the provider has been in the specialty? Does he ask the patient about the specialist’s grades in school, and her/his diligence in the intervening years to continue self-study and improvement?

    Two semesters. That is it. The difference between a PA and the illustrious physician – two semesters! I started attending college around 25 years ago, and subsequently graduated with a bachelors degree in business. PLEASE, pit me against any 25 year old MBA in the country and let’s see who is more experienced, trained, skilled, with business matters. If looking for business advice, would you take the 3yr fresh grad MBA’s advice over mine? The parallel is obvious: When looking for excellent healthcare, the last thing I care about is if provider 1 took two more semesters of school than provider 2 twenty years ago, or in Dr Feldman’s case, 35 years ago? I am sure he is an excellent provider, and I would be lucky to have him lead my care, but NOT because of what he learned (which is highly outdated at this point) when he went to med school however many decades ago. Dr. Feldman is likely an excellent provider (if misguided influencer) because of his many years of experience and ongoing learning. I wouldn’t give one lick if Dr. Feldman were a PA or an NP; he’d have the same level of confidence from me because I care so much more about his experience than whether he took 3 semesters of didactic study in college instead of 5 semesters of didactic study. Yes, his points about signage and nametags and full disclose is right on, but the misguided assumption that a provider’s college career is a litmus test for the quality of their care is damaging to patients and damaging to himself.