A physician in whose specialty the performance of procedures, diagnostic or therapeutic, such as endoscopies and surgical operations, are a significant element. Physicians who are not proceduralists have no specific label, but their services are often described as “cognitive”. Despite advent of the resource-based relative value scale (RBRVS) system in physician payment reform (PPR), the medical community still feels that the services provided by proceduralists are rewarded more highly than are cognitive services.