This could be a controversial one folks. I’d love for you all to weigh in on what you think. As a healthcare professional or a patient, what is your opinion? Should nurse practitioners with a DNP (doctor of nursing practice) refer to themselves as doctors when meeting patients?
The American Medical Association (AMA) has been fighting any alteration in the use of the word doctor for many years.
Other people can call themselves “doctor” in different fields. For example, graduates of PhD programs can be called doctors because a PhD stands for a Doctor of Philosophy. I know several people with PhDs, from chemistry to geophysics. But most don’t use the title unless they work as a psychologist or they only use it for work-related purposes. Not all that long ago, when President Joe Biden took office, there was a lot of talk about PhDs. His wife, who has a PhD in education, was referred to as Dr. Jill Biden. Some people were supportive, saying that she earned that right, while others condemned her for trying to be something they felt she wasn’t.
But back to the nurses
Yesterday, Becker’s Hospital Review published an article about three nurse practitioners suing the state of California for the right to use the word doctor to describe themselves. According to the article, California law says the only people who may say they are Dr. So-and-So are physicians and surgeons. In 2022, the state sued Sarah Erny, who holds a doctorate in nursing, for “violating the Business and Professions Code by inferring she was a medical doctor to the public.”
Erny had to pay almost $20K in civil penalties. The crux of the matter was how Erny presented herself to the public: “While in most instances Ms. Erny indicated that she was a nurse practitioner, she failed to advise the public that she was not a medical doctor and failed to identify her supervising physician. Adding to the lack of clarity caused by referring to herself as “Dr. Sarah,” online search results would list “Dr. Sarah Erny,” without any mention of Ms. Erny’s nurse status.”
California law says the only people who may say they are Dr. So-and-So are physicians and surgeons.
I think Erny’s case isn’t the same as the three nurse practitioners in the lawsuit though, including Jacqueline Palmer, who is featured in this Washington Post article. Palmer said she makes sure her patients know what her position is. She adds that using the title validates the hard work it took to get to where she is today. But now she is afraid to, given Erny’s harsh penalty.
Did I misunderstand this finding?
After reading about the nurse practitioners, I did some digging around because I wanted to learn more about California’s laws on this matter. Unless I’m misinterpreting what I read on the state’s government site, physical therapists with the appropriate educational level are allowed to call themselves Dr. PT, as long as they indicate the relevant degrees after their name:
Examples of verbal communication would be "Hello, I am Dr. Jane Smith, and I will be your physical therapist." In cases where the physical therapist is certain that all persons who could hear the conversation would know that Dr. Smith is a physical therapist and not a physician and surgeon, the disclaimer would not need to be included.
In conclusion, a physical therapist who uses the title "Dr" is responsible to make sure that no person believes that they are a physician and surgeon. In the event that a complaint is received by the Board that a physical therapist is representing themselves as a physician and surgeon, the fact the complainant has that belief would indicate that the physical therapist had not met the burden of responsibility.
If this is the case, why are PTs allowed and not nurses if the nurses are clear in their interactions that they are nurse practitioners? Or did I read this wrong? Please let me know in the comments if I did!
Patient safety, says American Medical Association
The American Medical Association (AMA) has been fighting any alteration in the use of the word doctor for many years. Some say it’s a power grab; others say it’s a matter of patient safety. If it’s a matter of patient safety, I respectfully recommend that the AMA ask its members to write fact-based and not patronizing pieces because the latter will not win them any favors.
I found this article, Nurses With a Doctorate in Nursing Practice (DNP) Should Not Call Themselves “Doctor” in a Clinical Setting, published in Missouri Medicine in 2022. It was written by Garry Gaddis, MD, PhD. I expected to see a well-thought-out argument when I clicked on the link. Instead, what I read was (the bolding is mine): “Patients generally value the care they receive from their [advanced nurse practitioner] clinicians, be they a DNP, or not. ANPs are generally perceived to be likeable and competent.”
Excuse me? Generally perceived to be likable? Has any article in any medical journal ever written that a doctor might be perceived as likable?
He goes on to call using the title doctor as fraud: “The fraud exists because in claiming the title “Doctor” in a clinical setting, the DNP who is in essence impersonating a physician ignores the substantial knowledge and training gaps that exist between a physician and a non-physician.”
In my opinion, a DNP who uses the term “doctor” but states clearly that they are a nurse practitioner, not an MD or DO, is not committing fraud in any way. The only way that it would be fraudulent is if the DNP insinuates or states that they are a medical doctor. That would be fraud.
The article is long, and he does make some valid points much further down, but when someone starts an article in such a patronizing manner, it makes it hard to want to read any further.
I’m curious to know from patients and other healthcare professionals how they feel about this issue.
Please leave your comments below. Let’s get a conversation started.
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Throughout my career, I have worked with different types of doctors. The Ph.D. doctors who ran research labs looked down on the researchers who were also Medical Doctors. They felt an MD was a lesser doctor than a Ph.D. researcher. As an Autonomous Family Nurse Practitioner, I have worked with MDs, but in Florida, I no longer require MD oversight. Some doctors have difficulty with this and need gentle reminders that I practice autonomously. Florida's change in this ruling removes the "failed to identify her supervising physician" issue Ms. Erny encountered, at least for this State. I have met people in almost every medical profession who obtained a Doctorate in their specialty, not physicians or surgeons and identify as doctors. But the DNP designation is treated differently. I did not pursue the degree because, in Florida, it accrued a large school debt without a substantial pay increase. Yet daily in my Primary Care clinic, patients call me doctor. And I have to stop and correct them out of fear of legal ramifications. I have asked patients why they want to call me a doctor instead of a Nurse Practitioner. Besides being too long of a title, they state that because of receiving such good care and taking care of all their concerns, they think of me with the respect of a doctor, even though they admit never receiving care from a doctor as they receive from me.
It is a fascinating social construct. Nurse Practitioners approach patients holistically, and doctors mainly medically only. NPs learn to cover everything, including education, in the short time our schedules allow us to spend with patients. We have adapted ourselves to uphold our training and our mission. My experience and observation of doctors limit the visit to diagnosis and medication with no education as to why the medicine is vital, how it works, or why the diagnosis is essential to address and correct. Indeed, there will be no discussion regarding lifestyle changes to support the plan of care as I do with every single patient.
I do believe the degree of Doctorate indicates the training required to be allowed to be called a doctor. But to patients, the care they receive and the sincere concern for their health and well-being means more than the degree. They call the people doctor that they feel deserve it, and those of us honored by such recognition will continue to correct them to avoid legal issues.