Who is a Doctor or who holds Doctorate? What's the difference in the minds of patients?

[CAdamsPAC]

Author(s): 

Steph Weber

 

 

 

 

 

Three California nurse practitioners with doctorates (DNP) have sued the state over its law that only physicians can call themselves doctors, saying it violates their first amendment right to use the honorific title without fear of regulatory repercussions.

The case highlights ongoing scope-creep battles as the American Medical Association tries to preserve the physician-led team model and nursing organizations and some lawmakers push for greater autonomy for allied professionals.

In the complaint filed in district court in June, plaintiffs Jacqueline Palmer, DNP, Heather Lewis, DNP, and Rodolfo Jaravata-Hanson, DNP, say they fear the state will sanction them. They note that “Doctor Sarah,” another DNP, was fined nearly $20,000 by the state last November for false advertising and fraud after using the moniker in her online advertising and social media accounts.

 

The fine was part of a settlement that the DNP, Sarah Erny, reached with the state to resolve allegations that she failed to identify her supervising physician and inform the public that she was not a medical doctor.

Under California’s Medical Practice Act, individuals cannot refer to themselves as “doctor, physician, or any other terms or letters indicating or implying that he or she is a physician and surgeon ... without having ... a certificate as a physician and surgeon.”

Instead, nurse practitioners certified by the California Board of Registered Nursing may use titles like “Certified Nurse Practitioner” and “Advanced Practice Registered Nurse,” corresponding letters such as APRN-CNP, RN, and NP, and phrases like pediatric nurse practitioner to identify specialization.

Individuals who misrepresent themselves are subject to misdemeanor charges and civil penalties.

The nonprofit Pacific Legal Foundation represents the plaintiffs. In court records, its attorneys argue that after “years earning their advanced degrees and qualifications ... they should be able to speak truthfully about them in their workplaces, on their business cards, the Internet, and social media, so long as they clarify that they are nurse practitioners.”

State lawmakers’ attempts to clarify the roles of physicians and nurse practitioners have seen mixed results. Florida legislators recently passed a bill to prevent advanced practice nurses from using the honorific title, reserving it only for MDs and DOs. Gov. Ron DeSantis vetoed it last month.

In May, Georgia lawmakers passed the Health Care Practitioners Truth and Transparency Act. It requires advanced practice nurses and physician assistants with doctoral degrees who refer to themselves as doctors in a clinical setting to state they are not medical doctors or physicians.

Still, some health professionals say that the designation should only be used in academic settings or among peers, and that all doctoral degree holders should ditch the moniker at the bedside to ease patient communications.

Named as defendants in the suit are three state officials: California Attorney General Rob Bonta, state Medical Board President Kristina Lawson, and California Board of Registered Nursing Executive Officer Loretta Melby.

A version of this article first appeared on Medscape.com.

[ventana]

Doctor is not protected 

physician is protected 

I have no desire to be a physician but if I EARN a doctorate I don’t see an issue around doctor.   PT. SLP. OT. Audiologist, phsychologist are all doctors at this point.  Picking out PA and NP and saying we can not utilize an earned degree is seemingly illogical.  Now having said that if I ever earned a doctorate I would still introduce myself as PA Joe Blow and not Doctor Blow because I am proud of my profession.

[SedRate]

15 hours ago, CAdamsPAC said:

Under California’s Medical Practice Act, individuals cannot refer to themselves as “doctor, physician, or any other terms or letters indicating or implying that he or she is a physician and surgeon ... without having ... a certificate as a physician and surgeon.”

Yet chiropractors, physical therapists, etc call themselves doctor. 

[sas5814]

I never use the title at work. For me the patient having a clear understanding of who they are seeing is 1st in importance. The health care system is confusing enough without muddying the waters more.

Where I work that makes me odd man out. The audiologist, the clinical pharmacist, the NP,  the PT, and the staff pharmacist all use "doctor". It is their right to do so.

Probably 20 years ago one of my work colleagues got jacked up by the medical board for misrepresenting himself. The irony was he didn't do it. The front desk person referred to him as Dr. (name) when checking in a new patient. He didn't even know about it until the patient became disgruntled about something and complained to the board. There was an investigation and the whole clinic had to do some kind of education about the issue. For the rest of his career he had to explain it on every credentialing and job application.

[SedRate]

35 minutes ago, Hemmingway said:

Probably 20 years ago one of my work colleagues got jacked up by the medical board for misrepresenting himself. The irony was he didn't do it. The front desk person referred to him as Dr. (name) when checking in a new patient. He didn't even know about it until the patient became disgruntled about something and complained to the board. There was an investigation and the whole clinic had to do some kind of education about the issue. For the rest of his career he had to explain it on every credentialing and job application.

Dang, that sucks. 

[Joelseff]

This topic was posted in the huddle (I know I know... I dunno why I still "hangout" there ) but I'll post what I posted there... I work in a hospital system where we have Psy.D, DPM, etc and they ARE called "Doctor" by everyone from the CEO down! Why is it an issue ONLY when a PA or NP is trying to use Doctor... (I preface this post to state that I don't agree with non physicians using the term but clearly the matter is not settled since others are able to use the title. 

[EMEDPA]

I have one and only use it when teaching global health and disaster med students.  If I really got a bee in my bonnet about it I would say Hi, I'm Dr Emedpa, one of the physician associates, but that is too much of a mouthful so I don't. 

All my IDs/scripts/etc do say PA, DHSc and if someone asks I tell them that I am A PA with a doctorate in global health. 

[iconic]

5 hours ago, Joelseff said:

This topic was posted in the huddle (I know I know... I dunno why I still "hangout" there ) but I'll post what I posted there... I work in a hospital system where we have Psy.D, DPM, etc and they ARE called "Doctor" by everyone from the CEO down! Why is it an issue ONLY when a PA or NP is trying to use Doctor... (I preface this post to state that I don't agree with non physicians using the term but clearly the matter is not settled since others are able to use the title. 

Psychologists and Podiatrists only hold doctorate degrees as those are entry level for them; they are also "experts" in their respective fields. I have never heard anyone have any controversy with those 2 calling themselves doctors. I think the ones that experience controversy are the ones where the entry degree is not a doctoral degree or was not always a doctoral degree (PharmDs, PTs, PAs, NPs, etc)

[ventana]

Doctor is not protected. 
physician is protected 

if you have a doctorate in your field you should be able to call yourself a doctor. 
 

I would personally not introduce myself as Dr Ventana, but instead PA Ventana but I could stop correcting patients who call me Doc. 

[rev ronin]

On 8/18/2023 at 6:02 AM, SedRate said:

Yet chiropractors, physical therapists, etc call themselves doctor. 

I'm not sure this is the case in California. As the state statute is summarized (and no, I'm not going to look it up, but this summary matches what I've seen here before about California law) even an optometrist would be at risk for NOT clarifying that an OD is not the same as an MD Ophthalmologist. Thus, while Ventana's correct in the general sense, California appears to have made itself an exception to the "rule".

[CAdamsPAC]

On 9/9/2023 at 11:58 AM, ventana said:

Doctor is not protected. 
physician is protected 

if you have a doctorate in your field you should be able to call yourself a doctor. 
 

I would personally not introduce myself as Dr Ventana, but instead PA Ventana but I could stop correcting patients who call me Doc. 

The lay public in general  equates "Doctor" with Physician, so when a clinician introduces themself as "Doctor Whatever" the patient generally  presumes they are speaking with a " Physician ". It imperative that a non physician  make it clear that they are not a physician.

 

[SedRate]

9 hours ago, rev ronin said:

I'm not sure this is the case in California. As the state statute is summarized (and no, I'm not going to look it up, but this summary matches what I've seen here before about California law) even an optometrist would be at risk for NOT clarifying that an OD is not the same as an MD Ophthalmologist. Thus, while Ventana's correct in the general sense, California appears to have made itself an exception to the "rule".

Oh, interesting. 

[ventana]

10 hours ago, CAdamsPAC said:

The lay public in general  equates "Doctor" with Physician, so when a clinician introduces themself as "Doctor Whatever" the patient generally  presumes they are speaking with a " Physician ". It imperative that a non physician  make it clear that they are not a physician.

 

100 years ago yup

50 years ago yup

20 years ago yup

5 years ago maybe

now nope

 

PT, OT, SLP, Pharmacist, orthotist, nurses and others are introducing themselves as doctor.  Heck I even heard of an Admin type with a Doctorate introduce themselves as a doctor......   the horse has left the barn and trotting across the fields on this topic....

[rev ronin]

12 hours ago, ventana said:

 the horse has left the barn and trotting across the fields on this topic....

That won't stop the AMA from beating it until it's dead and then continuing to do so...

[Hope2PA]

On 9/11/2023 at 8:46 AM, ventana said:

 Few points

1. I'm part of a medical research due to genetic predisposition. Question in education do you have a Doctorate, ie. PhD, or higher level professional, ie. MD, DO, JD(lawyer)etc.

2. Principal and educators with doctorate degrees DEMAND to be called Dr....by parents and students.
3. I do not have doctorate. Repeatedly tell patients I do not and 80% of time they respond by they know I'm not a physician, but still one of their Dr. I'm allied health not  PA or NP. They equate people as nurses or doctors but still know what a physician is. They know lab tech is not a nurse but still call them such. Funny nurses get their panties in a wad over that. 
3. I agree with others doctor is not protected. Dr. Susie, MD, Dr. John, DNP, Dr. Joni, DPT, ...., every person in medical field should be required  to factually disclose their exact education. The lying to public is what pisses me off. NPs DONOT have 3 years education compared to MD 4 and PA 2.  They FLAT OUT LIE to public and legislators. DNP is about half of MS PA. I know this is a side rant, I have absolutely NO respect for NPs in general because of this. Side note I know and respect a few who were nurses with Primary or pediatric physicians for 10+ years then became NPs and continued to work with physicians. 
 

[ampedmatt]

I agree with the idea the term “physician” should be protected, while “doctor” should be free to be utilized by those who have attained the degree.  Just my humble opinion.  

[LKPAC]

the term doctor may not be protected, but it's confusing to patients.  some in health care get a doctorate degree with less education than those of us with a masters.  Is a person's egotistical need to be called "doctor" more important that a patient's understanding of your true role in health care.  I don't think so.

[CAdamsPAC]

1 hour ago, LKPAC said:

the term doctor may not be protected, but it's confusing to patients.  some in health care get a doctorate degree with less education than those of us with a masters.  Is a person's egotistical need to be called "doctor" more important that a patient's understanding of your true role in health care.  I don't think so.

Yes, ego driven  actions manifested  by manipulation of the public's perception of who is providing care to them.

[ventana]

2 hours ago, LKPAC said:

the term doctor may not be protected, but it's confusing to patients.  some in health care get a doctorate degree with less education than those of us with a masters.  Is a person's egotistical need to be called "doctor" more important that a patient's understanding of your true role in health care.  I don't think so.

If we lived in a vacuum, I might agree. The problem is politics and scope of practice, along with being dependent on positions. Sure, on a one-to-one basis who cares what I am called, but politicians are somewhat dumb and over simplify things. It is insane that you can become a nurse practitioner with four5:00 hours of observational experience Over a few years on the Internet. This is nothing like becoming a PA yet they have more political, clout and freedom. 

[CAAdmission]

On 9/14/2023 at 8:40 PM, Hope2PA said:

Question in education do you have a Doctorate, ie. PhD, or higher level professional, ie. MD, DO, JD(lawyer)etc.

I'd hope a physician would never refer to themself as "doctor" in an educational setting. It would not be right for them to be confused with a PhD, unless they have earned one. 

[SedRate]

3 hours ago, CAAdmission said:

I'd hope a physician would never refer to themself as "doctor" in an educational setting. It would not be right for them to be confused with a PhD, unless they have earned one. 

What about a class in medical school taught by an MD? Lol