Nurse Practitioners Cannot Use "Dr." in Clinical Settings in Cali

A federal judge ruled that nurse practitioners who hold a Doctor of Nursing Practice degree are not permitted to use "Dr." within clinical contexts. See an article here. Additionally, approximately twenty-seven states permit DNPs to practice independently. In my thinking, since some Ph.D.s (e.g., psychologists) and others (e.g., Au.D.) can use the title in clinical settings, DNPs should be able to as well.

 

I remember there being a legal battle in Canada (can't remember the province) over an Au.D. not being allowed to use the title of Doctor. If I remember correctly, she ultimately lost that battle.

I've definitely heard with my own ears Psychologists being referred to as Doctor in hospital settings by Medical Doctors and other staff. I think there is a certain level of respect for what it takes to become a Psychologist that isn't quite there yet for Nurse Practitioners.

I think the concern with Nurse Practitioners being referred to as "Doctor" may have to do with how much overlap there is in scope between the two roles, and how it could be confusing to patients. My local hospital solved this by requiring each healthcare professional to introduce themselves by title like this:

Hi, my name is______, I'm a Doctor of Nursing Practice. I'll be treating you today."

 

I think the issue is doctor is a colloquial term as well as an honorific title, and the two get conflated.

 

By that same logic, why shouldn’t certain nurse practitioners who hold PhDs be addressed as “Doctor” as well?

All clinical personnel should state their title and role during initial introductions.

All clinical staff should introduce themselves to include their title and role during initial introductions.

I hold both a DNP and a PhD, and I introduce myself by saying, “My name is Xpect, I’m a Psychiatric Nursing practitioner.” Many of my clients call me Xpect, Doc, or Doctor, and I don’t correct them since all are appropriate and correct. However, I never personally use titles like “Dr.” or “Sir” (as is customary among doctors and surgeons in the UK, I believe) to introduce myself.

I couldn’t care less — in my view, restricting the use of any earned professional title is really just a power move by the AMA.

 

My logic: Is it a doctoral-level license? How much do the duties overlap?

As of today, nurse practitioners still have a master's-level license. Their duties almost completely overlap with multiple physician specialties. Psychologists, in most cases, have a doctoral-level license. Other than a handful of states, psychologists do not have prescription authority. Audiologists also have a doctoral-level license. I could be wrong, but psychologists probably work alongside psychiatrists more than audiologists work alongside ENT physicians. Similarly, optometrists are usually doing their own thing evaluating vision whereas ophthalmologists are rarely seen by the average person. An ophthalmologist did my LASIK surgery, and that's it.

In short, is there a high risk of confusion, and can that negatively impact patient care or trust?

 

I have a related story. Should masters-level mental health practitioners be allowed to use the doctor title? This woman wrote a negative review because she had her son assessed for autism by a licensed psychological associate, and her insurance or school district would only accept an assessment from a licensed psychologist. In Texas, LPAs have a masters-level license. They cannot bill insurance directly. They have to bill at a lower rate under the supervision of a psychologist, even though they can practice independently. I don't know why Texas hasn't fixed this.

I think this LPA, who has a PsyD, was billing under a psychologist, but for some reason, an LPA giving an autism spectrum disorder diagnosis was an issue. This mother seemed to not have previously known the difference between a psychologist and psychological associate. She just knew that he uses the title of "doctor."

 

This argument comes up a lot. It's really not as confusing as people like to make it. Calling someone a doctor in a hospital setting who is working at bedside means they are likely to be mistaken for a physician. That is confusing to patients, if they turn out to be a nurse practitioner.

Going to a psychologist or audiologist who calls themselves doctor is less confusing, because people are less likely to mistake those professionals as physicians, even inside a hospital. The overlap in scope between nurse practitioners and physicians is what makes the title confusion a problem, not their specific level of licensure or training. An audiologist is not diagnosing a bacterial infection. A psychologist is not prescribing hypertension meds. A nurse practitioner might be doing both, perhaps independently, without patients being clear who they are seeing.

 

The type of doctorate one holds wouldn't change anything in the minds of those who don't believe nurse practitioners should be referred to as "Doctor."

They shooooould... But I've found in my experiences that they often don't.

And if not the AMA, those governed by it. It also doesn't help that the average person (in the United States at least) believes that only MDs should use the title of "Doctor."

 

In my humble and wholly unqualified opinion the issue stems less from the title and more from overlapping areas of practice.

One of my specialist providers is a nurse practitioner operating her own practice. The care provided resembles that which I would receive from an MD.

Mental health is another area where we created a web of overlapping and confusing distinctions. The general public doesn't really care to distinguish between an LCSW, and LCSW with psychotherapy endorsement and an LMSW let alone the often hazy line between an LMHC and an LMFT (where one exists at all). Add to this degree inflation where roles formerly filled by Masters (or even Bachelors) level practitioners now hold some form of professional doctorate and I think it fair to say that society created the mess, not the ondividual practitioners who want to use their titles.

Rather than establishing alternate pathways to obtain an MD, we created rival professions with near identical scope of practice in some cases. Rather than creating a sibgle mental health practitioner class with separate endorsements and clear boundaries for everyone, we created confusing overlapping scopes by separate and distinct professions.

We made this mess.

Also, and this is really important, I've been in the hospital a few times. The number of times you encounter a nurse practitioner, pharmacist, physical therapist etc bedside is extremely rare. It's just not that confusing in the real world.

 

In a purely medical environment where most NP's practice, I do think it's misleading for them to refer to themselves as "doctor", unless they make it crystal clear that they're not physicians.

 

Here in California they cannot call themselves doctor. They are still very common and I've always been pleased with care that they've given me. For example, the general practitioner that I used for over 30 years was just an NP. The orthopedic surgeon office that I went to yesterday has one doctor listed there that I don't think ever sees patients. He has NP's working for him. The very busy practice needs 8 examination rooms.

Actually I'm not sure these are all NP's. Is there something else between an NP and a doctor?

 

I *think* Physician's Assistants are above NP's, as PA's can perform surgery, I had epidermal inclusion cyst removed from my back by a PA who did it solo in the office (outpatient).

Around here PA's go by PA-C to indicate certified.

 

Thank you!

After I posted my post, I thought about talking to the lady that I had been seeing for over 30 years. My last visit to her she said she was retiring. That made me very sad. I was expressing my sadness and also thanking her for all her help over the many years. I mentioned her being a Nurse Practitioner. She responded something like, "Oh well actually I'm ... Oh it doesn't matter. Come here and give me hug." Then I quickly added the last sentence before my 10 minute time limit ran out. So she must have been a Physician's Assistance with her own practice. Although she did list a doctor on her door above her name. Thanks again!

 

It's the other way around. NPs are more educated and experienced. In many states, they can practice with little or no supervision. And they can, in many states, perform simple surgeries.

 

DUMB. JUST. PLAIN. DUMB.

 

NPs and PAs are trained on different models of care. One is not above the other, but NPs have won more independence because they practice a different model of care from physicians. The last time I looked, no state has granted PAs the ability to practice independently. The intention behind the creation of the DMSc was to convince a state to grant PAs independence, but that state changed its mind.