Nurse practitioners sue California over restricted use of 'doctor'

https://www.beckershospitalreview.com/hospital-physician-relationships/nurse-practitioners-sue-california-over-restricted-use-of-doctor.html

 

Related article with additional context. https://news.yahoo.com/call-themselves-doctor-federal-lawsuit-140032342.html

 

The word doctor does belong to physicians in the practice of medicine.

Studies show (on mobile so I'll find a cite later) that patients cannot tell the difference. I know my primary care provider is a nurse but few of his patients, whom I know, are aware of that distinction.

 

Agreed. It’s all within context. It seems some of this may be related to NPs being able to practice independently now and their desire to market as doctor. Would Dr. X, NP be enough to clear the confusion but still point out the advanced degree? It’s interesting one of the lawyers claims the law would technically prevent the use of the Dr. title for dentists and chiropractors as well.

 

I agree. It is about turf and not really consumer protection. It is clear to see written Dr. Josie Smith, FNP and to introduce your self as "Dr. Josie Smith Nurse Practitioner". It is also important in any written or signed documentation. I have seen a Pharmacist at a hospital in scrubs and wearing a surgical hat. His scrubs said something like "Dr. Jose Gonzalez, DPharm.

Doctors don't own the term. I think they sued in some state to try and stop Licensed Marriage and Family Therapists from "diagnosing and treating" because those terms belonged to them. They eventually lost (Marriage therapists were sweating for a while though).

 

And optometrists. And chiropractors. And podiatrists. And psychologists. And audiologists. None of whom are physicians, yet all of whom use "doctor" as their professional title.

The real question is whether or not nurse practitioners are trained to a comparable level. Right now, not really. You can become an NP by completing a master's degree in nursing practice. And I'm not convinced the DNP is really a first professional degree. It seems to me to be a professional degree, and it's not always (ever?) the minimum qualification for entry into the nursing practice profession.

On that basis, I would reject the idea of calling NPs "doctor" in the workplace, even if they hold a DNP. But I do NOT reject the notion that the profession could get there. Just like optometrists, chiropractors, podiatrists, psychologists, audiologists....

 

Continuing the turf issue:

It really irks some MD/DOs that Nurse Practitioners and Doctor of Nurse Practitioner are edging into their territory. There are advantages cost wise for insurance companies. They have actively resisted any increase in scope for Physician Assistants. On Social Media I have seen DNP programs advertised and the laughing emojis or angry emojis are Physicians.

Not unique to Medicine. In one state Psychological Associates (Masters level but with out the freedom and scope of LCMH) were lobbying for changes to legislation to allow them to practice independently. This was successfully fought by Psychologists.

 

I would counter that none of those are practicing medicine as we commonly think of it (although each is an expert in their particular subfield, and podiatrists are skilled surgeons of the foot and ankle.)

 

Ontario has Psychological Associates as well. They can provide counseling and therapy and administer psychological assessments independently, but not interpret them without supervision of a licensed psychologist.

 

I find it weird that doctors are placed on such a pedestal as all-knowing figures. Are you of the opinion that only physicians are responsible for training and educating other physicians, particularly in practical skills like surgery? Does this mean that individuals like Vivien Theodore Thomas, who played a crucial role in pioneering open heart surgery, are regarded merely as lab technicians despite their significant contributions? Are you unaware of the number of patients that physicians refer to nonphysician providers? Do you believe a general practice physician can perform at the same level as an Acute Care Nurse Practitioner? Do you believe that a Psychologist with minimal training in pharmacology or even a general practice physician is vastly superior to a Psychiatric Nurse Practitioner who has been trained extensively in neuropsychopharmacology?

 

There was a time not too long ago when it was not the case. In fact, the field was known more for quackery than for science. The formation of the AMA help standardize both practice and the education of physicians. Then, for a long time, they were rather pedestrian. Even into the 1960s they made house calls and people paid them without insurance. But the AMA once again came to the rescue and restricted entry into the profession by limiting the number medical schools they accredited. I'm over-simplifying, sure, but you get the idea. It's my thesis that this dynamic threw open the door for alternative general practitioners like PAs and NPs.

 

Psychologists only prescribe in a handful of states and within certain federal agencies. They are required to receive a lot more training in psychopharmacology than a nurse practitioner. They are required to earn a master's degree in psychopharmacology and complete another supervised experience under the supervision of a psychiatrist.

 

The philosophies behind nursing and medicine are different. I've found nurse practitioners to be better listeners and more dedicated to finding the root of the problem. However, their training in medicine and pharmacology is lacking, in my opinion. I've caught some of their mistakes and misinformation. One time, a physician assistant had to step in and correct a nurse practitioner. This problem is compounded by the fact that many nurse practitioners are earning online degrees at low-quality schools. This is particularly concerning when it comes to psychiatric nurse practitioners because most of them only do medication management with minimal supervision from a physician.

With that said, I think this lawsuit is petty, especially for California. This state has had a non-traditional stance on practitioner education and training.

 

The state board complaint against Dr. Erny DNP is posted with her nursing license listing on California's professional license search website. Excerpting:

I'm probably okay with a page using "Dr. Sarah" where "Doctor of Nursing Practice" is equally prominent to or more prominent than "Dr. Sarah" on the page.

I'm okay with a conversation using "Dr. Sarah" where the patient was previously well informed that her doctorate is in nursing practice and she is a nurse practitioner and not a physician.

She loses me at the wording "I practice medicine..."

There's also more disputed in the complaint than how she presented her degree:

 

Well, then. I take that back. These disciplinary actions are not petty. It looks like she was practicing beyond her level of training.

 

I just thought of something else. Is it more unethical for a nurse practitioner to use a doctor title at work when their DNP program had little to no clinical coursework? Many DNP programs are leadership programs. Some are in other fields, such as health informatics. Linked below is TESU's 18-month DNP. It's not much different from a DHA.

https://www.tesu.edu/nursing/programs/dnp

 

Returning to this:

https://link.springer.com/article/10.1007/s11606-018-4580-x?_ga=2.62748780.1756635561.1689872283-1593445040.1689712763
"However, about half of respondents did not know PAs could prescribe medications and diagnose illnesses, and about one-third did not know NPs could prescribe medications and diagnose illnesses" - if they get a diagnosis and/or medication, they are liable to assume they have seen an MD/DO

https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/premium/arc/tia-survey_0.pdf - About 40% of patients thought a DNP was a physician, about 20% an NP was a physician and 15% thought a PA was a physician (although funny enough, 21% thought a psychiatrist was NOT a physician.)

 

This looks more like a public education problem. Doctor title or not, they don't know what each occupation can do.

 

Many people don't know the difference between a Psychologist and a Psychiatrist OR between an Optometrist and an Opthalmologist.

 

But in most cases, they are practicing in different fields (your psychiatrist isn't administering a Rorscharch, your optometrist isn't doing surgery) so it is easier to explain away as a patient education issue. When you go to a medical clinic for a prescription and you have two people with wildly different qualifications calling themselves doctor, you can't fault the patients for not being able to tell the difference.