Should the "Doctor" title really be an issue?

Specialties Doctoral

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The number one arguement against DNPs using the title Doctor, especially in the clinical setting, is that it might confuse patients. Ignoring the fact the most DNPs clarify that they are not medical doctors, should this even be an issue?My thoughts:- Most patients already think they are seeing a doctor even if you tell them you are a NP or PA- Even if they think you are a MD (so long as you aren't intentionally trying to make them think that) what difference does it make? You might not be trained to the same standards but you are trained to do your job. It's not like you are a carpenter pretending to be a plumber.

Specializes in Psychiatry.

I agree that a physician could say, "Hi, I'm physician Smith," if it bothers him or her. A doctor is a title, not a profession, and there's no confusion when a doctorally prepared NP is providing the same level of care with the same outcome, as documented by plenty of research.

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Specializes in ER.

I've seen orders written from MD's to pharmacists and the MD addressed the pharmacist In the order as "Dr". Anyone with a doctorate has earned that title. I do think until the public has been educated (may never happen) DNP's should probably introduce themselves as "I'm Dr so-and-so your nurse practitioner". Although I have plans to get my DNP and I'm pretty sure I'll just introduce myself by my first name. I found working in the hospital the patients could care less I was the RN and the other person helping them was a tech. They didn't care about titles at all, they just wanted help however they could get it.

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I've worked with psychologists in PM&R and they introduce themselves as, "I'm doctor Jones, I'm a psychologist." I'm currently working with and surrounded by psychologists and at least one pharmacist who call themselves "doctor." Never been a problem.

Ditto -- I've been working in psych nearly 30 years, and have always worked with psychologists who were referred to as "Dr. XYZ" by everyone, including the physicians, and none of the clients ever had any difficulty keeping track of who were psychologists and who were psychiatrists.

This is a non-issue, and the only reason it's perceived as a problem at all is because physicians, way back when, somehow got the crazy idea that they somehow own the honorific "Doctor." Anyone with an earned doctorate is a "doctor," regardless of discipline or role. It's a title, not a job description. If physicians just referred to themselves (and everyone else, did too) as physicians, not doctors, there wouldn't be a problem.

And some states having statutory title protection means nothing -- it doesn't prove there is a problem, just that the physician lobby in those states have sensitive egos and clout with the state legislature.

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Here is my take on it:

Physicians over time have somehow ASSumed that they have exclusive rights to the title "doctor" and they do not. ANYONE earning a doctorate degree has that right.

A physician that is an MD has a "Doctor of Medicine" degree. Funny how the RESIDENTS never clarify to patients that they are in a residency program, even though state law will not allow them to practice independently without the supervision of a board certified physician.

Pharmacists with a PharmD also have an earned doctorate...they have earned the title as well.

MSN degree has never changed a person's title...so that argument doesn't hold water. An earned doctorate, however, always has.

Patient's once-upon-a-time had to be educated in the difference between a CNA, LPN and an RN. I believe it looks better on the clinic or hospital to have nurses that have achieved the highest level of education in their respective field.

I have no problem with the cardiologist introducing himself as "Dr. Smith" as I do agree that no clarification is necessary in a clinical setting that someone using the title of "Dr" is an MD or DO.

However, I believe that a facility should allow pharmacists or anyone else that has earned the title to use it as long as clarification is made.

"Good Morning, I am Dr. Doe, your pharmacist"

"My name is Dr. Smith, I'm a nurse practitioner"

...and even better...

"My name is Dr. Jones, I am a medical resident"

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I'm a 3rd year medical student with a PhD in engineering (MD/PhD program). I NEVER introduce myself as Dr. ____ when I see patients because it would be confusing and dishonest since I am not a medical doctor. The ONLY people who should go by Dr. in a clinical setting have the following degrees: MD/DO, DDS/DMD, DPM, +/- OD. If you're at a vet hospital or clinic then a DVM can go by "doctor". There is a reason some states protect the use of the term "doctor" in a clinical setting: it's not to diminish the worth of degrees, it's to not confuse and mislead patients. For this reason, I've never heard a physical therapist or pharmacist go by "doctor" in a clinical setting (or in any setting) even though they have doctorates. DNPs shouldn't use the term "doctor" when introducing themselves to patients for the same reason I don't introduce myself as Dr. ____.

I couldn't disagree with you more.

Engineering is not a medical science.

Nursing is.

Yes, the state restricts the use in some areas because it IS FOR THE PURPOSE of diminishing the degrees of NURSES and other CLINICAL PROFESSIONS outside of a Medical Doctor degree.

Who do think heads up that campaign with the state? Medical doctors.

Physical therapists and pharmacists SHOULD BE PERMITTED to go by their earned title in the clinical setting.

Case in point: One of our physical therapists has an earned doctorate and when counseling the mother of a patient on the special needs of her child, the mother (who was a nurse practitioner), started arguing with the PT about the plan of care. The conversation got pretty heated and then the mother said, "Well, all you people have is an associate's degree, so what do you know!"

The woman's jaw about hit the floor when the PT told her that she was actually a DPT.

The PROPER INTRODUCTION would have clarified that immediately.

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Specializes in FNP, ONP.

I am here to tell you that where ego isn't an issue, title isn't an issue. NPs have had independent practice here for a long time. Physicians are accustomed to it and supportive of it. They have to be reminded it isn't the case everywhere and express surprise and wonder how the world even turns in those states, lol. When it comes to addressing DNP prepared NPs as "Doctor," they are likewise confused, only because they don't know who is and who isn't going to be addressed that way. The inconsistency is as jarring and confusing to them as it is to nurses. ;)

In my office,when I meet a patient for the first time, I say "Hi, my name is Blue Devil, I am a NP." If they ask my what they should call me, and they often do, I say they should call me "Blue." (I find that a little curious, because I doubt they ask my physician colleagues what to call them.) However, even after I tell them to call me Blue, many do not. My colleagues (including the physicians) and the staff, when speaking to patients, call me Dr Devil. When they are speaking to me directly they call me Blue, of course. About 1/2 my patients call me Dr Devil and the other half call me Blue. Blue was good enough for my parents, so I am pleased to have my patients call me Blue. I didn't earn a DNP so people would call me "Doctor."

I will admit that I did use the title in a very stupid and egotistical way one time, because I was irritated at someone. My partner and I had a conflict with the principle at one of our children's schools, won't bore you with the details (except to assure you were we right and she was wrong ;) ). We walked into a conference room with the principal, her boss the superintendent, the classroom teacher (who was on our side!) and a member of the school board that I'd asked to attend. Anyway, introductions were being made all around, and while my partner and I both hold doctorate degrees, we don't go around socially calling ourselves Doctor, lol. I was still trying to be nice to the principal despite our conflicts and said "Good Morning MRS Smith." She said rather hostilely: "actually Mr Devil, it's Dr Smith." She was unnecessarily snotty about it, when #1 I did not know she had recently completed her Ed.D (I did not get invited to her graduation or the memo with the update on her educational status apparently) #2 My tone had been very cordial and pleasant. I was already angry, hence the meeting. That tone/comment irked me, so I responded with: "well in that case, as a matter of fact, I am Dr Devil, and my partner is Dr Tiger (Princeton PhD)." It was childish and petty, and I regretted it the second I said it, as we usuallly regret the things we say when we are angry and frustrated, lol. To my recollection, that is the only time I have ever instructed someone to call me doctor.

Dumb story. Point being, the title is also dumb and isn't really important. I earned the degree because I wanted to and I enjoyed my NP education immensely. I believe in the DNP. I do think it improves NP practice. I do think it is important for leaders in the NP field to possess DNPs, and encourage others to pursue it. I do think the DNP is the future of NP practice. I don't think being called "Doctor" is a good reason to pursue DNP education, or oppose DNP education/practice for that matter. If there are DNP prepared NPs that really want to use the title and really want to hear people call them "Doctor" all day, well I wonder what that is really all about, but OK. You earned it, it is your's to do with what you choose. However, for me, it is not necessary to hear people call me by a title. I like what I do, I feel as though I do it well, and that's what it's about.

I reserve the right to throw it around next time I lose my temper with snotty bureaucrats. I am not perfectly enlightened 24/7/365.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I am here to tell you that where ego isn't an issue, title isn't an issue. NPs have had independent practice here for a long time. Physicians are accustomed to it and supportive of it. They have to be reminded it isn't the case everywhere and express surprise and wonder how the world even turns in those states, lol. When it comes to addressing DNP prepared NPs as "Doctor," they are likewise confused, only because they don't know who is and who isn't going to be addressed that way. The inconsistency is as jarring and confusing to them as it is to nurses. ;)

In my office,when I meet a patient for the first time, I say "Hi, my name is Blue Devil, I am a NP." If they ask my what they should call me, and they often do, I say they should call me "Blue." (I find that a little curious, because I doubt they ask my physician colleagues what to call them.) However, even after I tell them to call me Blue, many do not. My colleagues (including the physicians) and the staff, when speaking to patients, call me Dr Devil. When they are speaking to me directly they call me Blue, of course. About 1/2 my patients call me Dr Devil and the other half call me Blue. Blue was good enough for my parents, so I am pleased to have my patients call me Blue. I didn't earn a DNP so people would call me "Doctor."

I will admit that I did use the title in a very stupid and egotistical way one time, because I was irritated at someone. My partner and I had a conflict with the principle at one of our children's schools, won't bore you with the details (except to assure you were we right and she was wrong ;) ). We walked into a conference room with the principal, her boss the superintendent, the classroom teacher (who was on our side!) and a member of the school board that I'd asked to attend. Anyway, introductions were being made all around, and while my partner and I both hold doctorate degrees, we don't go around socially calling ourselves Doctor, lol. I was still trying to be nice to the principal despite our conflicts and said "Good Morning MRS Smith." She said rather hostilely: "actually Mr Devil, it's Dr Smith." She was unnecessarily snotty about it, when #1 I did not know she had recently completed her Ed.D (I did not get invited to her graduation or the memo with the update on her educational status apparently) #2 My tone had been very cordial and pleasant. I was already angry, hence the meeting. That tone/comment irked me, so I responded with: "well in that case, as a matter of fact, I am Dr Devil, and my partner is Dr Tiger (Princeton PhD)." It was childish and petty, and I regretted it the second I said it, as we usuallly regret the things we say when we are angry and frustrated, lol. To my recollection, that is the only time I have ever instructed someone to call me doctor.

Dumb story. Point being, the title is also dumb and isn't really important. I earned the degree because I wanted to and I enjoyed my NP education immensely. I believe in the DNP. I do think it improves NP practice. I do think it is important for leaders in the NP field to possess DNPs, and encourage others to pursue it. I do think the DNP is the future of NP practice. I don't think being called "Doctor" is a good reason to pursue DNP education, or oppose DNP education/practice for that matter. If there are DNP prepared NPs that really want to use the title and really want to hear people call them "Doctor" all day, well I wonder what that is really all about, but OK. You earned it, it is your's to do with what you choose. However, for me, it is not necessary to hear people call me by a title. I like what I do, I feel as though I do it well, and that's what it's about.

I reserve the right to throw it around next time I lose my temper with snotty bureaucrats. I am not perfectly enlightened 24/7/365.

I have to tell you I LOVE that story!!!!:anpom:

I would have paid money to see the expression on that persons face. Well played.

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I will admit that I did use the title in a very stupid and egotistical way one time, because I was irritated at someone.

(I gotta say, Blue, I don't think that, in the specific incident you describe, invoking your professional title was "stupid and egotistical" in any way. What's sauce for the goose is sauce for the gander, as the saying goes. The principal was the one who made titles an issue. You were being cordial and respectful; when she requested that you address her by her professional title, then I think it was perfectly appropriate and reasonable for you to request the same consideration. If we're going to use professional titles, then, by all means, let's all use professional titles.)

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No ! As long patients are made aware of your legal professional status!

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I have to tell you I LOVE that story!!!!:anpom:

I would have paid money to see the expression on that persons face. Well played.

I love this story as well and do not regret what you did for a second. The women wanted to start on an uneven playing ground and with one swoop, you leveled it.

Well played Doc, well played.

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Specializes in FNP, ONP.

I feel as though I "stooped to her level," actually behaving just as insecurely as she. In any event, what's done is done. We aren't the types to check the "Dr" box on forms asking for a title when addressing mail and we don't use it making dinner reservations, lol (I've been waiting my turn and heard it though).

In clinic, my patients know who I am and what they came to see me about, using a title as some sort of power play to remind them which of us is the medical provider is unnecessary. If they want to use it, they can. It is accurate. :shrug: If they want to call me Blue, well, as I said, it was good enough for my Mom and Dad, so that's fine with me too. If it is their first visit, or they are new to the state and unfamiliar with either independently practicing NPs, DNP prepared NPs, or both, it is understandable that they may need some clarification on how their care is going to be handled so that they can make informed choices. On those occassions, patients usually have a few questions about who or what I am exactly, lol. I explain.

In 4 years, I have lost exactly one patient who said they thought they were making an appointment with a MD, and would prefer to see a MD for her care, so she switched over to one of the physician providers in the office. Was she misled? I don't think so. All of our names/professional titles are on the website, in the yellow pages ad, on the 30 foot high sign at the street, on the front of the building in 8 inch letters, and on the wall behind the front desk when you walk in announcing if we are in/out for the day and if we are on time or how far behind schedule. They all read:

Joe Brown, MD

Bill Red, MD

Frank White, MD

Blue Devil, DNP, FNP

Jane Pink, MSN, FNP

I am not sure how she mistook me for a MD. ??? She did act as though someone had tried to deceive her. I walked in the room, introduced myself as a NP, and she seemed fine. Didn't ask me anything about it. As far as I know she was literate and able to read any of the many signs/pieces of paper with my name and title clearly displayed, all of which were available to her for an untold number of weeks before her visit. She called back a day or two later to complain to the office manager that she had been told she was seeing a "doctor" and wanted her co-pay back for that visit (she didn't get it), and wanted to switch to a MD.

Then she subsequently switched to the other NP in the office, reportedly so she could have all of her care from the same person, citing the fact that she wanted a female provider. I think perhaps she just didn't like me or Dr White, and it may have had nothing to do with the fact that I am a NP. Who knows. In any event, I still completed her visit "to establish care," which all new patients at our clinic have to do anyway, which never includes a physical. It is the History and ROS (including getting the reports on every prescription, narcotic and non-narcotic, they have ever filled that someone somewhere else on the website was upset about last week, lol), ordering labs and screening diagnostics due, etc. Then they have to come back for the CPE. We never so much as touch a patient on the 1st visit, so she didn't actually get any "care" from the under-educated NP provider. ;) I don't recall now if she addressed me as "Doctor" or not, lol.

I don't know exactly how the telephone conversation went when she called to make that initial appointment. I have overheard snippits often enough though. They always say something to the effect of "We have appointment available that morning with either Dr Brown, or Dr White, or with either of our Nurse Practitioners, Dr Devil or Ms Pink." I suppose if someone wasn't listening carefully, they might not get the distinction. However, then they get mailed a 'new patient packet,' again, with my name and credentials, NONE OF WHICH SAY MD, all over it. Since three of the other providers do have MD after their name, if knew you wanted an MD provider and felt strongly about this, wouldn't you call and start asking questions in advance of the appointment? Or perhaps mention it that day?

I realize that I am one person, in one office, and hardly representative of all NPs and my patients are not representative of all patients. But my patients aren't the sharpest crayons in the box across the board, and they get it. I don't buy the "patients are going to be confused" line. Sure, they would be confused if we refused to explain it to them. Once explained, they understand. They even understand that one of us is a DNP and one of us is not, once we tell them. The other NP tells me she gets a lot of questions about this actually, and I think it is a source of frustration for her. People kind of nag her about "How come that other NP has a doctorate and you don't?" She said one time one of her patients was irate and thought that everone called me "Dr" just because I am a male, and wanted to file some kind of women's rights/discrimination complaint someplace. ROTFLOL.

Physicians will catch on, they are fairly bright people. duh. They just need some time to get accustomed to the new paradigm. Patients will catch on. Not as bright a group on the whole by comparison, but they are capable of learning, and they can grasp nuance when given the bloody information and some reinforcement. It is just going to take more time. In one generation, I predict DNP will be the standard among NPs and as often as not they will be called "Dr" in the workplace, just like the other non MD doctorally prepared medical providers are in their offices. In two generations I predict all NPs will be DNP prepared and will always be referred to as "Doctor," and none of them would believe that we ever put up with this nonsense!

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