Curious...using the title "Doctor" for a DNP...

Specialties Doctoral

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For a friendly debate topic.....

I remembered reading an old post awhile ago where an NP (who got her DNP) was told by Human Resources that she couldn't use the title "Doctor" at the hospital, because it would mislead the patients.

I am wondering if anyone has seen or heard anything similar where they work (you personally or someone else).

If hospitals are "all about introductions", I see nothing wrong with telling a patient, "Hi, I'm Dr. Smith, I'm a Nurse Practioner"...I see no difference between that and saying, "Hi, I'm Dr. Jones and I'm your Cardiologist".

To me, that would be a HUGE slap in the fact to someone who has worked hard for that degree, because they are entitled to use that title.

What ya'll think?

Specializes in ACNP-BC.
So much depends upon context.

Within the confines of a hospital or exam room, if someone in scrubs or a white coat or a suit introduces him or herself as Dr. So and So, the assumption will probably be that the person is a medical doctor who has attended medical school.

If you introduce yourself as Dr. So and So, Nurse Practioner, some patients may get it, others may not. Context. Considering the patient's potential state, nervous, vulnerable, afraid -- what will they hear when you introduce yourself that way? The operative word is "doctor," not nurse practioner. If you're sitting naked under a gown on an exam table and a man or woman in white comes in and introduces him/herself as Dr. So and So, Economist -- what will your reaction be? Will you even hear the word "Economist?" If you do, what will all this mean to you?

If they get it, how will you know? If they don't, how will you know? Will the medical professional explain the context of the introduction? If the patient doesn't ask for an explanation, will the medical professional infer that the patient understands?

Much of this discussion in this thread seems to focus on the medical professionals, their pride in getting that degree, status within the profession, etc. -- which I'm not saying isn't important. You should be proud of your accomplishments. But the focus should be on the patient and the context of the communication. Meaning exists within a context.

I agree with you. You make a valid point.

Specializes in Nursing Professional Development.
So much depends upon context.

Within the confines of a hospital or exam room, if someone in scrubs or a white coat or a suit introduces him or herself as Dr. So and So, the assumption will probably be that the person is a medical doctor who has attended medical school.

If you introduce yourself as Dr. So and So, Nurse Practioner, some patients may get it, others may not. Context. Considering the patient's potential state, nervous, vulnerable, afraid -- what will they hear when you introduce yourself that way? The operative word is "doctor," not nurse practioner. If you're sitting naked under a gown on an exam table and a man or woman in white comes in and introduces him/herself as Dr. So and So, Economist -- what will your reaction be? Will you even hear the word "Economist?" If you do, what will all this mean to you?

If they get it, how will you know? If they don't, how will you know? Will the medical professional explain the context of the introduction? If the patient doesn't ask for an explanation, will the medical professional infer that the patient understands?

Much of this discussion in this thread seems to focus on the medical professionals, their pride in getting that degree, status within the profession, etc. -- which I'm not saying isn't important. You should be proud of your accomplishments. But the focus should be on the patient and the context of the communication. Meaning exists within a context.

While I agree with you philosophical argument -- it doesn't resolve the issue. Patients will understand that which is clearly communicated to them. So that argument does not resolve the basic question as to whether or not DNP's or RN's with PhD's should or should not refer qualify for the "Doctor" title of address. All professionals (regardless of their discipline) should clearly introduce themselves and explain their role in the patient's care.

Also, there is not just one single context involved in this discussion. There is also the question as to the use of the "Doctor" title outside the patient room -- at professional meetings, etc. In academic contexts, people in different disciplines mix and mingle all the time -- and the fact that they are all "Doctors" in different disciplines doesn't seem to cause a big problem. It is only some physicians who seem to have a problem with other doctorally prepared individuals using the title they have earned -- and they expect the rest of the world to cater to them about it when they are actually the late-comers to the world of doctorally prepared people. The PhD degree is much older than the MD and is the higher ranked degree.

What should the patient assume of the physician "doctor" versus the nurse practitioner "doctor" ?

A provider that has received training that is more thorough and rigorous.

Why would you say I am Dr. so- and - so..doctor nurse practitioner? That is confusing--I would say I am doctor smith Nurse practitioner. When the patient asks what is that you tell them.

I work with a biomedical engineer who check pacemakers. he goes in with his white coat and if a patient calls his doctor he does not correct him. However, I have never seen our NP allow a patient to call her doctor without letting them know that she "doesn't have her doctorate yet" and she is an NP. Using doctor does impress--but it also instills confidence about level of education. Nurses have just as much right to instill that confidence as a physician. We also use clothing to instill confidence--this is why male physicians wear suits-- it is important to patients.

Specializes in Pain Management.
As someone with a PhD in physics who stumbled upon this site, I find the irony of this post overwhelming. Historically, it was physicians who borrowed the term "Doctor" from the academics in order to gain respect from the public. To turn around and accuse others of this either points to historical ignorance or just plain arrogance.

AMA 303 is a poke in the eye.

So you have a PhD in physics and just happened to pop into a nursing website and give an outside rebuttal about the physician vs doctor debate in your one and only post, then in closing, make reference to an AMA resolution that is fairly obscure to those outside the debate.

Curious.

I just suffered through the MCAT and by far, my worst section was physics. Could you recommend a good overview text?

Much of this discussion in this thread seems to focus on the medical professionals, their pride in getting that degree, status within the profession, etc. -- which I'm not saying isn't important. You should be proud of your accomplishments. But the focus should be on the patient and the context of the communication. Meaning exists within a context.

That is teh correct. I have a master's degree in acupuncture and I work as a RN in a hospital-based, outpatient pain management department. It would be inappropriate in that context to present myself beyond how I function in the department.

To do so would be an exercise in self-ego stimulation as instead of an exercise in patient advocacy.

Specializes in ED, Cardiac-step down, tele, med surg.
A provider that has received training that is more thorough and rigorous.

Can it be guaranteed that the more thoroughly and rigorously trained provider will provide better care? I think in some instances a less thoroughly trained provider can provide better care, especially if they have had more experience in the field. Thanks for you input.

Specializes in Pain Management.
Can it be guaranteed that the more thoroughly and rigorously trained provider will provide better care? I think in some instances a less thoroughly trained provider can provide better care, especially if they have had more experience in the field. Thanks for you input.

And sometimes an obese, sedentary smoker lives longer than a person that eats clean and runs marathons.

Outliers of the group do not somehow confer special qualities to the group. In general, better training and more supervised clinical exposure [how does 5 years of RN experience in the ICU compare to 3-4 years of residency, for example?] leads to better practitioners.

Specializes in ED, Cardiac-step down, tele, med surg.
And sometimes an obese, sedentary smoker lives longer than a person that eats clean and runs marathons.

Outliers of the group do not somehow confer special qualities to the group. In general, better training and more supervised clinical exposure [how does 5 years of RN experience in the ICU compare to 3-4 years of residency, for example?] leads to better practitioners.

Then where's the evidence that M.D.'s are better practitioners than NPs within the scope of practice of the NP's? I don't think there is any and until that scientific evidence appears we can only make assumptions, which give us nothing. It seems to me that a lot of this drama is based upon gender politics, where medicine, a male dominated entity garners more power than a female dominated entity. And the above example that you have given has been researched, there's actual data to show smoking and sedentary lifestyle are harmful. There's no data to show M.D.s necessarily provide better care with in the scope of the NP.

Specializes in Neonatal ICU (Cardiothoracic).

Quite an interesting take on the subject!

I never considered if a MD practicing within the scope of an NP would provide better or equal care. I would imagine that in the grand scheme of things, the MD would have more "head knowledge," but overall outcomes would remain the same.

Specializes in Pain Management.
Then where's the evidence that M.D.'s are better practitioners than NPs within the scope of practice of the NP's? I don't think there is any and until that scientific evidence appears we can only make assumptions, which give us nothing. It seems to me that a lot of this drama is based upon gender politics, where medicine, a male dominated entity garners more power than a female dominated entity. And the above example that you have given has been researched, there's actual data to show smoking and sedentary lifestyle are harmful. There's no data to show M.D.s necessarily provide better care with in the scope of the NP.

Where is the evidence that medicine is male-dominated and therefore physicians make more than women nurses? Sounds like the biased, unscientific claims made in my Graduate Nursing Theory book...or assumption, if you will.

And finally, once again, the burden of proof is in the claimant, meaning it is the responsibility of nurse practitioners to show they are as good of practitioners as physicians, not the other way around. Aside from research that showed that nurse practitioners that were supervised by physicians were possibly as good as residents, there is none.

A common critique of physicians is that they are reacting from ego when they try to limit the scope of nurse practitioners, but if you take a step back and look at the situation, it seems like the notion that nurse practitioners are at least equal to physicians in ability while only having a fraction of the training (because of some inherent benefit of the nursing model confers to the nurses over the physicians) is a function of ego.

A real patient advocate would demand good research to show that solo nurse practitioners are not causing harm to the patients and function as well as physicians.

I have been reading these posts and am quite dismayed by most of the comments. In my opinion and experience (not scientific) any practitioner who misleads a patient regarding credentials is and should be held accountable. This occurs on every level. The "nurse" you see in your doctor's office may very well be an MA with 10 weeks training. The PA who introduces himself as "Hi, my name is XYZ with neurosurgery" is probably mistaken for a physician b the majority of patients. The visitor who identifies herself as Dr. Smith may well be a dentist using her title to gain access to her neighbor who in the ICU. I will say this, I have NEVER heared a DNP introduce his or herself as anything other than, "Hi, My name is XYZ and I am a nurse practitioner working with the trauma surgeons here." Or, "Hi, I am Dr. Smith, a nurse practitioner working with the neurosurgeons." There are 25 NPs in our system and many of them are doctorally prepared. As a bedside nurse, I often hear my patients refer to the PAs as Doctor so-and-so, and I correct them. However, I have never had a patient refer to an NP as a physician. They repeatedly tell me that they are glad that the nurses at my hospital are so well educated. We have one of the highest % of CCRNs and CNRNs working in ICU in our city. It is a requirement of every healthcare provider to clearly and correctly identify him or herself when interacting with patients. This is true for physicians as well. Each of my trauma patients has a variety of physicians, each serving a separate purpose. There is a trauma surgeon, possibly and intensivist and may also be an orthopedic or vascular surgeon, physical medicine, even psychiatrist involved in their care. Talk about confusion. When the orthopedic surgeon comes in and the patient asks about his blood pressure medicine, do you think that surgeon has any clue about the medical management of his blood pressure, NO. But to the patient, a doctor is a doctor is a doctor. We just need to be good practitioners all, and demand the same from our peers. The titles will sort themselves out.

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