NP's calling themselves MD's

[shelly304]

Does anyone else get as peeved as I do when nurse practitioners and/or physicians assistants call themselves doctors? Several of the NP's and PA's in the ER clinic where I work do this and it makes me grit my teeth each time I hear this. All the pts. call them "Dr." because that is how they represent themselves to the public. Am I being overly sensitive? I would never represent myself as an RN because I AM NOT ONE! After a really, long, crappy day, I was reprimanded by a pt. because I refered to the NP as Miss Smith and not Dr. Smith! The pt. actually told me I was being disrespectful by not saying "Dr. Smith" when speaking of her! And once again I explained to a pt., Miss Smith is not an MD. Then I get the "deer in the headlights" look from the pt. when I try to explain nurse practitioner. I know in the grand scheme of things this probably falls far but ..... Any advice or comments?

[wooh, BSN, RN]

I'm finding it highly ironic that the solution to a possible lack of education (patients that might get "confused" if we call people by their rightly earned title) is prohibiting people from admitting to their education (healthcare professionals who've earned a doctorate that isn't a MD.)

I've spent my last 4 shifts dealing with the effects of a resident who does her rounds at 6-7am, and tells families they're going home. Then I spend the next 6-8 hours before the attending gets there explaining to them that they can't go home yet. "But the DOCTOR said we were going home!" You know what, calling residents "Doctor" is confusing the patients and families. These "doctors" that have no more right to discharge a patient than the NPs or PAs or me, or for that matter, the women that run the cash register in the cafeteria, well, these "doctors" are walking around in white coats, with a stethoscope around their neck and "Dr. Resident" on their coat and nametag telling patients they can go home. It's very confusing! How far do you think I'll get if I try to get a policy that only attendings can call themselves by the title "Dr." because it's confusing the patients and families when residents do so?

Patients get confused. The answer is to educate them. (And in this case, educate this particular resident that she needs to make sure it's going to be MANY HOURS before the attending comes by and the patients are going to be discharged.) The answer is NOT to pretend that the only people in the building that have an education are the ones that went to medical school.

[core0]

When you earn a PhD you earn the right to be called doctor because in fact you are earning a doctorate degree. Most of my college professors were educated at a doctoral level and hence were referred to as Dr. XXX. I would never consider calling them Mr. or Ms. XXX.

I understand the concern over confusion when calling a PhD educated psychologist "doctor" (for example) around a patient, but they've devoted alot of blood, sweat and tears to earn that degree and doctor is the title they have earned. I do not see how a nurse who has earned a doctorate degree.

as for comparing new MDs vs DNSs...I don't know that I'd agree given that a DNS might have many years (even decades) of real life experience caring for patients whereas a new MD might not have been alive as long as the DNS has been practicing. I know I'm using an extreme example, but I think real life experience should not be discounted.

I think there are two issues here. One is the academic setting. It is perfectly appropriate to refer to someone with a doctorate in an academic setting as Doctor. One of our instructors had a doctorate in microbiology before going to PA school. We referred to him as Doctor X in class but in clinical situations he was very careful to remind us that this was not appropriate. Is the PhD relevant to the academic setting is another Oprah but I don't think anyone has a problem with referring to someone that has a doctorate as Doctor.

The other issue is in the clinical environment. From the physician point of view its about who is ultimately responsible for the medical care of the patient. Rightly or wrongly the public generally refers to that person as a doctor. Interestingly there are a number of studies that shows that the public uses the term doctor as anyone that provides their medical care. Similarly they use nurse in a broad term of someone that takes care of them in a professional capacity when they are ill. The proliferation of doctorates in areas that the public does not particularly view as providing medical care further confuses this.

Historically the term doctor was used by physicians long before the term nursing was used in an organized manner. Also historically in Britain the vast majority of physicians actually receive a masters in medicine and are referred to a doctors. The MD is a mark of academic prestige in medicine (essentially a PhD in medicine as opposed to science) and physicians with an MD are usually referred to professor (at least this is what I got out of my interaction with the Scottish NHS YMMV). Also historically surgeons are referred to as mister since they are an outgrowth of barbers not medicine.

Take this to its absolute extreme. Let us suppose that the CNA on the floor has a PhD in French Literature. Would it be appropriate to refers to that person as doctor? As in Doctor smith would you feed Mrs. Jones? I think that most people would regard this as inappropriate. So having defined where one end of the spectrum is, the real question is where is the other end? The physician community sees the DNP as a back door attempt to achieve parity with physicians. If we define the physician as the ultimate decision maker on medical care in the hospital does the addition of additional doctors help or cause confusion?

Even the title of the post betrays the confusion over this. The actual OP post was not that NPs called themselves MDs, but that NPs (and PAs) were referring to themselves as Dr X. As someone who has been trying to get a particular patient not to refer to me as Doctor for five years I understand the confusion.

David Carpenter, PA-C

[MikeyJ, RN]

I'm finding it highly ironic that the solution to a possible lack of education (patients that might get "confused" if we call people by their rightly earned title) is prohibiting people from admitting to their education (healthcare professionals who've earned a doctorate that isn't a MD.)

I've spent my last 4 shifts dealing with the effects of a resident who does her rounds at 6-7am, and tells families they're going home. Then I spend the next 6-8 hours before the attending gets there explaining to them that they can't go home yet. "But the DOCTOR said we were going home!" You know what, calling residents "Doctor" is confusing the patients and families. These "doctors" that have no more right to discharge a patient than the NPs or PAs or me, or for that matter, the women that run the cash register in the cafeteria, well, these "doctors" are walking around in white coats, with a stethoscope around their neck and "Dr. Resident" on their coat and nametag telling patients they can go home. It's very confusing! How far do you think I'll get if I try to get a policy that only attendings can call themselves by the title "Dr." because it's confusing the patients and families when residents do so?

Patients get confused. The answer is to educate them. (And in this case, educate this particular resident that she needs to make sure it's going to be MANY HOURS before the attending comes by and the patients are going to be discharged.) The answer is NOT to pretend that the only people in the building that have an education are the ones that went to medical school.

I don't think anyone is saying that we "pretend that the only people with an education are those who went to medical school". That is not the case at all. And if hospitals put in a change where we educated every patient on different professions and who is who, then perhaps we could do that. However, given what we have with our current situation, it really isn't a smart move to allow everyone with some doctoral degree to be called "doctor" in the hospital setting.

[pagandeva2000, LPN]

I'm finding it highly ironic that the solution to a possible lack of education (patients that might get "confused" if we call people by their rightly earned title) is prohibiting people from admitting to their education (healthcare professionals who've earned a doctorate that isn't a MD.)

I've spent my last 4 shifts dealing with the effects of a resident who does her rounds at 6-7am, and tells families they're going home. Then I spend the next 6-8 hours before the attending gets there explaining to them that they can't go home yet. "But the DOCTOR said we were going home!" You know what, calling residents "Doctor" is confusing the patients and families. These "doctors" that have no more right to discharge a patient than the NPs or PAs or me, or for that matter, the women that run the cash register in the cafeteria, well, these "doctors" are walking around in white coats, with a stethoscope around their neck and "Dr. Resident" on their coat and nametag telling patients they can go home. It's very confusing! How far do you think I'll get if I try to get a policy that only attendings can call themselves by the title "Dr." because it's confusing the patients and families when residents do so?

Patients get confused. The answer is to educate them. (And in this case, educate this particular resident that she needs to make sure it's going to be MANY HOURS before the attending comes by and the patients are going to be discharged.) The answer is NOT to pretend that the only people in the building that have an education are the ones that went to medical school.

I really agree with you, a person should be recognized as their earned title. But, what I often wonder is HOW LONG will this really take? I only say this because of the population I deal with. We have really exhausted all avenues to the best of our ability to demonstrate this fact, but what do you really do if the patient will not accept this (which is my reality...can't say what this is for everyone else). And, are we going to pound this in the head of the patient and make them feel guilty for not knowing? I am not saying this to challenge your argument or stance in this. I am saying this because I have witnessed this for years and saw this cause even more confusion and disenchantment for the clients and even amongest ourselves.:redbeathe:nurse:

[PMHNP10]

Take this to its absolute extreme. Let us suppose that the CNA on the floor has a PhD in French Literature. Would it be appropriate to refers to that person as doctor? As in Doctor smith would you feed Mrs. Jones? I think that most people would regard this as inappropriate. So having defined where one end of the spectrum is, the real question is where is the other end? The physician community sees the DNP as a back door attempt to achieve parity with physicians. If we define the physician as the ultimate decision maker on medical care in the hospital does the addition of additional doctors help or cause confusion?

I understand the confusion, but yeah, I would call anyone who has rightfully earned a doctorate, doctor, out of respect for what they've done, regardless of setting. Now if they then give me permission to call them Mr. or Ms. XXX or even by their first name then I'll happily do so.

[pagandeva2000, LPN]

I understand the confusion, but yeah, I would call anyone who has rightfully earned a doctorate, doctor, out of respect for what they've done, regardless of setting. Now if they then give me permission to call them Mr. or Ms. XXX or even by their first name then I'll happily do so.

I would do the same. Heck, all of these titles are higher than my licensed practical nursing education/license, so I definitely say to give the respect where it is due. But, if a patient doesn't view or perceive it this way, no matter what we say, then what do we do?

[wooh, BSN, RN]

I don't think anyone is saying that we "pretend that the only people with an education are those who went to medical school". That is not the case at all. And if hospitals put in a change where we educated every patient on different professions and who is who, then perhaps we could do that. However, given what we have with our current situation, it really isn't a smart move to allow everyone with some doctoral degree to be called "doctor" in the hospital setting.

So when the residents are confusing the issue, can we prohibit them from calling themselves "Dr. Resident," since we aren't allowing "everyone" with some doctoral degree to use their rightly earned title?

[wooh, BSN, RN]

I would do the same. Heck, all of these titles are higher than my licensed practical nursing education/license, so I definitely say to give the respect where it is due. But, if a patient doesn't view or perceive it this way, no matter what we say, then what do we do?

We can't change their perception, we can only educate. If they perceive things a certain way, it's not really going to matter what anybody calls themselves or someone else.

[MikeyJ, RN]

So when the residents are confusing the issue, can we prohibit them from calling themselves "Dr. Resident," since we aren't allowing "everyone" with some doctoral degree to use their rightly earned title?

A resident is a physician. Not sure what hospital you work in, but on the floor I work on, residents manage the patients. When we have a patient who is crashing, or we need a med change, or we have a question about an order... who do we call? The resident.

[pagandeva2000, LPN]

We can't change their perception, we can only educate. If they perceive things a certain way, it's not really going to matter what anybody calls themselves or someone else.

That is the point I am trying to make. From what I have seen, we have tried to educate our patients for YEARS. To no avail. Most of us STILL introduce ourselves, or our collagues in the titles they have rightfully earned. But, at this point, it seems that we are doing it for ourselves, rather than the patient if they are adamant in viewing things the way they want to see them.

I can see the frustration...really. I believe that the people who have earned their title paid the blood, sweat and tears to be called who they are. I want them all to receive their just due, their respect, their kuddos and duckies! But, if it does not matter to the patient, if they insist that they are going to see it for what it is, confuse them or even scare them, then, what else is there?

[MikeyJ, RN]

I know I am going to get flamed for this but I am going to state it. I have discovered that there are many NP's (whether they are DNP or MSN) who are slightly regretful and perhaps jaded that they chose not to pursue medical school. Definitely not all -- most are in fact proud they are an NP and do not want to be referred to as doctor -- however, there are many who seem to feel this way. In an attempt to compensate and make themselves feel better, they choose to pursue their DNP in an attempt to finally be referred to as "doctor" in the clinical setting.

A perfect example is a professor I had not too long ago. He told us how he was accepted into medical school and actually did a semester but realized he did not like the medical model. He regretted it later on and decided to pursue his DNP. He regrets that he did not stick the MD route out but is content with his DNP. HOWEVER, if a patient talks to him (or anyone for that fact), he has this need to tell everyone he is "Dr. Joe". In fact, he had the clinic he worked at print "Dr. Joe, DNP, APN-BC".

I know most DNP's do not fall into this category, but it makes me believe a lot more do then I thought because of the recent decision that allows DNP's to have more priveleges and allows them to be called "doctor" in certain clinical settings.

Furthermore, I think it is an insult to the nursing profession to be called "doctor" in the clincal setting. We are nurses, not doctors. I want to be distinguished from a physician. There is a certain stigma with physicians and I personally would not want that stigma. In fact, when I go to a regular family clinic, I request to see a nurse practitioner because I know they were taught using the nursing model and not the medical.

[wooh, BSN, RN]

A resident is a physician.

And someone with a PhD in French Literature is a... Doctor! So why does one get to claim the title and the other doesn't? If it's confusion, then our residents need to quit calling themselves "Dr. Resident" because my patients think they can do things only an attending can do.

Easy solution: Maybe instead of everyone fighting over "Dr." we should just start referring to MDs as "Physician Bob." (They don't all have to be "Bob" though, some could be "Physician Dave.":))

Not sure what hospital you work in, but on the floor I work on, residents manage the patients. When we have a patient who is crashing, or we need a med change, or we have a question about an order... who do we call? The resident.

Some of the residents do that. Some just cause trouble and confuse the patients. For a lot of my patients, the specialty NPs and PAs are managing the patients more than residents are and actually have more "power" than the residents. One specialty, I can actually send home the patient once their NP signs the d/c papers. Of course, one specialty, I can send them home with a resident's signature. Maybe whoever can sign D/C orders can be called "Dr." and those who can't, don't get to call themselves "Dr." That would resolve the only "Dr." confusion I've noticed patients having the last few weeks.