The Term Physician

[motoluver]

One thing that bothers me is the term "physician". I hear nurse practitioners referred to as non-physician providers or mid-level providers. Granted NPs don't have the level of education as an MD/DO but the care they have been trained to provide legally is just as high quality. Mid level sounds inferior to who would be considered a high level provider... If an NP was providing medical treatment outside of his/her scope illegally then yes I would consider that mid-level because they aren't trained to provide that care.

First I don't think anyone should ever try to hide their credentials (NP, PA, MD, DO, etc). Patients have the right to always know the level of education of the provider that is treating them. With that said, it bothers me to read " non-physician" providers. The actual definition of the word physician is an individual that practices medicine. In WA State as an NP I can legally practice medicine under my own license without supervision... Many other states are the same. And in states requiring supervision it should be considered supervision by a medical doctor, etc, not supervision by a physician... The term physician does not belong to MDs or DOs exclusively. Don't get me wrong EVERY patient should not be miss led about your credentials but if I see a patient and state "I'm a nurse practitioner and will be the physician treating you", etc that should be acceptable... The argument about who can be called doctor, and physician I feel is ridiculous. The only importance I see is the fact that every provider clearly states his credentials to every patient. After that if I have a DNP I should be free to be called doctor or physician and as an MSN-NP, called a physician. The term physician and doctor were around well before the creation of medical school so to think they have the only right to that term is preposterous... I do understand the goal of not miss leading patients but if credentials are offered to every patient, beyond that I feel the term doctor to those educated appropriately or physician to anyone who practices medicine and healing is free game to all no matter your credentials.

Am I off on my thinking of this? Would love to hear your thoughts on this. Any MDs or DOs want to offer their personal feelings on this? Not trying to start an argument but would love to hear how others feel on this topic of who has the right to the term doctor or physician.

(I know there are other threads on the term "doctor" but didn't find anything on the term physician.)

[BostonFNP, APRN]

Of course when we do participate in the threads that explicitly involve us, we get comments made over the fact that we're participating.

https://allnurses.com/nurse-colleague-patient/doctors-vs-nurses-983712.html#post8457439 (which, for comparison, I don't think I've seen the reverse at a certain other board where half of it is a wasteland that shan't be entered).

Well, I am glad you are here participating, and I think its ridiculous that other members wouldn't welcome that as well. You need both sides of the issue for a worthwhile discussion.

Post Graduate Year (PGY) 1 is the first year of residency where as clerkships are done during medical school. Unlike other residency years, however, PGY1 means a completely different thing in terms of experience in April (almost a full year in) than, say, July (fresh faced from med school).

I guess I couldn't figure out from the post if the poster was just finishing his PGY1 or just finished his clerkships and was about to start PGY1. If I understand it correctly, being (almost) May, the poster was either just finishing or not yet started. And I agree there is a huge difference there in terms of experience.

Dunning Kruger, and I think for most interns (PGY1), that trough is hit pretty early on into intern year. I also think that the OP on this thread hasn't quite hit the trough yet with regards to his own professional development.

That was my impression as well, which is what made me think of the above.

The concept of "associate physician" is not one without major controversy and is meant to the solution of, mostly Caribbean graduates, medical school graduates with $300k in debt, but unable to find a residency. Pretty much everyone I've seen who knows about that concept and knows the gap between theory and practice that residency fixes has huge issues with that program.

It's interesting, our pharm rep brought a speaker with him a month back to talk about the novel anticoagulants. He introduced himself as Dr. X and gave a routine 15-minute presentation. After the presentation I started a discussion about the medication, the recent data, and some cases from my own practice, and Dr. X made a few strange comments that just didn't make much real-world sense. I eventually stopped him and asked what his practice experience was, so he started to list several different hospitals and clinics, so I asked him about his capacity in those practices, and it turns out they were his clerkship rotations. He had never done a residency and had gone right into pharma. I was a little shocked.

[JPINFV]

It's interesting, our pharm rep brought a speaker with him a month back to talk about the novel anticoagulants. He introduced himself as Dr. X and gave a routine 15-minute presentation. After the presentation I started a discussion about the medication, the recent data, and some cases from my own practice, and Dr. X made a few strange comments that just didn't make much real-world sense. I eventually stopped him and asked what his practice experience was, so he started to list several different hospitals and clinics, so I asked him about his capacity in those practices, and it turns out they were his clerkship rotations. He had never done a residency and had gone right into pharma. I was a little shocked.

[harmonizer]

Quick question. How common do you see the sentiments like those of the OP, who sincerely believes that both NPs should be considered physicians AND practice medicine (the first being the topic of the thread and the second being explicitly mentioned in the first post)?

-Not very common at all. Most NPs I know do not want to title "physician". To me, it is protected title. Just like physician do not want to be called " nurse practitioner." However, the title "doctor", however, was used by some NPs because they obtained doctoral degree, which is legitimate since the title physician is already there to distinguish legal scope of practice. I always make it clear when I see the patient that I am an NP from the start.

-In legal sense, I think they can replace the word "practicing medicine" with "treat and diagnose and prescribe." The word practicing "medicine" is too vague anyway and hold much clarity.

-However, here is the frustrating part. Some legal documents (some of those NP are allowed to sign) neglect the scope of practice of other providers so they only have "physician" on the signature line. I usually cross it out and write either "specialty + nurse practitioner" instead. However, I see more and more paperwork now use more inclusive term like "providers" at the signature line.. Also NP cannot certify disability because they are "non-physician provider." .. these might be the one of the reasons why OP want the title...

[Glycerine82, LPN]

I like what Boston said. As a patient, I much prefer to see NPs. They are usually more knowledgeable on current information, treatments, etc. and I feel I get better quality care, so I like being able to pick out the NP from the MD.

[SummitRN, BSN, RN]

Physician means MD/DO.

We can argue about the term Doctor, but I think that in the current world, DNPs should only call themselves Dr. if they are in the classroom or perhaps PMHNP DNP. In mental health, DSW, PsyD, PhD, MD and DO are all commonly accepted as calling themselves Doctor. But NOT Physician.

Otherwise, why should one feel than NP is not a good enough title?

[MedicineDOc]

Hello again all,

Firstly, thanks for all the responses! I'll try to address some of the salient points I saw, without getting in details.

To Motoluver, paraphrasing your question, are GPs overqualified given their training? I am a PGY1 (post-graduate year 1 after completing medical school, who will be a PGY2 come July). Given where I am in my training currently, I cannot sufficiently answer that question yet; I have not yet completed my training and I haven't seen practice through the eyes of an Attending Physician yet. You do make a great point though in that the way it is set up seems to favor a gateway into the subspecialties, and I would wager a bet that many of my IM colleagues would agree with me on this. Nonetheless, it's a difficult question to answer and I wish that one day I can contribute to helping find the answer to optimize healthcare delivery systems in our country.

To Boston:

Thank you the detailed responses, and very helpful for my understanding. My training level is addressed above. I want to make it clear that I offered my response to this thread as a resident physician perspective (my personal point of view, specifically) on this topic. I also think you started talking about things that I did not mention or you may have misunderstood the intention of my original post. No worries! I am not talking about practice, I am not talking about 'knowing what you do and what you don't know' nor do I believe I am overstepping in any way at all. (These are all separate topics, imo) I only speak from a Resident Physician's perspective. I gave you insight into my residency program, yet you state that I am overstepping by speaking of practice. Sorry If I misunderstood this part. But I could say this, you have not trained as a resident physician or undergone formal residency training, so the point's you make are conjecture. Similarly, I have never nor do I intend to make any comments about NP education training, since I've never trained as one. If I have participated in conjecture myself, I apologize, as it was not my intention. I'll beat a dead horse, and mention again, my purpose was to offer perspective from a Resident Physician's point of view. Again, this is an online-forum, so it is very easy to misconstrue a posts or posters intentions, so no big deal; we are simply making conversation and I mean no harm.

To PsychGuy:

Thank you for the kind words. I too also value the diverse healthcare backgrounds that many of the NPs I work with come from.

To JPINFV:

Great to hear another IM resident's perspective.

Sorry I couldn't address every posters comments, but if you have any question's, I'll try and come back later to answer them.

Bottom-line: Physician or NP or whatever field you are from, let's just use this thread to help learn about ourselves!

As always, warmest of regards,

MedicineDOc

[greygooseuria]

Physician is a term that only MDs/DOs can and should use. I think chiropractors are trying to inch into that territory though.

I plan on eventually getting my DNP and PhD because I'd love to do research, but I doubt I'd ever want to be called doctor in the clinical setting. It seems so impersonal and my last name is hard to pronounce as it is. Plus, respect should come from your character, not a title.

I have a lot of respect for MDs/DOs. Most of my friends are either RNs, NPs or MDs (and all are very smart). I find that the quality of care really depends on the individual who is providing the care and not the letters after their name. I have had waaaaay too many experiences of physicians doing incredibly stupid stuff to my patients (and these are MDs that have been practicing for decades) like discontinuing someone's potassium supplements and increasing their lasix despite them already being hypokalemic (I discovered this at 5AM when the CNAs called me into the room and her heart beat was erratic, ran to get the chart and knew the problem immediately). This was when I was an RN. Maybe I'm just an odd case because I read textbook after textbook to learn and so I'm prepared for these things. I don't know. I find foreign med school grads that come here and practice are the absolute worse. I hate sounding xenophobic but I work with a lot of these docs and they are awful. There are some really good ones too but they are few and far between. A lot of their patients go septic or have really bad adverse outcomes compared to the American educated docs. I mean, I know they do their residency here if they come here to practice but if the foundation is crap maybe even with residency their practice will be crap too?

[nursetim, NP]

NPs don't want to be "physicians" and "practicing "medicine", we have our own title. That's how we can claim independent practice. We argue that we are not practicing "medicine", but "advanced practice nursing", which allows us to diagnose and treat certain conditions under our specialty

If they just want to refer to all of non-physician providers, they can just say "physician assistant and nurse practitioner." I do not like the term "mid-level" either.

We do in fact practice medicine. I have never seen anyone use a nursing diagnosis in documentation or in conversation. "Pt. has altered body image secondary to increased subcutaneous adipose tissue." Will never happen. "Mid-level", meh, irritates me a little but I consider that my hang up.

Here is how I figure my role in healthcare. I handle the simple stuff so that the physician can use his depth and breath of knowledge on the more complex cases. My job is to do the sports physicals, yearly physicals, spot irregularities and refer to those with more training. We are a vital link in the healthcare chain.

while I don't really desire a doctorate from a professional standpoint, it personal (ego) for me. When I earn my degree, I have no intention of calling myself anything but TIM in the clinical setting. Now making restaurant reservations or traveling, you bet.

[Jules A, MSN]

while I don't really desire a doctorate from a professional standpoint, it personal (ego) for me. When I earn my degree, I have no intention of calling myself anything but TIM in the clinical setting. Now making restaurant reservations or traveling, you bet.

Thank you for your candor. I like it! Trust me I looked into the DNP, and would have done it if I felt it would increase my skills in proportion to the cost but the ego boost of being called Dr isn't worth $30,000 and 2-3 years of my life, lol.

[IsabelK]

I have a DNP. In the clinical setting podiatrists, dentists, optometrists (not ophthalmologists--they are MDs), and others are called "Dr. So and So" without issue. I work in a clinical setting and I've been flat out told I can't use the title "Dr." because it might confuse patients and families.

I have a response: Everyone should use Mr. or Ms. So and So or their first names if it's an issue. Physician is the protected title, not "Doctor". I should be allowed to use "Dr." as long as I make it clear that I am not a physician: "Hi, I'm Dr. So and So. I am not a physician, I am a nurse practitioner with a doctorate." Doctor is my degree, not my license. Same with physicians.