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Doctors like to assert, maintain control and continuously patrol over their territories; at least some do. In a recent post on THCB, “Nurseanomics” by Maggie Mahar addresses the heated debate over the difference between a doctor and a nurse. Mahar takles the question that Legislators in twenty-eight states are dealing with. Should a nurse practitioner (NP) with an advanced degree provide primary care, without an M.D. being in charge? But another pressing question that needs to be addressed is: Should nurse practitioners be called doctors (DNP)? (DNP is a Doctor of Nursing Practice.) That is the question that I will address here. I reached out to the medical community to get their reaction. It’s not surprising that the immediate response of some doctors when asked if nurse practitioners should be called doctors (DNP) is “No!” evidenced by Dr. Stangl’s comment.
“NO! Nurse practitioners should NOT be called “doctors” because they are NOT! While many NPs do an excellent job of handling certain types of problems in certain settings, they do not have near the depth or length of education that physicians do and should be credited for what they Do have, which is their nursing background and expertise.” Susan Stangl, MD
Take a look at this comment that appears in THCB:
“An NP has mostly on the job training…they NEVER went to a formal hard-to-get into school like medical school,” wrote one doctor. “I have worked with NPs before, and their basic knowledge of medical science is extremely weak. They only have experiential knowledge and very little of the underpinning principles. It would be like allowing flight attendants to land an airplane because pilots are too expensive. HEY NURSIE, IF YOU WANT TO WORK LIKE A DOCTOR…THEN GET YOUR BUTT INTO MEDICAL SCHOOL AND THEN DO RESIDENCY FOR ANOTHER 3-4 YEARS. NO ONE IS PREVENTING YOU IF YOU COULD HACK IT![his emphasis]”
It’s clear that for these doctors, the simple answer is No. After all, why would doctors want additional prey in their territory? Even with the shortage of primary care physicians, doctors aren’t looking at nurses to help fill the void. The medical profession is quick to respond, and in some cases, with outlandish comments (evidenced in Mayer’s post) against a group of professionals who have earned an advanced degree. I posed the question again to my (yes) colleagues in the medical community. The question again: Should nurse practitioners be called doctors (DNP)? Doug Farrago, MD, explains:
“It is about the word DOCTOR. If you want to be a doctor, then by all means, I implore you to become one. We need you. The training is a bitch and; unfortunately, a gauntlet you have to get through. You don’t get that in NP school. You will be all the better for it, though. It really comes down to paying your dues. You just can’t call yourself one because you, well, just want to. Nurse practitioners came about to strengthen the healthcare system by making them “physician extenders” not “physician competitors”. By going this new route the NP group has made this relationship uncomfortable at best. I will get “hate email” over this but I didn’t do anything. The NPs are blatantly changing their strategy, demanding to be called doctors and are in direct competition with us yet I know they will rip me for pointing this out. The bottom line is the you are not a doctor. You are an nurse practitioner. It is a fact and it is not demeaning to say it. It is just a term. Get over it. I call myself the KING of medicine but just because I call myself one doesn’t mean I am one. Or does it?”
OK, I believe this is where we need to dissect the question. Although the question is simple and direct, it is being answered very quickly, without stepping outside the box. Doctors have a tendency to stay within their own territory. Yes, Dr. Farrago it is about the word “Doctors.” So when the question, “Should nurse practitioners be called doctors (DNP)”? is asked, the immediate reaction from most doctors, adamantly is “no!”. When you think about the question, the answer makes sense; a nurse is a nurse, so how can a nurse be called a doctor? That is the black and white response, but like many questions and areas in life, there’s more than black and white, we need to look into the gray areas for a different approach. We need to step outside the box. Remember, the question is should nurse practitioners be called doctors (DNP)? It does not ask if nurse practitioners should be called medical doctors. (In that case, there’s a simple answer and that would be no, not unless they attended medical school and obtained the Doctor of Medicine Degree.) Kevin Soden, MD, medical journalist has this to say:
“This is a fairly straightforward answer. A nurse practitioner should not be called doctor unless they have gone through a well-defined course of study showing mastering of a prescribed content like any other doctorate program. The danger that I can see for the lay public is the confusion that may arise if a person gets a doctorate degree in nursing and when they see patients, they or their staff refer to themselves as doctor. The average patient might think they are seeing a medical doctor with more advanced training in diagnosis and treatment. It’s important that the patient be educated in this regard.”
Here’s an interesting comment by Michael Blumenfield, MD -
“I see more downside to upside to calling NPs “doctor” in the hospital setting. It would suggest to patients that nurses who were not NPs were somehow not as important, responsible or critical to the patient’s care. In fact at times the opposite is true i.e. in trauma and critical care units etc as well as other places [take out psych] such as psych units etc where they have just as important roles and have had as much training as NP. I see this as even more important than the blurring of identification with physicians which might create some minor problems. Nurses deserve a great deal of respect which I believe that they have. I would hope that the hospital environment not become the place for working out political agendas.”
Time to scrutinize the question, Let’s look at the history. What does doctor mean?
Doctor originates from the Latin word (gen.: doctoris) which means teacher, it is abbreviated “Dr” or “Dr. and it’s used as a designation for a person who has obtained a doctorate-level degree.
Doctorate “is an academic degree or professional degree that in most countries represents the highest level of formal study or research in a provided field. In some countries it also refers to a class of degrees which qualify the holder to practice in a specific profession, such as law or medicine. Examples of the former are the Ph.D. (Doctor of Philosophy) and the S.J.D. (Doctor of Juridical Science), while examples of the latter include the U.S. degrees Doctor of Medicine, and the Dutch Professional Doctorate in Engineering.”
Doctorate dates back to the Middle Ages, the Medieval Era as a license to teach.
The first university, the University of Bologna, was founded as a school of law by four famous legal scholars in the 12th century, and the first academic degrees were all law degrees, and the first law degrees were doctorates as stated in Wikipedia.
Theology, law, and medicine were the earliest doctoral degrees.
The term “doctor” refers to an individual who has earned a degree of Doctor of Philosophy, or Ph.D. Beyond academia and in the classical professions, such as medicine and law, professional doctorates emerged such as the Doctor of Medicine M.D. (an abbreviation of the Latin Medicinæ Doctor), Doctor of Osteopathic Medicine D.O.
While many US lawyers and physicians who pursue purely academic and research careers in law and medicine do so after having earned a J.D. or M.D., respectively, these degrees are considered professional doctorates because most who earn them pursue careers as working professionals. In more recent times, other professional doctorates have emerged such as the EdD (usually held by school administrators), the DBA and the DPA (nearly always earned by prior recipients of the M.B.A. and the M.P.A., who continue to pursue ongoing professional careers in business and public administration) and the Doctor of Physical Therapy (DPT.)
There are other health professions such as physical therapy, podiatry, dentistry, chiropractic medicine, optometry, and veterinary medicine, where the title “doctor” is used professionally.
What is the issue?
First, it is true that some doctors can be territorial, but is this really the issue? I had a long conversation with a good friend of mine who’s a medical doctor and not surprisingly, he’s not a proponent of nurse practitioners being called doctors. He said, “The problem as I see it is that the academic term “Doctor” is distinctly different than the common understanding of “Doctor”. Having Nurse Practitioners use the term “Doctor” just mixes up the two uses and is confusing for the majority of people. If somebody wants to be a common “Doctor” then they need to go to medicals school and residency.” He adds, “…territorial is irrelevant. PATIENTS go to their DOCTOR. That is just common vernacular that has developed over several centuries.” While medical doctors aren’t the only doctors; does the issue become academic vs. institution. Is it okay to call a nurse practitioner “Doctor” when he or she is in an academic setting and NOT in an institutional setting? Shouldn’t it go both ways?
Heated Debate
This ostensibly will remain an intense heated debate. Kevin Pho, MD, founder of KevinMD writes a blog addressing the role of nurse practitioners. “Merely bringing up this idea brings out the worst in turf battles, with most discussions devolving into nurse versus doctor cat-fights,” writes Kevin Pho, MD.
Cat-fights we can do without – team is the best approach
KevinMD writes, “…doctors and nurses have to realize that it’s the patients who come first, and to care best for them, a team-based approach is needed.” Will this debate lead to cat-fights between doctors and nurses? As health care continues to change, perhaps it’s time we move out of the box and greet the DNP, the doctor, the teacher, the doctorate as a health care provider. If DNP is a Doctor of Nursing Practice, that simply means that they are teachers of nursing practice; it does not mean they are medical doctors. And yes, in regards to Dr. Soden’s comment, what simply needs to be done when the DNP sees a patient is to introduce her or himself and make it clear that she/he is a Doctor of Nursing Practice, not a medical doctor. DNP will be an asset to patients, but it’s important to realize what Dr. Blumenfield points out. There are many exceptional nurses who provide excellent care and they may not be an NP or DNP. It’s important to note that there are health care professionals who believe that by obtaining the highest level of learning, that they should be called doctors.
“OF COURSE THEY SHOULD BE CALLED DOCTORS,” says Michael Butler, DC, MS, R NCS T says in an email. He adds, “THEY PASSED CERTIFICATION OF HIGHER LEVEL OF LEARNING. THE PATIENTS THEY SERVE RECOGNIZE THEIR EXPERTISE.” Bonnie Marting, DNP, ARNP replies: “Regarding the question of whether NPs should be called doctors: Using the term “doctor” implies a higher education than the masters prepared nurse practitioner. It is an excellent opportunity to introduce the patient to the ever-evolving world of healthcare and the extent of the education this type of healthcare provider has. It does not confuse one with “physician”, simply clarifies.”
Bottom Line
We need to tread the waters very carefully here. The last thing health care needs are fighting nurses and doctors. Both groups are professionals with advanced degrees and we need to recognize that each entity in health care is unique and special. While medical doctors aren’t the only doctors; does the issue become academic vs. institution. Is it about titles and territory? Or is it about the patient? It’s vital that in the 21st century and with changing health care policies, that it’s time that both doctors and nurses work together as professionals for the good of the patient. No matter the title and the number of degrees, it’s vital that communication with patients is transparent and that they know who you are and are not misled.
Questions to think about
- In a hospital setting, should medical doctors be the only doctors allowed to use the title doctor?
- Lawyers can technically be called doctors since they obtain a Juris Doctorate degree, but they do not use that title. Should the same go for nurse practitioners that obtain the Doctorate of Nursing Practice (DNP)? Should they obtain the DNP but not be called doctor in a hospital setting to minimize any confusion to patients?
- Will patients be confused by a nurse practitioner calling themselves doctor?
- If nurse practitioners are very clear in introducing themselves as a doctor of nursing practice, will that alleviate the confusion?
- Should nurse practitioners be called doctor only in an academic setting and not in a hospital setting?
- Is it time to change the “common vernacular” of Doctor? – Doctor in a hospital setting does not necessarily now mean medical doctor since the advent of the DNP.
- Should Colleges and Universities along with the American Association of Colleges of Nursing present an ad campaign to the general public to educate them on the new title of nurse practitioners? After all patients should not be misled, and transparency is critical.
Your turn: What do you think? Should nurse practitioners be called doctors (DNP)?
Barbara Ficarra, RN, BSN, MPA is the executive producer and host of the Health in 30® Radio Show and founder of Healthin30.com, a featured writer on Huffington Post, and an administrative head nurse at a teaching hospital.
OK, let’s stop the crap. Many studies show that an NP providing primary care does so at a level equal to an MD (the AMA sponsored one such study and it was published by JAMA see: http://jama.ama-assn.org/cgi/content/abstract/283/1/59.) The AMA sponsored study was published in 2000–and we are still having this conversation and it is driven by MDs that quote AMA studies when it pleases them and ignores them when it is a strike against their position.
So, here’s the deal:
NPs are as good as MDs or primary care. (AMA says so—see above)
DNPs are NPs who are as good as MDs for primary care.
So, DNPs and MDs are both doctors with essentially the same outcomes in primary care.
Thus, a Doctor in a primary care setting (which may include a hospital folks!) is a Doctor whether he/she is a DNP or an MD.
Does the DNP role compete with MDs in primary medicine specialties? Yes, and as it should. The AMA and its approved medical schools cannot produce enough MDs to fill the demand required. Therefore, the DNP folks are stepping up—it’s just supply and demand.
So, do DNPs want to be seen as primary care doctors? YES, and anyone who says differently is dissembling.
But wait, this fight has happened before. The AMA fought the DO crowd as they expanded beyond high-class chiropractic and became physicians.
SO, will the DNPs need to expand their training as they come of age as a respected member of the primary care team? Yes, and it will–after all no outside group is forcing the DNP designation.
Finally, the AMA and the MDs and DOs need to step back and realize that the DNPs are showing up and the genie is out of the bottle.
Oh, and to all the MDs posting that it’s not about the title–I agree–so stop arguing and fighting the title. If a DNP can provide the same level of care as you then why should you worry that this exceptional provider of primary care is calling her/himself by the same title as you? After all, it’s not about the title. Or is it?
Randall, regarding your claim that MDs have allowed (after a fight) DOs to work as equals and, as such, should allow DNP to work as such… please note:
MDs and DOs adhere to the same academic schedule: 4 years of undergraduate work, 4 years of strenuous graduate work (of which 2 years are academic and 2 years are clinical in nature), 3-5 years of post graduate work (internship and residency), 1-2 years of post residency fellowship (often), and 1-2 years of fellowship involved research (less often). Please note that at each step of education there is a terribly difficult selection process that each individual must pass through, or else their medical training is discontinued.
Thus, physicians who are colloquially referred to as “doctors” by the general population must complete between 11 and 17 years of highly competitive and strenuous training before they can practice clinically and independently in their respective field. It must, therefore, be implied, that during this 11 to 17 years of difficult work that 11 to 17 years of valuable knowledge and ability has been obtained. Understanding this, the knowledge and ability of nurse practitioners who complete 6-8 years of (arguably less competitive and, possible, less strenuous) work is nearly 50% of that obtained by a DO or MD.
I completely agree with Bryan. One should not compare the academic lengths of an MD and a DO with an NP.
When it comes to it, it’s just a title right? My mother can be called a doctor if she wants. But is she one? No. When it really breaks down to science knowledge and training, MD and DO’s have more experience before actually going out and heal.
I work at a clinic as an interpreter where there’s 3 NPs and 2 MDs and a DO. Most of the time after NPs see a patient they leave the patient room to ask a MD or the DO questions before going back into the room. I never see that with MDs or DOs. NP’s are gentle and extremely sweet and take their time with every patient. Bu just in a general practice clinic I can see the difference between an NP, DO and MDs, on who has more training and knowledge than the other.
I guess the question is: Is an NP an equivalent PHYSICIAN to a MD and a DO.
And this is coming from a interpreter/patient not a health professional.
exactly- you are not a health care professional
See the December, 2010 editorial by Jeff Susman, M.D., Editor-in-Chief, The Journal of Family Medicine:
http://www.jfponline.com/Pages.asp?AID=9173&issue=December_2010&UID=
I think Dr. Susman’s analysis of the issue is highly objective and one that Congress, and the AMA and its constituents should seriously consider.
See the editorial by Jeff Susman, M.D., Editor-in-Chief, in the December, 2010 issue of The Journal of Family Practice:
http://www.jfponline.com/Pages.asp?AID=9173&issue=December_2010&UID=
What I find interesting about this debate is that it revolves solely around doctors and nurses. Plenty of other healthcare professionals in hospital settings that are NOT M.D.s are referred to as “doctors” but somehow that doesn’t seem to cause as much debate as the idea of a nurse being called “doctor”.
In the units where I work, Pharm.D’s and psychologists are referred to as doctors. Podiatrists and Optometrists and Dentists are always referred to as doctors but these practitioners are not MDs anymore than DNPs will be but there seems to be no concern with calling them “doctors”.
For anyone to say that nurses should be the ONLY healthcare professionals who are not allowed to call themselves doctors when they obtain a doctoral degree really suggests that this is debate is about something else.
As a patient, I know it will be confusing to have the MD/doctor and the NP who is a “Doctor’s assistant” with the same clinical title. Recognizing academic credentials are important and a doctorate in Nursing means being at the top of the nursing profession. If we call a NP “doctor” it will imply to the patients that the NP has the same academic credentials of the MD/doctor…isn’t this a form of ‘fraudlent misrepresentation” …?
May be the solution is to call the NP with a doctorate in nursing:”Doctor-Nurse” and the MD/Doctor: “Medical Doctor” …by this logic, we can then call the specialist who has more education than the MD/GP: “Medical Doctor Specialist” … or, maybe the clinical title of “Doctor” should be confined to the MD only as this would serve to simplyfy the confusion caused by the perceived need to be the “top dog” – afterall, the patient should come first; not our egos.
Rita,
A nurse practitioner is an advanced practice nurse, and not a “Doctor’s assistant.” In many states they can work independently.
In fact, the terms “physician extender” or “doctor’s assistant” are not appropriate when referring to a nurse practitioner (and can actually be rather offensive).
rediculous.
These providers (physical therapists, eye doctors, pharmacists) are called “doctor” under a seperate pretense. When I go to the eye doctor, I expect to see a qualified professional of the highest possible degree of training who can manage the care of my eyes. Same for my medications when dealing with a pharmacist. If I am an inpatient in the hospital, I expect that someone who introduces themselves as “doctor” has the highest possible degree of training (both clinical and didactic education) in whole-health-care management. While a DNP does have the highest degree of training in his/her respective field (and, in most cases, is among the most qualified primary care providers), I don’t believe that they have the highest degree of training to deal with ALL diagnoses and ALL care-planning. I do believe, in many circumstances, that my care can be managed by a DNP. But, if I were to have a multifactorial health issue that required detailed knowledge of obscurely atypical pathology/pathophysiology, I know I would MUCH rather my care be handled by a qualified medical doctor. I could see myself being confused by a DNP introduced simply as “doctor”.
When a pharmacist comes into the room and introduces herself as “doctor”, I understand the limits of her knowledge, the background of her education, and the scope of her practice. When I visit a doctor for health-care, I would like the title “doctor” to define the limits of THAT person’s knowledge, the background of THAT person’s education, and the scope of THAT person’s practice. Because DNPs provide the same type of care as primary care medical doctors, the term doctor, to me, does not allow me to make the distinctions listed above. While DNPs are as competent and as capable as primary care MDs/DOs in many respects, this is not true in 100% of cases. They do not have the same knowledge, education, and scope as medical doctors. I want to know WHO I am dealing with so that I, as a patient, can make the best decisions about my own care. If I think that I have a health issue that would be better addressed by a medical doctor because of its complexity, I would like to know what my provider’s qualifications really are.
I understand that a doctoral degree in any field is tough to come by and involves rigorous training, but I don’t believe that the scope of a DNPs care and knowledge is equal to that of a medical doctor in all cases. I want to know what I’m dealing with so that I AS A PATIENT CAN BE MORE EQUIPPED TO MAKE MY OWN DECISIONS.
Annemarie, I’m going to assume you are a student in a DNP program or are a licensed DNP. If so, congratulations! Regardless, you need to understand that these decisions are NOT TO BE MADE BY EITHER DOCTORS OR NURSES! These decisions should stem from your patients. Ultimately, we are what it is all about. Don’t allow a system to be created that doesn’t allow patients to innately know the qualifications of their providers.
Patient, I agree when you say “I don’t believe that the scope of a DNPs care and knowledge is equal to that of a medical doctor in all cases.”
You are absolutely right, they are different. However, it is important to note that “different” should not imply “lesser.”
The scope of practice and philosophy of a DNP is different than a MD, with its own advantages, strengths and of course weaknesses. While I agree that in certain situations (especially those involving complex pathophysiology) I would prefer a MD, in other situations (in which the needed care transcends to different realms of health and well-being) I might opt for a DNP.
Too much emotion. The facts: there is in the state of Minneosota, at the University of Minnesota a curriculum in which a Nurse Practioner can obtain a Doctorate in Nursing. The course work is completed in approximately an 18 month time frame, costs about $18,000. Much can be done on-line. It’s used mostly for those who teach in academic centers- their pay and advancement is better. Unfortunately, in private practice medicine, this Doctorate in Nursing does not confer any higher payment from third party contracts. A nurse practioner is reimbursed about the same as an MD for a similar patient encounter, whether they have this doctorate or not. This is why most don’t get this degree. I work with 8 NP’s in my OB/GYN practice and have an excellent relationship with them and find them to be quite competent in their care. But they don’t want to be called “Doctors” simply because they don’t have that degree.
Robert Stocker MD
All through nursing school, they learn little science and more sociology… All of a sudden at a dnp level you expect them to grasp the scientific principles which form the foundation of medical practice? So you build the foundation after you have built the building. Interesting! Why have dnp? Just increase the intake for the medical course. Or do away with doctors altogether. Phase them out and let there only be nurses. I don’t know how it is in the us, but in india, only those students chose to become nurses who tried, but couldn’t qualify to get through the premedical test. After qualifying as nurses, they tend to introduce themselves as ‘doctor’ even if they only have a diploma in nursing. So i do believe that a lot of this has to do with the coveted prestige that they couldn’t get, and can’t stomach the different prestige that they enjoy. The msc nurses do try to overstep their bounds but their lack of knowledge of fundamental science and resultant errors become readily apparent due to their symptomatic and experiential approach to problem solving. As far as “experienced nurses getting same level of knowledge as an md” goes, 10 years of experience probably gives them what a student in medschool knows. That same student 10 years after residency would know a lot more than an equally experienced nurse. And the training an md receives is pyramidal with a wide base in fundamental sciences then life sciences then human biology and then finally in medical sciences tapering off to subspecialities. A nurse is trained more in social studies shifts to basic applications in medical sciences and continues as a straight pole to basic applications in subspecialities. A pyramid is definitely more stable than a pole. Statistical conclusions cited by nurses are based on the outcome of a small sample of diseases, even a basic knowledge of statistics (a fundamental SCIENCE and not sociology hence incomprehensible to nurses as they have little scientific background) should tell you that more diverse the sample studied, the more accurate is the inference to the actual truth. How do you judge competence on the basis of only 3 conditions and those too, among the easiest to diagnose and relatively easy to treat. Surely, there are more diseases than just the 3 mentioned, seen in primary care. Are the others not important? Well, they are to the patient atleast and nurses are definitely more concerned about the patients than the doctors! The sad part is that the ones to offer an “honest” and “unbiased” opinion are the ones with even less knowledge about the field than the nurses so there isn’t much more to expect from them. However, let the nurses be prepared to take the same responsibilities and risks as the physician if they wish to enjoy the same status as the physicians. I’m proud to be a doctor and why shouldn’t i expect that prestige when i have given the best years of my youth in the long and arduous study of the science for 8 years, sacrificed leisure and time with my family, spent 90 hours a week, including 2 spells of 32 continuous hours of clinics (sometimes on holidays when others are enjoying) for 4 years as compared to truncated syllabus for 5 and a half years, 8 hour clinical shifts, 52 hours a week for 6 months and 3 hour clinical shifts at 21 hours a week for 2 years?
The ego driven Medical Doctors here need to support their position with studies and not unsubstantiated opinion. The bottom line is that studies, as referred to above, clearly support that nurse practitioners provide care equivalent to that provided by physicians. If the care provided is equal, is there even a concern if a patient confuses a Medical Doctor with a Doctor of Nursing, apart from the Medical Doctor’s ego? I think not. The danger of title confusion among patients is unsubstantiated and ridiculous. If a Nurse Practitioner achieves a doctorate level education, the title Doctor is a clear and accurate description of the degree conferred.
If I spend (at least) 4 years in graduate level nursing courses to complete my DNP, someone had better call me “Dr”. If those who receive a PhD in engineering, philosophy, or psychology are called “Dr”, then why would it make sense to deny a Nurse Practitioner the recognition of advanced education and training? I understand that it may be confusing to patients, but one simple sentence could easily clear up any confusion. Something like, “My name is Dr. So-and-so; I received my doctorate in nursing practice.” Personally, I wouldn’t mind NOT being called “Dr.” in a clinic setting, but the fact that I would be denied this well deserved title really rubs me the wrong way. Respect for one another in a health care setting is crucial for the recovery of a patient, and it is unprofessional for providers to have such harsh views of one another. An ad campaign to the general public about the role of the Nurse Practitioner is a great idea.
Ultimately, doctors of nursing and doctors of medicine entered the health care field to provide better lives for others, and they should work together to achieve a common goal.
Ms. Ficarra,
The various responses to your question ”should nurse practitioners be called doctors (DNP)?” have raised several issues; appropriate use of the title of doctor, formal education of doctors of nursing practice (DNPs), scientific foundation of DNPs, clinical experience and collaboration. I will speak to two of these issues; patient outcomes for those treated by nurse practitioners (NPs) and use of the title of doctor. You quoted a physician as saying, “They only have experiential knowledge…” and “it would be like allowing flight attendants to land an airplane.” Presumably, this meant allowing DNPs to practice independently was similar to allowing flight attendants to land a passenger plane. These comments show either an ignorance of DNP education and training or an emotional loss of objectivity. A nurse practitioner that has earned a doctorate degree in nursing practice has a minimum of seven years of college education. This education includes courses in the hard sciences such as chemistry, biochemistry, anatomy, physiology, pathophysiology and genetics to name a few. Additionally, DNPs are licensed registered nurses and pass certifying board exams to practice as advanced practice nurses in an area of specialty. The licensure and certification process ensures competency and public safety. Doctors of nursing practice, as well as other NPs are fully qualified to promote health and disease prevention, as well as independently diagnosis and manage health issues within her or his specialty area.
The Journal of the American Medical Association (JAMA) published the results of a clinical trial in which 1,316 subjects were randomly assigned to the care of either a nurse practitioner or physician. After six months of care the researchers, which included four physicians, concluded that there were no appreciable differences in patient outcomes between the two groups (Mundinger, et al., 2000). A two-year follow-up study by Lenz, Mundinger, Kane, Hopkins, and Lin (2004) supported the original findings. Numerous other studies have since supported similar findings in other populations and settings. Nurse practitioners are trained to take care of patients and they do it well. There can be no reasonable analogy made between patient care rendered by a nurse practitioner and a flight attendant landing an airplane.
You quote another physician, Dr. Doug Farrago as stating “you just can’t call yourself one [a doctor] because you, well, just want to.” While this statement is technically correct, it is irrelevant to the conversation. This discussion is about nurses using a title they have legitimately earned. I believe Dr. Farrago’s additional comments get to the real issue physician’s have with DNPs. Dr. Farrago continued by categorizing NPS as “in direct competition with us.” In your article, you presented a history of the title of doctor. You additionally present numerous other examples of various fields which award doctorate degrees so I wont restate these here. I was encouraged to see the comments by Dr. Kevin Soden who agreed that if a nurse has completed doctorate education then it would be appropriate to use the title of doctor. Doctors of nursing practice have done just that, completed a doctorate program of study.
Lastly, I cannot help but feel there is a gender issue involved in this debate. Historically, physicians were primarily men and nurses primarily women. A 2011 survey has shown that the gap between male and female physician’s pay is actually widening, even when adjusted for hours worked and area of specialty (Reuters, 2011). Similarly, a 2006 study showed that male NPs earned between 7.9 and 8.2% more pay than their female counterparts (Newland, 2006). This is relevant because in our society financial compensation is linked to one’s value and power in the market place, and therefore value and power in society. From this standpoint, women are not as valued in the workforce as men. We now have a predominately male dominated group feeling economically challenged by a predominately female group. The physician responses seen in this blog reflect an emotionally driven attempt to deny nurses use of a rightfully earned degree title and limit use of their training due to fear of economic infringement. In light of well documented support for the care provided by nurse practitioners, these emotional responses are astounding.
References:
Ficarra, B. (2011). Nurse Practitioners – Doctors? The Health Care Blog. Retrieved from http://thehealthcareblog.com/blog/2010/05/12/nurse-practitioners-doctors/
Lenz, E. R., Mundinger, M.O., Kane, R.L., Hopkins, S.C., & Lin, S.X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research and Review, 61, 332-351. doi: 10.1177/1077558704266821
Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.Y., Cleary, P.D., …Shelanski, M.L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians. The Journal of the American Medical Association, 283(1), 59-68. doi: 10.1001/jama.283.1.59
Newland, J.A. (2006). 2006 Nurse practitioner salary & practice survey. The Nurse Practitioner: The American Journal of Primary Health Care, 31(5), 39-43.
Reuters. (2011). Pay gap between male and female doctors widens. Retrieved from http://chicagobreakingbusiness.com/2011/02/pay-gap-between-male-female-doctors-widens.html
I have read so many of these arguments over the years, and all of them are the same. There are a few people saying they had a great experience seeing a nurse practitioner, a few saying they will never see one again, or they don’t know what they are talking about. Then i see the angry frustrated MD, arguing that all DNP’s are doing nothing but trying to play doctor. Then there is the actual ARNP that says all they want to do is use they title that they earned and provide the care they are trained to give. Every one of these blogs, comments, yada yada yada are all the same. I have sat back and read most of these comments on this one and i just cannot sit here and not say anything. To the few MD’s that have said so many demeaning, and degrading comments about nurses, you all should be ashamed of yourselves. I could never imagine working with any of you people. You want to call yourselves superior to us because you have an MD after your name. I have worked with some amazing doctors and some amazing nurses, I have also worked with some terrible on both ends. They were all colleges of mine and I would never in a million years talk down, or degrade any of them like you all have in this post.
To the doctor from india or wherever, as to say i became a nurse, and then a DNP because I wasn’t smart enough for med school, made me laugh. I went to a tech school for my LPN right after high school, all i ever wanted to do was help people. Being a doctor was my number one goal but i wanted to start right away. A year after I finished my LPN i decided i wanted to work on being an MD. I double majored through school in nursing and pre-med. I worked as an RN through most of it. I hit a cross roads at that point wondering what i wanted to do. After taking the MCATs i and being accepted to med school (don’t ever tell me i wasn’t smart enough to get in, I held a 3.6 GPA while double majoring, and working full time, and scored a 34 on my MCATs)
My life was flipped upside down right before the start of my second year of med school, when an unfortunate accident almost killed me. It was a long recovery, and at that point i decided that i wanted to stay in nursing. After my recovery i went back to work, and also started working on my NP. I now have my DNP and I have my own practice. I am partnered up with one other DNP, and an MD, who approached me for the opportunity to start this practice. The doctor i work with does not oversee me, but does in fact collaborate with me. I have never and will never do anything out of my scope of practice. Oh and i do carry and pay for my own malpractice ins.
For the most part i understand where both sides are coming from, and I agree that it can be confusing when not identified in the right manner. But to say i am trying to be a fake doctor, and use a title that i did not earn is an outright insult. When i was a charge nurse, I remember a couple of physical therapists, enter a room and introduce themselves by saying, “Hello my name is DR. Smith and I’m your physical therapist. Now how come no one ever chastised them for using the title Dr. in a clinical setting. They did in no way have their MD, just a DPT. Yet to this day they are still able to use that title, and you all have not said one word. And I have a good friend who is a chiropractor, one of the best in this state. (not my opinion, he rated as the second best in our state) He uses the title Dr. when he sees patients, but hes not an MD. Should he stop as well, because he is going around telling patients he is a doctor, but has not received his MD. For the most part my patients know when they enter they are seeing a NP, when i introduce myself to new patients, I always address myself as Dr. Carr, and tell them that i am the Nurse practitioner. I have never not identified myself as a physician, nor have I ever not told the patient, that i am a nurse practitioner. It is also on my name badge, and my name and title are embroidered on my lab coat.
It is all a pointless war between nurses and doctors. I for one am tired of doctors like the ones that have posted on this site, and pray to God that i never have to work with any like you, and that no one i know ever has to be a patient of yours. We can just put the he said she said BS to bed, and call this argument what it is. A large group of doctors claiming they should be the only ones to carry the title DOCTOR. They funniest part is most of you have missed or forgotten the part where MD’s had to fight at one time to use the title of doctor. It was originally used only for students who had reached the highest level of their law degree. The term doctor originated as meaning teacher in the first place, not medical care giver. Lets teach each other, i know that i would not be where I am today if it wasn’t for the Doctor that i am partnered with at my practice. He has also learned a lot from me, with my nursing background. At the end of the day its all about the patient( i couldn’t care less if you guys say NP’s only say this to try and end an argument because my first priority is my patients, not what you all think) not the titles, or the bureaucracy.
Dr. Thomas Carr, ARNP, DNP
^^^ nurse ^^^
Ahh how this takes me back. I’ve been a internal medicine hospitalist for about 4 years now, and I started my first job as a hospitalist when I was 26.
My first job was in Philidelphia. I loved the job and my 7 on/ 7 off schedule and had 2 PA’s and 2 NP’s working with me-all which were almost 5-20 years older than me. I respected them and their experience which made my job a whole lot easier. It was a good team, but there were two people that caused me distress. An NP and an PA. They were both experienced and in their 40′s. One day, a patient came in with severe pain on her foot, where we saw a small sore. The two men were simply convinced it was just a small infection, but the tests did not add up. I suspected is was something more, so I told them to wait and run a few blood tests. I reviewed the tests myself after and went home.
The next day I came back to find out, they had stepped out of their grounds by lieing and telling the patient they were medical doctors and given the patient a bactrin which had caused complications causing her to go in septic shock. When i confronted the men they both snapped and told said
“We are just as qualified as you are.
“You doctors think you’re just the **** because you wasted your lives in medical school and residency. I know just as much and even more than you do and i should be earning as much.”
I called security right after and the two men were stripped of their right to practice medicine and sued for pretending to be doctors. I quickly called a oncologist because i believed the sore to be skin cancer and he confirmed and treated her and thank god, he saved her life.
I don’t have a problem against NP’s or PA’s. I honestly love them, but they SHOULD NOT overstep their boundaries and try to be doctors. They should know their limits and leave so should doctors.
I completely agree. As I have with Bryan’s comment towards the beginning of the comments.
NP’s should know their limits. If they are an NP then I do not think they should be called doctors. BUT if they have exceeded towards DNP then yes, they should be called doctors, doctor in nursing. And should address their patients as a doctor in nursing practice. No matter what anyone says, there will always be a difference. There’s a reason why in undergrad pre-med students take more math more physics and more science than nursing students.
I’m a pre med student that runs an organization on campus that seeks out MDs, DOs, RNs and NPs as special guest speakers. There were two NPs that came to our classroom and I asked them what’s the difference between MD’s and NPs. The answer was, I quote: “There isn’t, I don’t know why we have doctors! Just kidding. We are equal. They just have tee bit more training. We are no different at all.”
I really didn’t like their answer. But nodded anyway. Please don’t tell me you have a BSN, and a Masters and you are equal to an MD and DO that had double the schooling you have and trainining =(
DNP’s do not aspire to be MD’s. DNP’s are experienced nurses with advanced degrees and many many hours of clinical experience. The recent shift in policy to expand Nurse Practitioner programs, to include additional courses to fulfull doctoral levels of education, has caused much debate amongst us as well as our collegues concerning what we should call ourselves. We have no intention of misleading the public into believing that we are doctors of medicine. But we are doctors of nursing practice and have earned the right to utilize the title. Doctors of medicine do not own the word “doctor”, and if they don’t want the rest of the doctoral prepared community to use the same title they use than I think they should be tasked with coming up with a new title for themselves.
Physician: medical school
Doctor: anyone who gets a doctorate
As a basic RN and Paramedic I am shocked at how poorly every MD I have seen could not or just did not care enough to allow me to take a full breath when listening -lung sounds. Most in fact did not bother. My fellow Nurses and Paramedics tend to spend more time assessing Patients than I have been given by any MD. That has been my experience. MDs if I’m lucky will look up to say hi. Most of the time PCPs have there face in the clipboard, throw a script at me, usually an antibiotic, that i did not need and walk out of the exam room. Most PCPs rush rush and act like they don’t care,,Abt resistance is the direct cause of the I don’t care PCP not explaining that pts do not need an Abt for a cold. Keeps me busy giving Vancomycin in the HH infusion industry. Majority of MDs are not that great and how often do they really wash there hands. I’m not a DNP or NP but
The ones I know are like detectives and good luck getting pain Meds through them if your addicted to narcs. MDs could learn from a good Dr of Nursing Practice.
Now maybe you know how LPN’s who have worked in every facet of nursing and have even run buildings (assisted living) and been in management feel when we are not considered nurses.
To hear how so many physicians are upset regarding DNP’s using thier Doctorate title is heart wrenching. It seems to me that physicians will continue to belittle nurses, no matter how smart the nurse is, or how many advanced degrees the nurse obtains. It doesnt take a rocket science to understand the educational level between the DNP and MD. Nursing programs are very demanding and rigorous. No, it doesnt compare to Medical school, but its no cake walk either. Registered Nurses, LPNs, And Advanced Practice Nurses are the glue to HealthCare, without nurses healthcare wouldnt survive. Since the MDs have much education beyond any APN, why dont MDs attempt to run clinics and hospitals without RNs, LPNs, and APNs. Maybe medical school and residency revealed to them how to work without nurses!!!!!!!
When a patient is looking for care they primarily look for an MD or a DO. I don’t know anyone who would be looking for a Nurse Practitioner (no offense, just the way it is).
If a patient notices their physician is not a Medical DOCTOR, they won’t want to call that person a doctor, regardless of whether the Nurse Practitioner wants to be thought of as that. If the nurse has reached a doctorate level, and wants to be regarded by others as a doctor, he or she will have a hell of a time trying to do so.
…And this is coming from a Doctor of Veterinary Medicine.
I beg to differ Dr. Vet, I am a hospitalist DNP who also has a busy clinic practice based on the patients who dumped their MD after meeting me. I have numerous letters and referrals from patients of MD’s doing exactly what you say doesn’t happen, they rather see me as a DNP than their old MD. Most of the time because the MD misdiagnosed them, didn’t listen, was to busy etc. I see more patients admitted to the hospital because of poor medical treatment than anything else. Just another little note, at my hospital, the preferred provider to place central lines is the DNP, why you asked? The hospital did a two year study on infection rates, complications and patient satisfaction the DNP outcomes were so superior the hospital administrators asked us to re inservice the almighty doctors. So yeah, your way off, it is not how it is. Sorry! The public is smart! Just because you have an MD doesn’t relate to better care. I can tell you one thing that scares the hell out of me about doctors, they don’t ask for help when they don’t know something and they really don’t know what they don’t know because they have been trained to think they know it all. If you want to know the real difference between a DNP and MD, that’s it! I know that I can’t know everything, but will damn sure find someone who does, which is usually a specialist MD, that should help the ego log. Thanks
I think part of the problem is the disconnect between what to address someone and their profession. I have no problem with a DNP introducing themselves or being referred to as “Dr. Smith” just as a dentist, pharmacist or professor would. But just as a dentist would never tell anyone that they are a doctor, nor should a DNP.
The role of the nurse practitioner (NP) began in the 1960’s, when Loretta Ford (nurse) and Henry Silver (pediatrician) developed a continuing education program in response to the health care demands for primary care providers in underserved and rural areas. The NP role has evolved over time. Educational and clinical training has become more rigorous, as it should. The health care need of the 1960’s has not changed drastically; however, the face of health care has become more complex.
The Doctor of Nursing Practice (DNP) as the terminal degree for the NP is a natural progression of the advancement of the nurse practitioner role in health care. There are some individuals in health care who do not believe NP’s should be called doctor in the clinical setting despite having earned the degree. I do agree nurses should identify themselves as Dr. XYZ followed by, I am the nurse practitioner.
More recently, the use of the title of “doctor” by NP’s has been receiving a lot of opposition and attention from physician groups who oppose NP’s using the title in clinical practice. Physician groups have gone so far as to lobby the New York Senate legislature for sole ownership of the title. Senate bill (S02250) was introduced in January 2011, the purpose was to define who and who cannot use the term “doctor.” According to the state Assembly’s website the bill
“Restricts use of the title “doctor” in advertisements to medical doctors, dentists, chiropractors, veterinarians, podiatrists, and optometrists who have received a degree in the appropriate profession and have met all professional requirements of the appropriate program registered by the New York state education department or accredited by an accrediting organization acceptable to such department or are otherwise licensed to practice in the state of New York.”
The bill was referred to the New York Senate Consumer Protection Committee.
Any NP who has completed a doctoral program has earned the right to be called doctor by virtue of their education and should not expect anything less. NP’s are not physicians, nor do they pretend to be. They are however, nurses who are skilled clinicians.
According to the Institute of Medicine 2010 report, The Future of Nursing
“Nurses with DNPs are clinical scholars who have the capacity to translate research, shape systems of care, potentiate individual care into care needed to serve populations, and ask the clinical questions that influence organizational-level research to improve performance using informatics and quality improvement models”
The semantics surrounding the use of the title “doctor” detracts from the bigger issue of a troubled health care system and the need for a unified voice from both physicians and nurses to address the growing health care crisis.
Respectfully,
Kim Kintz, Adult Nurse Practitioner and Doctoral Student
Oregon Health & Science University
Portland, Oregon
This really made me confused. My question, what is a Nurse Practitioner? reading through this topic gave me an idea that they may have a lot of similarities when it comes to their practices but I think Nurse Practitioners will still be like nurse. To me it’s like they are higher than RNs but they are not as high as MDs when it comes to the skills and knowledge, the ‘know how’ and the ‘how to’. Thank you for sharing your opinion on this.
I’m a Pharmacist, and ex-nurse. I have a DPharm, and do introduce myself as Doctor, but never outside work. It seems that Nurses have a chip on their shoulder, and always will. There are many idiotic Doctors, usually the younger ones, who’ve helped nurses develop that inferiority complex, but then again Nursing by definition is in place to assist. They focus on CARE, and not as much treatment. Sure they do care about the patient more than the MDs,but they don’t have the same skill set. I’ve seen:
-Nurses telling me they know more about drugs than Pharmacists, lol.
- Nurses prescribe dose strengths that don’t exist.
- Lecturers at Nursing school take cheap shots at Docs.
- Saying that they do all the Docs job anyway etc
To every Nurse reading this, if u keep stressing about your status, you are pathetic and should know that you’ll always be lower than Docs. Any Doc is higher up the ladder. But that’s if u choose to look at it like that. And some Docs need to respect the nursing staff more, especially interns. Nurses should defo get paid more, but anyone who thinks Nurses have the same calibar inMedical practice, as they certainly do in Nursing, needs to see a doctor. I know far more about drugs than the Docs, but that doesn’t mean I’m equal to an MD in his proffession.
I think you miss the point of the discussion. The article specifically talks about advanced practice nurses, who have reached a doctorate level of training (DNP). As a PharmD you refer to yourself as “Doctor” while at work, so why shouldn’t a DNPs?
It surprises me that you mention that “Nursing by definition is in place to assist,” especially since you state that you were/are a nurse yourself. I would be curious to know the source of such definition (since in my nursing career I have never heard of such).
While RNs focus largely on “care,” perhaps you should become more acquainted with the role of a Nurse Practitioner. As the AANP defines “NPs are advanced practice nurses who provide high-quality healthcare services similar to those of a physician. NPs diagnose and treat a wide range of health problems. They have a unique approach and stress both care and cure. Besides clinical care, NPs focus on health promotion, disease prevention, health education and counseling.”
Throughout my nursing education, I have not heard once of nurses taking cheap shot at medical doctors. If anything, they always emphasize the optimal team work mechanics and the specific roles of each professional. Moreover, it is immature and rather ignorant for you to say that “nurses will always be lower than Docs.” It is not very hard to comprehend that both roles are different (and there is no better or worse, inferior or superior).
However you seem to miss this point as well when you state “I know far more about drugs than the Docs, but that doesn’t mean I’m equal to an MD in his profession.” Your profession is DIFFERENT of a MD, so evidently you would not be equal, but that does not mean that one has to be better. The same holds true for DNPs. They are not trying to be MDs. They expand their training, education and knowledge to provide high-quality care (without ever forgetting their nursing roots). As the AANP states, “NPs have distinguished themselves from other healthcare providers by focusing on the whole person when treating specific health problems and educating their patients on the effects those problems will have on them, their loved ones and their communities.”
So are DNP equal to MDs? Of course not. Are they “worse” or “lower” to MDs? No. They are simply different, with their own set of skills, strengths and weaknesses, just like any other health care provider.
I apologize, but there is no way you are a “DPharm”. Really?
I have a great deal of respect for people who pursue nursing and those who pursue medicine. They are meant to serve as complimentary parts to a person’s wellbeing and for their healthcare needs. Bearing this in mind, true, by all technicality, a doctorate level program earns a person the right to use the title “Doctor.” However, we should definitely tread carefully when dealing with the public in the health setting when using titles such as these, so as to not confuse and mislead…that would not be helpful whatsoever and may cause a patient to be mistrusting. Careful consideration should be given to the intent for seeking out the doctorate in nursing, are nurses wanting to expand their horizons to improve healthcare and move nursing into a highly recognized and trusted field or are they just wanting the title? Anyone going to school for a title would be a bad fit in the healthcare system and they need not apply.
Considering the amount of work to achieve a DNP level (in addition to the number of years), I doubt that “just wanting a title” would ever be a reason for a nurse to choose to go back to school to become a NP (or DNP for that matter). The scope of practice of a NP is different, as it focuses in an advanced-practice specialty.
NPs order, perform and interpret diagnostic tests, diagnose and treat acute and chronic conditions, prescribe medications and other treatments, manage patients’ overall care, spend time counseling patients, etc.
I’m sorry, I made a couple of mistakes;
- As a PharmD. I do NOT refer to myself as Dr at work.
- Nurses are not “lower”, however, if a person obsesses about titles and privliges at work, then they will inevitabely convince themselves that they are lower.
I do think that Medicine is going backwards if Pharmacists and Nurses are given prescriber rights, solely to free up a Doctors time. he govt doesn’t want to spend in the nation’s welfare, and so is trying to buy cheaper labour by handing over physician roles to others.
I have had this argument with many of my colleagues. I do not think that DNP’s should be called doctors because they are simply not Doctors. I am an Infection Control Practitioner and am Director of Infection Control . However, my credentials are BSMLS, (ASCP,(M)), MPH (CIC), Phd (ABMM), quite different from a nurse and a Doctor. However, as Director I found myself in the line of fire between nursing staff and the medical staff (MD and DO’s). Doctors refused to call DNP’s Doctors because they are simply not Doctors. Nurses do not have the appropriate education to be called Doctors. I am quite disguised when an DNP introduce themselves as Doctors because it is very misleading to patients and to fellow colleagues. Its an insult to individuals whom have dedicated their life to science and whom have achieved academic success to become Doctors. I will NEVER call a nurse a Doctor because:
1) They believe that they know more than everyone.
2) They can run the hospital with out any other profession
3) They only needed basic science class.
4) Their egos are extremely high
I wil never call a nurse a Doctor
wow. I guess ignorance is bliss.
Mr Carr, you are in fact a nurse.
As a patient, parent, military veteran and paramedic, it is my duty to inform you that I would never allow my children or myself, to just “settle for a nurse, instead of having a real doctor.
Why did you just stop at nursing and not persue that Medical Degree?
You call it your practice
You say you collaborate not confer with the doctor like you are on the same level as that doctor?
You can do surgery? You seriously have the knowledge and training to do surgery consults and the procedures?
I find that difficult to believe.
Personally I say no thanks.
My husband is a PA, and doesnt call himself a doctor…..
“Why did you just stop at nursing and not persue that Medical Degree?”
- You are not “just” settling for a nursing doctorate degree. You are choosing it because of its philosophies and approach of care.
“You can do surgery? You seriously have the knowledge and training to do surgery consults and the procedures?”
-Can all MDs do surgery? Ask this to psychiatrists, pediatricians, pathologists, etc….
And, your husband does not call himself doctor because he is a physician assistant, that is his actual title. The degree for a PA is not doctorate level. So he is not a doctor, nor a physician. He is a physician assistant, which is just as important member of the medical community.
My point is we do not call ourselves something we are not.
When one of these nurses come in and state “hello, I am Doctor Collins” that is misleading and a lie.
Want that title? Go to school and earn it.
Also go look at the education needed to obtain a Medical degree and a nursing degree… to claim a nurse is equally educated, is ingorant as well as a bold faced lie.
You miss the point of the article and discussion. Nobody is asking whether nurses (RNs) should be called doctor. The article clearly discusses the use of ‘Doctor” for nurse practitioners (DNPs).
A DNP is indeed a doctor. A doctor of nursing practice. They have earned the “Doctor” title by achieving that level of education. The same is true for any one else who has earned any doctorate degree.
Refer to the article above more attentively. It explains in very simple terms all the fundamentals that you seem to be missing (e.g. origin of the title, degrees, etc).
Does he have his doctorate degree? If not, why would he? I have never met a NP who calls themselves a doctor unless they have EARNED their doctorate degree- ya know- post graduate degree…
A DNP has earned a doctoral degree in advanced nursing practice not in medicine, this individual has worked hard and met all the demands of the program and deserves to be recognized as doctors in nursing practice. The problem arise with the title being so long and the public’s preference to acknowledge the public by shortcutting the title; a doctor is not called medical doctor is called only doctor. The fear is that when the DNP introduces self as doctor in nursing practice the public will just take the short cut and call them doctors; it is just a matter of getting used to the long title and acknowledging what the person deserves. It wouldn’t be fair to call a medical doctor “medic” just because we want to take the short cut would it?
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After reading several of these posts, I realized that there seems to be a fundamental misunderstanding of what this issue is really about. Doctors of Nursing Practice DO NOT WANT TO BE PHYSICIANS!!!! If we did, we would of gone to medical school (And yes, I had the grades to attend medical school). I chose nursing! I keep reading all these comments from MD’s about how DNP’S are inferior in knowledge and do not go through the same depth of education and therefore are trying to be “fake doctors.” I do not want to be a physician, and did not choose my degree so I could pretend to be one. I do not pretend that my education will prepare me to do what a medical doctor does. I am not qualified to practice as a physician, and that is not what the DNP’s are trying to say. I think the physicans are misunderstanding. DNP’S are qualified to practice as a Doctor of Nursing and the curriculum adequately prepares them for that role. The issue here is that MD’s, and much of the general public, misuse the word “doctor” and interpret it to mean physician… and this is not correct. I have a friend who received her doctorate in the culinary arts, and so she is basically a doctor of food! LoL. A “doctor” is just someone who obtained a doctorate level of education. I don’t want to be called physician Blackwell, or be mistaken for a physician. In fact, I am very much a proponent for a specific title for us like Prac. Blackwell instead of Dr. Blackwell because I WANT my patients to know that I am something different. I have a different skill set, scope of practice, and unique method of practice based upon my background in nursing…and many patients prefer it! I don’t WANT to be mistaken for a physician. It does, however, infuriate me that physicians apparently think they own the title of “doctor” and I can’t receive the due respect of that title even though I earned it. Again, let me reiterate this because many seem confused, I did not earn the right to be called a physican…but I did earn the right to be called a doctor if I want to. I would also like to say that I see what some of the MD’s are saying… Many patients think “doctor” means physician, and I can definitely see how this could confuse the general public, because it seems to have confused many of the physicians and nurse practioners alike responding to this post. We all just need to accept that the face of healthcare is changing! If there isn’t a place for the DNP’S in the medical field, then they will disappear. Physicians need not feel like we are trying to step on your toes! Don’t you guys want help with the large patient loads? DNPs know that medical doctors are a wealth of knowledge, and utilize and depend on them accordingly. Why does it have to be a competition?
In the state of Texas, nurses are allowed to use the title “Doctor,” but also must follow with the appropriate credential such as DNP or PhD (Texas Board of Nursing, 2011) as many states require as a result of physicians. Why are physicians so concentrated on oppressing nurses? This oppression occurs in the workplace and has extended out into attempts to control the profession of nursing. In the workplace, changing this has been a very long road and still has miles to go. Interestingly, at one point administration did not blink an eye at the mistreatment of nurses at the hands of physicians and this continues in some organizations. Now physicians and the American Medical Association seek to continue oppressing nurses through dictating the use of the prefix of “Doctor” when we have the doctoral degree.
The origin of the term doctor comes from the latin term meaning to “teach, show, cause to know” in 1300, then in 1400 the meaning “holder of the highest degree level in a university” was used. But it was not until 1600 that the term was used in meaning a “medical professional” (Harper, 2012). A nurse with a doctorate is a medical professional and received the highest degree of education at the university level. The designation of “doctor” is not owned by medical doctors and should not be treated as such. Other professions use the title of “doctor” if they have completed the educational level of doctor.
If the importance of a care provider identifying one’s credentials and licensure is important then physicians should not discriminate against nurses. The American Physical Therapy Society (2012) supports the use of the title of “Doctor” being used by physical therapist who have completed a doctoral program. Do doctors who went to allopathic school or osteopathic school have to identify their credentials clearly to the public? No, but they should because sometimes they misrepresent themselves. All people have the opportunity for misrepresentation such as in the case of a physician trained in family practice but practices as a dermatologist enters a room with a patient and state “I am doctor so and so, I am not a dermatologist but will act as one today?” No. Dentists, veterinarians, doctors of psychology, and doctors of pharmacy all utilize the term as well, but have not received the attacks nursing has endured. So what is the basis for their argument?
DNP curriculum is not the same as medical doctors, has different material involved, but is no less a doctorate. If nurses wanted to be physicians, then we would go back to medical school. Many nurses view their form of practice as superior to the medical doctors, because we show more care and give more education to the patients. Medical doctors are not prepared for the roles DNPs and Phds of nursing are prepared for, but still assume the roles such as leaders in committees. Most doctors spend 4 years of college, 4 years of medical school, then years of residency being isolated from people. Medical school does not include any class on leadership, but medical doctors are taught that they are to assume authority through simply the position of medical doctor. Medical Doctor only grants one the right to serve people in their ailments, nothing else.
American Physical Therapy Society. (2012). Retrieved from http://www.apta.org
Douglas Harper (2012). Online etymology dictionary. Retrieved from
http://www.etymonline.com/index.php?term=doctor&allowed_in_frame=0
Texas Board of Nursing. (2011). When the profession is nursing and the title is Doctor. Texas State Board
Of Nursing Bulletin, 42(3), 4. Retrieved from http://www.bon.texas.gov/about/pdfs/july11.pdf
I think its time to educate the general public regarding the title of ‘Doctor’. The title is not just for MDs only anymore. With doctorate degrees being held by nurses, pharmacists, physical therapists, and other healthcare disciplines, the public needs to understand that those having the highest level of education within their specific discipline have earned the title.
A doctorate is the highest degree available in any field of knowledge. Nurses that have worked for the highest degree available in their profession have earned the doctorate degree, therefore, have the right to be called “doctor”. A mathematics professor, sociology professor, or biology professor at the university level that has earned their doctorate are called “doctor”. Why is it different that a nurse that has earned his doctorate should not be called by the same title? There are arguments about the possible confusion of role in the eyes of the patient. Nurse practitioners should clearly identify themselves as “Dr. So-and-so, nurse practitioner”. The truth of the matter is that nurses are entering more specialty and advanced roles. Some are independently practicing. The Doctorate of Nursing Practice (DNP) is not a physician, but is an important health care professional helping to ease the burden of the physician shortage. The advanced practice nurse should be viewed as a complement to, not in competition with the physician.
Recently, there has been consideration given to requiring universal board certification of both physicians and doctorate of nursing practice nurses. The supporters believe that those that pass the certification could then earn the title of “doctor”. Like any hot topic, there are valid points worthy of review on both sides. The bottom line about the title of “doctor” is that it refers to highest degree available to any field of knowledge, that includes nursing.
Haha I have to say this is funny. DNP and that mudslinger did a test on the so called physician equivalent DNP. The nurses took a WATER-DOWN version of the USMLE (which is the easiest exam a physician will take on their quest to becoming board-certified) and 50 PERCENT FAILED. Thats quite scary. The national average for physicians is about 90 percent. Yet, they’re still equal right? Its funny because I actually hope DNPs start going into business. Lawyers will love it. I can already picture all the lawsuits. Yes DNP are superior because they are nicer and more patients like them right?
Mudslinger and her minions are actually not very well liked in the nursing community (which are mostly NPs) and actually reject this idea of the DNP. http://allnurses.com/nurse-practitioners-np/dnps-taking-certification-301106-page2.html
I have talked with NPs who attended medical school and had their eyes opened to the things they just didn’t know. I can understand the want to become doctorate, but implying it to be better or as good as your boss is a very stupid way of doing it. All I can say to you nurses is
WHY DID YOU BECOME A NURSE IF YOU DIDN’T WANT TO BE CALLED NURSES?
Look at the PA’s. They want to change their names to Physician Associate and they are getting help from all over the place because they didn’t overstep any boundaries.
Although I can see your want to increase your role, most DNPs I’ve met are in an executive role and barely practice medicine. Its the high ego-ed nurses who just HATE being called being “a nurse” that is doing damage to this.
I am a very intelligent, trustworthy and passionate nurse. I am proud to be a Nurse Practitioner. I don’t need to be called Doctor to get my job done.
I have a hard time believing you are a NP.
Anyway, DNPs are not trying to overstep any boundaries. Simply trying to be respected. Again, they are not better nor worse than MDs. They are just different professionals, with their own set of skills and knowledge.
Opps I went back and took a look. Its STEP 3 not Step 1.
There is no need for disagreement or arguement on this topic. The word -doctor- as stated above, originally refered to teacher. As things stand currently, almost every discipline has a terminal degree which comes with the title of “doctor”. Even though the word commonly refers to medical doctors, it does not belong them. As for the possible confusion of patients, as long as we educate the patients regarding what kind of “doctor” we are, I see no problem there. A big part of healthcare today is increasing patient awareness through education, our patients are more than capable of understanding the difference in their health care providers, we just have to teach them.
You must realize, many nurses not only carry an undergraduate degree in nursing, but also a bachelors degree in other fields of study. I myself am a Nurse Practitioner, and I have a BS in Medical Microbiology and Biotechnology, and yes all the prerequisites for medical school. There are many nurses who hold similar backgrounds, and to say nurses are not educated in the sciences is completely incorrect. As a future DNP, I assure you I can grasp scientific principles.
I am a DNP student but also a nurse practitioner in a large community hospital. What I am learning in my program I am actively applying to my practice. Once graduated I plan to wear the DNP embroidered next to my name as I will be very proud of the credential and I will explain it if patients or others ask…. but may not incorporate the title of “Doctor”. I like the personal (first name basis) and professional relationship that my patients, my physicians, and I share. Many times when a patient’s condition begins to deteriorate…. the attending physician is no where around or like the other day..one MD tapped me on the shoulder and asked me softly “You got this?” and I confidently nodded “yes” and he left the room The physician is comfortable with the nurse practitioner handling their patients on an emergent basis. as they know we will contact them with questions or situations outside of our scope of practice…………….I’m saying all of that to say……I think that titles are secondary…….primary is how confident and comfortable with the provider the patient is…..after all healthcare is all about the patient!…I do not want to get into a shouting match about titles…it takes time away from patient care.
However our doctors do not refer to the DNPs, PharmDs, as “doctors” but they do however refer to the psychologists (PhD) as “doctor” makes you want to say…uummm…
Honestly, if my name was changed to hospital affiliate tomorrow, I would still go to work and do my best to take care of my patient’s needs. I have interviewed various DNPs for jobs in my practice, and quite frankly I’ve grown to really appreciate the Nurse Practitioners. The Doctors of Nursing Practice always seemed to make the way we address them a priority. To me there was no difference in clinical ability between the two and the NP seemed more patient friendly. I absolutely love the NPs that work with me because they are respectful and good at what they do, and in return I show them my utmost respect as well. Having the title Dr. does not automatically give you the respect some of you put before your patients. MDs and DOs themselves are not respected if they fall behind the standard set by the physicians. What does having Dr. do for your job as a health care professional? Heck, some days I don’t ever wear my white coat and introduce myself as Mr. instead of Dr. because it plays no role in helping me be a better physician.
In my opinion Nurse Practitioners are so good at what they good because they don’t have to worry about everything. All these health-care providers want independence but say that their model is different and what not. It makes no sense to me. When I enter a room, I question the patients on their problem as fast as I can so I can move on to the next patient who needs me. As I worry about making sure the patient gets the right treatment, my NP then has the opportunity to really get to understand and get the know the patient without a care about the next patient or billing or any of the annoying things that I will have to attend to later. While I’m in surgery or running tests they spend as much time as needed on the patient and that is why all my patients love them.
This is what health care should be like, A TEAM APPROACH. Not bickering about a title as if it will help you do your job better. Take away the physician from the equation and what do you have? You have a Nurse Practitioner who won’t be as effective because they will be too occupied worrying about their next patients, billing, and getting sued. I will take an NP over a DNP any day and many of my colleagues agree with me on this.
It is a sad day when we cannot unite and celebrate the progression of a discpline. I wonder what happened to the words ” healthcare team”. Whether you are called doctor or not, we all are here to accomplish the mission of promoting health.
Nurses have come a long way as did every other healthcare profession in developing the members of the discpline. So now we have evovled to the the DNP. I do not see the problem. Other members of healthcare should celebrate that nursing took the initiative to improve on a profession so that your team members are even more valuable contributors to the team. Applaud!
I am very concerned and discouraged after reviewing all these thoughts regarding the debate of having DNPs called doctors. I do not understand why this should even be an issue if a DNP has completed and earned the right to be addressed as a doctor. The comparison of the term doctor being used for physicians and nurses is valid and does occur in practice, but why the huge debate? Is there a serious problem with other doctors, such as pharmacists, philosophers, etc not being able to use their earned doctor title because it causes confusion? Why just the fight with nurses. I know physicians and nurses practice together as a team and if this is only about not causing confusion. Then it is simple to have the nurse practitioner identify herself as Dr. Reed, Nurse Practitioner and have the physician identify himself by their appropriate title. Do not rob the DNP of the right to use their justly earned title of Dr. just because their might be feelings of NPs trying to grab some of physicians’ turf. In the healthcare world containing a shortage of primary care practitioners there is plenty of pie to go around. We should all work as a team and collaborate our focus in providing the best care for our patients, and not focus our energy on silly arguments about titles.