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Nurse Practitioners – Doctors?

By Barbara Ficarra

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

  1. In a hospital setting, should medical doctors be the only doctors allowed to use the title doctor?
  2. 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?
  3. Will patients be confused by a nurse practitioner calling themselves doctor?
  4. If nurse practitioners are very clear in introducing themselves as a doctor of nursing practice, will that alleviate the confusion?
  5. Should nurse practitioners be called doctor only in an academic setting and not in a hospital setting?
  6. 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.
  7. 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.

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Diane AdamsBrian SenodenosRon Hyattanother namemerchant services Recent comment authors
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Kelly
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Kelly

It means she has a clinical Doctorate degree (in addition to a Master’s degree) in advanced Nursing Practice. The “C” means she is also board certified. She’s a doctor but not a physician. Similar to how an OD is an ophthalmic doctor, but they are not physicians. Nonetheless they have reached the terminal degree that qualifies them to practice in their area. You should ask her about it– I’m sure she would be happy to tell you about her credentials.

Diane Adams
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Diane Adams

I thought I was seeing a doctor until I looked at her business card. She has “Dr.” before her name, but the “DNP-C” behind it. That’s how I ended up at this website; I wondered what the DNP-C stands for. That’s interesting. I do like her, but she is not really a physician. Wow.

Brian Senodenos
Guest

Upon reading the “commentary” it is quite clear why the public has such a low opinion of physicians. Your academic accomplishments create entitlement issues and your colleagues reinforce your false beliefs. Group ideology is amazing…you guys sound like you are members of a cult. Your degree establishes you as a physician. Here is the reality, there are other doctors out there besides medical doctors. Your clinical time, training, and sacrifice earned you the title of physician. Societal beliefs and your inflated sense of self advocates ownership of the title of doctor. DNPs are in fact doctors…they are not physicians!

Kelly
Guest
Kelly

Your analogy is very over simplified. While I agree NPs generally should follow conservative healthcare and use guidelines (they shouldnt experiment into new frontiers or do invasive/off-label things as the foundation of their practice)… Don’t discount that NPs have a lot of training that make them excellent healthcare providers. NPs have had far more training beyond their RN role to enhance and develop their skill set. They add a lot to the healthcare system… An absolute hierarchy when it comes to healthcare is not in the best interest of effectively getting healthcare services to the population. Everyone brings things to… Read more »

Ron Hyatt
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Ron Hyatt

There’s a reason why “officers” who were promoted from enlisted ranks are only allowed to go so far. THE SKILL SET LEARNED IS DIFFERENT. Doctors are Generals, setting strategy. Nurses are Sergeants, executing the plan.

another name
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another name

I’m a 20 year ICU nurse. Our hospital just hired a 5 year experienced nurse practitioner who comes with none of the professionalism discussed here. She is book smart. That’s it. And she’s pushing her weight around our ICU. And she’s 300 pounds of obnoxious, full of herself “wisdom.” We are actually, passively, “teaching” her on the job. This idiot will order ventilator changes without any concept of the pulmonologist being on the case. She will come to her own conclusions about weaning a patient from the vent. I’ve asked her, “Do you really want to start weaning with a… Read more »

Kelly
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Kelly

That sounds like a terrible working envirornment. I can assure you i have worked with many ICU PAs and NPs personally… and they are fantastic. Sometimes even attending physicians would ask for their input on certain issues they may not see as often as the NP because they only rotate in the ICU on service a few months a year. Bottom line: There are good physicians and bad physicians. There are also good NPs and bad NPs…. I would highly encourage you to take the proper channels necessary to address safety issues with any unsafe healthcare provider. If we don’t… Read more »

merchant services
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Hi, I do think this is a great website. I stumbledupon it 😉 I’m going to come back once again since i have bookmarked it. Money and freedom is the greatest way to change, may you be rich and continue to help other people.

Mark
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Mark

James,

Not trying to be a dick…and though I think I know what you’re hinting at, I’m a bit confused by your lack of syntax. Please elaborate, I think you may have some valuable insights.

James
Guest
James

Nope, not a nurse or doctor, however, as a squadron medic I got called ‘doc’ a lot in the military. Been around hospitals, Doctors and Nurses a long time and there has always been a certain level of resentment by nurses toward Doctors, primarily because the Nurse spends so much more time with and caring for the patient, as they feel they know more about the patients needs. There are good and bad Doctors, there are good and bad nurses. But, personally, I don’t think this is about anything in this discussion. I’m afraid that it’s about the Affordable Care… Read more »

Kelly
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Kelly

No points lost for grammar. (I’m working on a phone too… Lol) Yes we are saying a lot of the same things. 🙂 I understand you, as a physician, not wanting to share the title of doctor in a clinical setting. This is human nature… To me, you don’t seem arrogant… I expect someone who is trained as extensively in one field to be biased towards that field or profession. It means you chose a field you resonate well with and are passionate about. 😉 I am certainly not expecting any physicians to lobby for nurses. Nurses who expect that… Read more »

Mark
Guest
Mark

*I mean interventional damn auto correct

Mark
Guest
Mark

Kelly, I think we’re arguing about semantics for the most part. I’m one of the few, soon-to-be docs who is in favor of letting NPs practice independently in general practice…I see the value and the need. The only caveat of course, that I propose and some programs do, is that all the NP’s fresh from graduation ought to be supervised for 2 years by an MD/DO or another senior NP, prior to being able to set up his/her practice. You could think of it as an NP residency of sorts, except that the NP’s get the same pay commensurate with… Read more »

Kelly
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Kelly

Engineers don’t work with patients, but in their settings they are referred to as Dr. by fellow co-workers. Their doctorate doesn’t relate to patient care, it relates to engineering. You are certainly entitled to your opinion. But, I think patients are a lot smarter than you give them credit for. They know the different between their podiatrist, chiropractor, veterinarian, dentist and brain surgeon. There are a lot of degrees that didnt exist in the past… But our knowledge has grown and therefore we have more degrees to obtain and demonstrate that knowledge. In other countries they don’t put NPs through… Read more »

Mark
Guest
Mark

Kelly, most physician’s have not forgotten the basic underlying principles of science…those that specialize, have grown and extrapolated in their respective field, and as a result become experts. You may not use everything you’ve once learned, but the principles, the very foundation of the life sciences is not lost on you after 10-15 years of practice. That’s just silly. Good job, you’ve amassed anecdotal evidence by having talked to a few physicians who have admitted this to you. What sort of sampling representation is this? A PhD, as a study track (there is a big distinction between a formal 4… Read more »

Kelly
Guest
Kelly

There are a handful of typos in my post. Apologies… I was working off a phone this morning.