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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.
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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.
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.
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!
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 the table to help meet a patients needs.
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.
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 do anything… We are contributing to the problem.
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 CXR that looks like that, and a peek pressure like that?” And then I’d see her trot her fat ass down the hall trying to figure out what I’ve told her.
She is dangerous. I don’t follow her “orders.” I follow the neurologists orders and then I butt heads with her. Daily.
But that’s what our hospital wants, huh? A cut-rate “specialist” with a doctorate in “nursing” writing orders on a brain damaged patient with no real time experience or proctored education. She’s just turned loose on society, and they gave her prescription priviligk es on top of that.
Ridiculous.
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.
Jad, do your research. What you have said ,on all accounts, is not accurate. You have a misunderstanding of the requirements.
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.
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 Act and setting the stage for a shortage of MD/DOs that will occur if fully enacted. The patients will still be seeing a “Doctor”.
Just a thought
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 are in for a life of unhappiness. (Police officers don’t lobby for lawyers. Architects don’t lobby for contractors. Why would it be different for nurses?)
I think most RNs NPs and patients understand that a physician sacrifices a lot and is an expert. To me it seems pretty well accepted so I’m surprised you feel you have to defend your degree. As you advance you’ll feel it more…maybe as a resident not as much. I think there are a lot of experienced NPs who have been discounted by physicians. And this makes them more defensive.
Just because something has been though historically, doesn’t mean it should still be. If that were the case our country would look a lot different. We would have separate bathrooms for races, not everyone would be able to vote, and we mighg still have slaves. So your argument isn’t that strong (if its just “well thats how it is”) for taking away people’s option to use the title if they earned it. (Dramatic, I know… haha) Personally, in the futureI see more NPs, particularly DNPs, opening up their own primary care practices and people will know they are seeing the NP because its an NP office. While you may have some in the hospitals… they really are best serving the community. in this case, the title of doctor is to demonstrate competence. Really primary care is moving more towards protocols, guidelines, and managing/triaging referrals… case management/ nursing. Primary care is no longer a one stop shop where you go for broken bones, allergies, pain, minor surgery, OBGYN… Now adays there is a specialist for everything (makes sense as there is a lot more to know!)
PS. I agree on the white coats. It’s ridiculous. They are germ spreading reservoirs and vectors. Personally, I think white coats are for residents (who get a kick out of it) and people who need it as a confidence booster. I think it looks much more professional when someone has the confidence to forego the white coat and just dress professionally. In that case, I have to hand it to the radiologists. They don’t have anyone to put a show on for… So they keep it real, despite their different personalities . Haha.
Good luck with your studies! And Happy Thanksgiving. 🙂
*I mean interventional damn auto correct
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 their experience, as it is today.
AKA…I’m not advocating an NP in the ED should all of a sudden make $50k just because he or she is under supervision for 2 years. The NP should still make $80-100+k in that setting, as it is today, depending on location, experience etc. Then after 2 years he/she can practice independently.
Going back to the DNP issue where we disagree.
Perhaps if I formulate my reasoning differently, you might see where I’m coming from?
We both seem to agree that the education is different – and serves different purposes. If I seemed arrogant and contrived at times, its really because I feel/maybe even incorrectly assume that some RN and NP don’t appreciate what makes me different, and how truly hard it is to become a physician.
The term Doctor has been historically applied to physicians in a clinical setting. It’s not that Dr’s have a strangle hold on the title. Physicians have a strangle hold of that title IN THE CLINICAL setting. This is how people identify who the terminal expert is. This is how it has been for decades if not centuries.
Think of it as an honorary title of distinction that society has imposed on us. I don’t like having to defend my degree, which by the way is far from over once I enter residency…
I agree with you that nursing has evolved. That more is expected of the advanced practice nurses. But doesn’t it have an aura of ridiculousness to it…. Dr. Nurse?
Alos, everybody wears white coats as well nowadays, so you really have to read the initials on the ID to even know who’s who anymore. I personally could care less who wears a white coat, its just an illustration of the “I want to be cool” and be perceived as a doctor complex. I get along with all the nurses on my rotations, and SHOCK even grab food with some of them…but lets face it, even the nurses that I know, chuckle at the x-ray techs wearing white coats, parading around, while the radiologists comes in wearing a cardigan, khakis and Birkenstocks. LOL.
Can we at least agree on that every radiologist we’ve encountered is an odd duck? Seriously it never stops to amaze as they never disappoint. The international guys are the exception though…most of them are ok 🙂
Secondly, I personally feel, that your illustration of DC, DDS,DMD, etc. doesn’t really apply, because these people work in their own offices/are not part of a hospital and are not surrounded by ancillary personnel and allied health professionals. I mean can you see my point?
A lot of lay people know the difference between healthcare professionals, but many don’t as well. I’m not a 23 year old med student. I got in medical school at 29 (MS1) after doing years of other things I’ve hinted at in previous posts, so I feel I have a modicum of experience with patient interaction. And if by chance regular people do know the difference, being able to discern one form the other is paramount to their understanding of whom they are dealing with.
Even at the dentist’s office, people often confuse the hygienist with the dentist.
Anyways, I need to stop and study… thank you for the work that you do. Have a Happy Thanksgiving!
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 the ringer as much to be able to take care of patients independently. There is always an argument in the US about them not having enough education compared to physicians… And that they need supervision above state boards of education… So the DNP degree adds more education to start to address this.
Personally I am not a fan of using the title of doctor for anyone, just say what you are and leave it at that. But no one who does all that work should be told they cannot use the title.
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 year study track, vs. ingenuity, and scientific contribution on a period of longer duration) is not “harder” than a MD.
The reasons are:
NUMBER ONE, unlimited number of PhD spots, the average PhD grades and test scores required to get in, are lower than the average MD. Fact!. Look it up. Stop spouting contrived quotes from a “few people” you’ve talked to. Secondly, a physicist, or an engineer would never address themselves as Droctor in a clinical setting…even the one’s I’ve worked with in the research hospitals designing and creating new ocular imaging techniques and devices, wouldn’t have the balls to say the things you’re saying.
I have a BSME (mechanical engineering) and worked in nuclear research labs, and devised cutting edge research in magnetics…I could have stayed on and earned my PhD, but it wasn’t necessary. A PhD in engineering is, in my experience, the publication of your original work, that is peer reviewed, but you’re using the skills that you’ve already established in your undergraduate engineering degree. It is not needed to invent or be entrepreneurial. I also wanted to apply my knowledge of the physical sciences in the medical field..guess what, I need an MD for that.
Researchers (PhD candidates) take their time and study differently than MD’s. Medical students and MD’s as GME’s, are responsible for an asinine amount of information in a shorter period of time- that’s the distinction, and which is also why the degree is “harder” to obtain.
I need you to pay attention now… “harder” does not designate more important. Should the interventional cardiologist be praised for saving a life, while the Bio-mechanical engineer that invented the stent, be neglected?
No, both serve a purpose. But the physicist/engineer would never introduce himself to the patient, IN A CLINICAL setting, as Dr. XYZ.
If you want to quantify the intellectual veracity that is required to be a rock-star physicist, vs a rock-star neurosurgeon, 9 times out of 10, I’d give the Physicist the edge in innate intelligence. But it’s not a question of innate intelligence, the argument is based on “difficulty of the degree.” Edge, the MD. Hands down.
An analogy might be: the world class Olympic sprinter or gymnast, who 9/10 times is innately more athletic and gifted than a Navy SEAL. But he or she isn’t a SEAL, b/c they didn’t go through BUDS or anything related to SEAL training, and thus shouldn’t say “well I’m almost a SEAL, I mean look at my power and speed and agility, I can handle obstacle courses just as well,” while neglecting the other 90% of things it takes to be a SEAL.
As a patient, would you want to be treated by the guys and gals who invent the stuff and enhance the field on a daily basis? Or would you want to be treated by a DNP, somebody who has a more holistic treatment perspective? I believe it depends on the situation. Specialists will treat the severe cases. DNP will be subjugated to GP.
But why confuse the patient population? I’m Dr. Kelly, your nurse practitioner…what? Haven’t you asked yourself why does this degree not exist in any other country? Because people don’t understand the need to get a professional doctorate in nursing. It doesn’t equate.
There are a handful of typos in my post. Apologies… I was working off a phone this morning.
If you are defensive use your earned title, physician. No one else can use that title unless they aren’t an MD or DO. (There are far more doctors than just MDs). The argument about what’s harder is irrelevant. Quite frankly I’ve even had several physicians admit its much easier to be a physician than have a doctorate in physics, quantum mechanics, or any Mathematical PhD. But who cares? It’s about demonstrating that you are qualified to do what you do.
A DNP still has 8 years of college. This includes a masters degree along with clinical experience with patients before their doctorate (which MDs do not). Of course the education is not the same. A DNPs training is more focused to the population they are going to be certified to work with. Its more about applying research and guidelines for pt care than inventing them. The title of doctor is about demonstrating to patients that their provider is competent to do those things because they are someone who has reached the terminal level of education. Its not about demonstrating that one could pass some difficult entry level chem and physics classes (of which you will forget the material after several years of practice).I agree there should not be coercion, it should be Dr Smith DNP. While there is some overlap, there is a difference in the types of things NPs and physicians do, as you have pointed out. We don’t experiment on Pts to invent new treatments and procedures… We incorporate science but put the patient and their quality if life at the center. It doesn’t make us any leas deserving of being about to use our titles as dictated by out degrees. With regard to using the title followed by the degree… the true is same of MDs, DOs, ODs, DDSs, DMDs, DCs, DVMs, etc.
As a medical student (and as a former EMT/ER tech) and recent MPH graduate, I am of the opinion, only in regards to primary care, that qualified NP’s should be allowed to independently practice…why not? The shortage of physician’s in our nation’s rural areas is appalling, these nurses would provide a valuable service in preventative healthcare.
*By qualified NP’s I mean: two years of supervision, post program completion, under a physician or senior NP.
I do have my reservations of nurses calling themselves “Doctor.” In a clinical setting, only physician’s should be allowed to call themselves Doctor. Those who bring up the “PhD in History argument” etc, are operating on a logical fallacy – one that neglects independent variables based on a methodology conceived through bias.
It is an honor, to bestow the scientific and clinical title, because we worked so hard to get there. The level of academic rigor and detail, is simply not present in nursing curricula, BSN or advanced. I have tremendous respect for Nurses, PhD’s, etc…but if you did not put yourself through medical school, then in a clinical setting, do not call yourself doctor. In lecture, on publications, on letterhead, sure no problem. “Dr. Jane Doe, DNP.” is perfectly acceptable. In the end, it will be the MD/DO initials that count the most…and so it does in the eyes of most patients.
Our citizens in rural America, will be happy to be treated effectively by NP’s for GP purposes. Major complicatins will require the NP to seek out transport to the nearest ED anyways, where specialists will descend upon the patient, and blot out the sun! 😉
I often understand RN’s frustrations, as they see procedures repeated ad nauseum, but just because you think you know what to do and what is going on because you’ve seen it a thousand times…doesn’t mean you know why. 90% of the time, healthcare and its affiliated procedures are technical/mechanical, but for those rare occasion’s where things do not run smoothly you’re going to want a physician at your bedside, because he or she will know at a fundamental molecular level what to do. Period.
My pre-med courses and the necessary GPA requirements of these said courses, are from an intellectual stand-point, far more challenging than any RN curriculum. It’s all books-nothing clinical and I stand by those words. Hell RN’s have to do 1-2 sequences of general chemistry, sometimes the non-major chemistry. I’d love to see an RN attempt to take o-chem, or bio-chem or p-chem…and do well!
As physicians we are called on to be scientists and clinicians…true, the greatest percentage of Physicians only practice in clinical settings. However, a physician could and a large number still do, advance and invent procedures, therapies, drugs, etc. alongside their PhD counterparts, or independently among their cohort of fellow MD’s and DO’s. That’s the difference. Physicians are the end of the line. So, yes, I get defensive over this issue, because “you” haven’t earned the title.
Kelly, I think you have made an interesting point thus far. In my opinion if you have reached the highest level of training in a specified field and obtained a doctorate degree then what is the problem with being referred to as a doctor? Every one of my professors who have a PhD, I refer to them as doctors. You guys are acting like a Nurse Practitioner degree is just a chip off the old block; it’s still an 8 year educational program. I’m sure every “doctor” knows the role they are suppose to play, rather its in education or an institution. I’m pretty sure a DNP knows he/she is not as educated in the “medicine” aspect as an MD is, but does that make them any less of a doctor? Do you think someone with a PhD in Psychology is going to as much in Sociology than someone who has a PhD in Sociology? Yet both of these people would be referred to as doctors holding the highest level of degree in their field and neither one frowned upon more than the other. My point is that these two type of doctors are taught different aspects of the medical field, both playing major roles. If I went to school for 8 years and obtained a DNP, “DOCTOR” of nursing practice, your damn right I would want people to consider me a doctor! The emphasis is on level of education, not the type of education.
This isn’t a battle about who is better. There are some things nurses are better for and there are some things physicians are better for.
As medicine advances… primary care services become well established protocols and standards of care. That’s what nurses are great at— taking well established things… and using them to put the patient’s quality of life and preferences at the center of what they do. It’s no longer a “science experiment” to provide primary care services. The primary care physician is no longer the “jack-of-all trades.” Most abnormal things now get referred to a physician specialist… AKA: “the scientist.” People with a medical mind want to practice science… that may be why, in part, we have such a shortage of primary care providers.
Regarding your statement “Until u pass through the prequiste training its not just the same you would never be able to know as much as the physician.the amount of knowledge that separates us is a lot more wider than you think.” I disagree… nothing “magical” happens to someone in medical school. Medical school is not a mystical place that transforms someone as a human being. Many physcians will tell you that after years of practice they can’t remeber the first thing about the fundamentals they learned in medical school. Everyone gets into their area and only uses only what pertains to their practice. In medical school students read a lot of books, attend a lot of lectures, and spend learning in the field. Other programs and methods of education can teach people what they need to know using the same format, they don’t need the title of “medical school.” One is either capable or one is not. There is a path to deal with ANY professional who proves they are unsafe and not capable. With many physicians not wanting to do primary care anymore… we need something to fill the gap in a way that maintains standards and promotes quality of care.
No one here is suggeting that DNPs are physicians or MDs. It’s about raising the bar for education though so that nurses who are providing primary care services can say they have a level of education that makes them a leader and scholar in their area. People don’t tell their dentist, optometrist, or veterinarian that they are trying to be a MD when they use the title Dr. The title serves to show the public that they are well educated experts in their field. The same should be true for a DNP.
Idk y this is as issue. No matter how well trained or how many degrees and number of years of experience a nurse has they would NEVER be as good as the physician.Now talking about the number of years of experience and how it relates to how better an experienced Dnp is…well if d level of knowledge of an experienced DNP or PA (say 30yrs of experience) can be equated to not a Dr who has had d same number Of yrs of experience but to an intern of 1st or 2nd Year resident , that only means that There’s no basis for these arguments it clearly shows how deficient they are in the area of knowledge.it only shows that because of the number of years they hv acquired just a little of the Skill but There’s more to that. You hv to know the reasons behind what you are doing. You also need to know what To look for and how to go about it. I bet the DNPs are also lacking in that Regard so it would be dangerous for the avarage man out there if u allow the nurses to offer primary health care services. Nurses are wonderful people and are a very important part of the health sector but this whole Dr -Nurse-advancedNP issue wouldn’t be an issue If only they didn’t have self esteem issues becausethey think for some reason that doctors are arrogant , understood who they are and their importance and relevance to the health sector, and the limitations of their practice. Because no matter how much you are Being called a DR its never the same. Until u pass through the prequiste training its not just the same you would never be able to know as much as the physician.the amount of knowledge that separates us is a lot more wider than you think. So I think offering the best services to our patients would be the sole aim of advancing ourselves And getting higher degrees not proving that u know better than the average intern. Let the Nurses be satisfied with. Who they are and Their place in the Health sector and let the nurses be content with that. If u want to be callled an MD go through med sch acquire the training go through residency……pls lets learn to do the right thing . Because this Dr-nurse battle Leaves the health sector no where rather its the patient that is exposed to a half-baked Quality of service. Even if u re called a Dr it Doesn’t and can Never keep u on d same strata with the average physician rather it would only be constiuting an unnecessary confusion for the lay man out there. Nurses we appreciate you but pls for the sake of our Patients KNOW YOUR PLACE.
I’d like you guys the patient’s perspective. I’ve known many MDs, RNs, and I’ve worked at a medical insurance company. I have epilepsy, been through many surgeries, medications, and doctors, both good and bad. I find this bickering over who is called “Doctor” petty and disheartening.
In my experience, nurse practitioners are more accessible (easier to get quick appointments) and patient-centric , and willing to listen. In theory, they should also be more cost-effective. NPs are allowed to provide primary care in some states, and they should be. But patients must be made to know that they are not doctors (although my NP performs her duties far better than any previous MD), and I think the role of a non-MD should be carved out so that they can provide routine care (including clinics) and advice at a lower cost. Going beyond that really blurs the lines.
Most patients (myself included) don’t really know what all of our options really are…we demand more transparency. The internet is making a big difference with that now, but for those who don’t stay informed, they have to know there is *someone* they can go to that doesn’t break the bank. I am personally tired of people taking up ER resources (some of our best doctors) with the flu…
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I dont think anyone is suggesting RN training alone should suffice for advanved practice.
The whole point of raising the bar for education is to promote advancement of healthcare providers using the nursing model. Converse to other models of care, the nursing model at the advanced practice level highly focuses on emotional intelligence/ dealing with patient pyschosocial issues in addition to clinical skills.
Calculus has little to do with providing healthcare services. I would guess that most practicing physicians don’t remember much in the way of their medical school prerequisites.
As someone who is both a nurse and who has traveled to a third world country, I can assure you… We are no where leaning towards third world by raising the bar for nurses and incorporating them into healthcare services more. Many many developed countries heavily rely on nurses and advanced practice nurses (particularly for primary care services). There is a place for everyone (MDs, NPs, DOs, PAs, RNs, ODs, DCs, etc) in the healthcare community to provide services without any shortage of patients.
I am slightly troubled by your statement that nurses as a whole are unstable, uneducated people (especially since you are a nurse). As a nurse myself I have not found this to be an accurate assessment of my personal experience. I do not mean this in a negative way… but I would look at where you are working and dig deep to find out what makes you have these impressions. As a licensed professional (and the patient advocate) its our job to do this. I wouldn’t want anyone caring for me who wasn’t able to critically think and come into work with a solid emotional state.
You have an overinflated ego!
Agreed! Most of the nurses I know couldn’t make it through one semester of calculus, much less medical school. This is just so much “PC” nonsense and it is just another sign of our times. We appear to be well on our way to becoming a third world country. I am a female R.N., and most of the nurses I know are extroverted caregivers; they are not, however, very analytical or emotionally mature/stable. I would not want a nurse to care for me in the capacity of a doctor!
You are correct that NPs aren’t MDs or PAs. Their education and training are different, though not necessarily less rigorous by any means. It of course depends on the specifics of the who/what/when/where of their education and experience. In fact, it is completely possible that an NP may be better educated and have better and more comprehensive experience than an MD or PA. Consider they old joke: What do you call a medical student that gets all Cs? Doctor. And there it is… the title is not the thing, but rather the abilities, experience, and education of the individual practitioner/provider, whether MD, PA, or NP. So what really fuels this debate substantively isn’t the title, but the POLITICS, POWER, and MONEY. The rest is pure rhetorical nonsense at this point (sadly).
BTW, it should be noted that NPs are AT LEAST both bachelors and masters level educated, which is not necessarily true for PAs. Also, prior to completing med school, many MDs will have had minimal patient care experience and/or interaction comparatively to many (if not most) hospital and clinic nurses or NPs. There’s a reason that “bedside manner” is an issue that often comes up when discussing/reviewing MDs versus NPs or PAs. When it is the nature of your job to spend large volumes of time in actual patient care and interaction, it’s definitely not a “you’ve got it, or you don’t” thing. No, it’s essential and non-optional, and it’s becoming more and more relevant to providers’ interests as medical care becomes a more open market. Perhaps another reason MDs feel their feathers being ruffled…
Nurse Practioners are not physicians and they are not physician assistants. While I have no issue with NPs becoming more independent and raising the bar by getting doctorates, in no way is it acceptable to have them take physician boards. If there is an issue with how rigorous our board exams are, then the advanced practice nursing boards should be made more rigorous. You don’t have optometrists and chiropractors taking physician boards, NPs should not either.
Interesting post…many variegated positions on this. Ultimately, as a practitioner for over 13 years, my response is it doesnt matter. Be careful what you wish for, you just may get it. I would propose that after working with many PA’s and NP’s / supervising for many years, we can learn from each other and I have the utmost open mind and respect for their respective professions. I would say that is a PA or NP, wants more independence, then good for them. They should be able to sit for say the internal medicine board exam, and if passed, get a valid liscence and be able to have their own practice. Just remember , you will also have all the liability and cost associated with being a full partner, or solo practitioner…good luck to you all
Have you ever interacted with a 3rd year medical student? They barely have the skill to talk to a patient. I just completed a Pediatrics rotation in NP school with an M3 (3rd-year med student). I figured we would be comparable to each other right? NO! Not at all. We entered rooms together and I knew way more about addressing the patient, tackling the problem, and deciding a plan than the med student. I will preface that I am 7 weeks from graduation and practically work independently at this time in my clinicals already. Of course he knew what was going on beneath the surface, I mean pathophysiologically, but so did I. Plus, I guided the interaction and asked most of the questions. No one is saying that nurse practitioners are medical doctors. But we are. and always will be good at what we do.
The debate for the title “Doctor” rages on. I am a DNP student in the state of Oklahoma, where Nurse Practitioners who have earned their Doctorate in Nursing Practice are not permitted to use the title “Doctor” in the clinical setting. I do not agree with the view that patients would be confused by the title. I do not intend to become a “Physician” or represent myself as one. The term “Doctor” does not mean “Physician”. I call my optometrist, my dog’s veterinarian, my chiropractor, and my dentist “Doctor”…and I understand that when I do that they are not my “Physician”. It is ridiculous that upon earning their terminal degrees, these various practitioners can use their earned titles in their clinical settings and I will not be able to.
I am a healthcare professional….a chiropractor…and I am considered a ‘primary’ care provider. As most concerns go in the healthcare arena…’Follow the Money’…..The Traditional Medical Care Universe does not like competition.