Health Teams Divided on Who to Call

The turf war in health care over who should be called "doctor" is heating up as non-physicians seek a larger role in patient care.

Driven by the promise of higher-ranking jobs and respect from colleagues and patients, more nurses are going back to school to earn doctorate degrees—and requesting to be addressed as "doctor" afterward, the New York Times reported Monday. The debate has implications for patient care as a wider range of practitioners, including pharmacists, earn credentials that qualify them to assume the title.

Using the word "doctor" to describe them all troubles some physicians, who believe it could cause confusion as patients are treated by multiple practitioners in diverse practice settings. "There is real concern that the use of the word 'doctor' will not be clear to patients," Roland Goertz, MD, board chairman of the American Academy of Family Physicians, told the Times.

WEIGH IN: How do you introduce yourself to patients? Do you prefer to be addressed as "doctor"? Share your views in the comments below.

The debate over who should be called "doctor" (and in what context) is not new, nor is physicians' opposition to others holding the title. But physician groups are becoming more vocal on the issue recently, especially as policymakers look to interdisciplinary care to control health costs and meet a growing demand for services in the wake of health care reform.

Responding to Dr. Goertz' comment on KevinMD.com, physician blogger Kevin Pho, MD, wrote that "physicians, as always, are being reactionary and playing from behind the public relations curve. Those who earn a doctorate degree, whether it be in nursing, pharmacy, or psychology, deserve to be called 'doctor.' Period."

Rather than claim a monopoly on the title, Dr. Pho said physicians groups should lobby for universal board certification. Applicants would have to pass a rigorous exam equivalent to the ones physicians take to practice primary care or internal medicine. That way, he said, "those that pass truly deserve to be called 'doctor,' no matter what their background."

Context is everything

Those opposed to expanding the definition of "doctor" argue that patients are already confused by the trail of initials appended to practitioners' name badges. Citing its own research as evidence, the American Medical Association (AMA) holds the position that "ambiguous provider nomenclature" used in marketing for health services is "exacerbating patient uncertainty."

The physician lobbying group's 2010 "Truth in Advertising" report found that 44% of patients have trouble distinguishing licensed MDs from non-physicians in ads and marketing materials that describe health services. AMA strongly supports the Healthcare Truth and Transparency Act of 2011 (HR 451), which would prohibit non-physicians from misrepresenting themselves as doctors when interacting with patients or advertising their services.

Exactly what qualifies as misrepresentation is still subject to debate, however. In the age of coordinated care, health practitioners who identify as doctors might have to disclose their profession as well, as is the case in Arizona, Delaware, and other states, NYT reported. In a patient encounter described in the article, a doctor nurse quickly introduced herself by saying, "Hi, I'm Dr. Patti McCarver, and I'm your nurse."

It's a concise greeting that gets to the point, but also addresses a major concern of physicians—context. Physicians argue that using the word "doctor" in the context of a check-up or screening scenario increases the likelihood of patients assuming the provider is a physician. By indicating their profession up front, practitioners can avoid confusion and initiate conversations about different doctoral degrees and the training they require.

What works for doctor nurses like Dr. McCarver might not work for practicing pharmacists, however. Since the PharmD replaced the BSPharm in 2004 as the minimum required to practice, many community pharmacists say they're "over" an argument that has already been discussed at length within the profession.

Writing in an online forum on the topic, one pharmacist put it simply: "We (or at least I) don't want to be called 'doctor,' anyway. People are more honest to me if they don't associate me with some sort of title-prestige."

For other articles in this issue, see:

• Parents Still Fear Routine Child Vaccines
• Pfizer Warns of Fake Drugs Sold Online