Inside the argument over who gets to call themselves 'doctor'

Three nurses with doctorates of nursing practice in California recently sued the state's attorney general, leaders of the Medical Board of California and the California Board of Registered Nursing over the right to call themselves "doctor."

California law states that only those who either graduated from "a medical school approved or recognized by the board while enrolled in a postgraduate training program approved by the board" or those who didn't but meet certain requirements may use the words "doctor" or "physician," the letters or prefix "Dr.," or the initials "MD" to refer to themselves.

However, the three nurses in the lawsuit are arguing that they are not misleading patients because they use "doctor' and the title "Dr." in conjunction with their nursing degrees. They are seeking to invalidate the law, asserting that it violates the nurses' First Amendment speech rights.

"It's not an ego trip; it's not a power trip," Jacqueline Palmer, DNP, RN, one of the nurse practitioners involved in the lawsuit, told The Washington Post in a July 18 report. "It's just validation that I worked hard to get where I am today."

Meanwhile, the American Medical Association and California Medical Association filed an amicus brief Sept. 6 urging that licensed allopathic and osteopathic physicians in the state should be the only practitioners allowed to refer to themselves as doctors. 

"[The] courts have consistently relied upon a readily discernible goal of the Legislature to prevent confusion and potential harm to members of the public who may be misled into believing they are dealing with physicians whenever those terms are used by non-physicians," the brief said. "The original purpose of [this law] remains as relevant and vital today as in 1937 when [it] was enacted."

"Patients find it increasingly difficult to identify who is or isn't a physician," AMA President Jesse Ehrenfeld, MD, also said in a Sept. 15 story for the association. "The potential for confusion is especially heightened when nonphysician health care professionals use terms that are customarily understood to refer to a physician."

However, the push to ban nurse practitioners and physician assistants from using the "doctor" title due to the potential cause for confusion has been met with opposition from other organizations, including the American Association of Nurse Practitioners.

"[AANP] supports the use of the title doctor in conjunction with licensure title for doctorally prepared nurses and other health care providers in the clinical setting," a policy statement on the association's website reads. "AANP opposes legislation and regulations that would prohibit nurses and other health care professionals from clearly representing their credentials to patients and the public."

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