Trendspotter: Should NPs With Doctorates Be Called “Doctors”?

In case you aren’t aware of it, more and more nurse practitioners are getting doctor of nursing practice (DNP) degrees, rather than master’s-level certificates. In fact, this will be the standard degree for new NPs by 2015, according to the American Association of Colleges of Nursing.

The question is, should these newly minted NPs be called “doctor”?

In a post on The Health Care Blog, Barbara Ficarra, RN, BSN, MPA, argues that's OK if the NP makes it clear to patients that she or he is not a medical doctor. I think this will not only confuse patients, but will also erode the distinction between physicians and midlevel practitioners.

The debate over whether NPs are as skilled as primary care doctors is often described as a turf battle. But as several physicians quoted in Ficarra’s article note, it’s far more complicated than that. For example, Susan Stangl, MD, said:

“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.”

Other physicians say that NPs should complement rather than compete with physicians, that calling them “doctors” could demean other nurses in patients’ eyes, and that it’s just downright strange to call both physicians and nurses “doctor.”

To be sure, there are other nonphysicians who routinely call themselves “doctor,” including dentists, podiatrists, and chiropractors. These professionals also have nurses or medical assistants in their offices. But I’m not aware that any of them employ midlevel practitioners such as NPs and PAs. So, whatever you think about a podiatrist being called a “doctor,” there’s no risk of him being confused with a nurse.

Another way to think about this issue is to look at the specialty practices where many NPs work. An NP employed by a cardiologist or an OB/GYN needs specialized knowledge beyond what’s required to work in primary care. Yet I suspect that a cardiologist or an OB/GYN would bristle if any of his NPs were addressed as “doctor.”

As Ficarra points out, there are many professionals in our society who are addressed as “doctor” by virtue of the fact that they have a PhD, whether that be in a science, economics, or education. So, from that standpoint, it seems appropriate that a doctor of nursing practice be called “doctor,” Ficarra says. But I’d submit that it’s one thing to address someone by their academic title in an academic setting, and something else to do so in a medical practice, where the term “doctor” has an entirely different connotation.

In any case, this debate bears testimony to the narrowing of differences between various kinds of primary-care providers, as well as the urgent need for more primary care. NPs are officially regarded as primary-care providers in 22 states, and 28 states are considering whether they should be allowed to practice without a physician’s supervision.

Meanwhile, NPs already function pretty independently in rural areas, where their supervising doctors are far away most of the time. Many have prescribing privileges and hospital privileges. NPs also staff retail clinics, where they are supervised at a distance. And in many busy primary-care practices all over the country, patients are more likely to see an NP or a PA than a doctor, because there aren’t enough physicians to see everyone.

That’s all right, because we need more primary-care providers. Moreover, studies show that NPs can do much of the same work done by an internist, pediatrician, or family physician, and that patient outcomes are similar in both cases.

But let’s not forget that when a difficult diagnosis is called for or when a provider has to reach back in his or her experience to understand unusual symptoms, it’s still better to have a doctor in the house.