Although many in the healthcare setting have earned a Dr. title, not all are MDs—leading to confused patients and, in some cases, fines and legal issues.

Medical doctors (MDs) do not have a monopoly on being addressed as “doctor.” Many healthcare practitioners, like veterinarians, dentists, and pharmacists, have earned degrees with the title “doctor” attached. However, without clarification as to one’s specific type of doctoral degree, patients often falsely assume that someone referred to as a “doctor” must be a medical doctor. According to an American Medical Association (AMA) survey, almost 40% of respondents incorrectly labeled a Doctor of Nursing Practice (DNP) as a medical doctor, and almost 20% mistakenly thought that Nurse Practitioners (NPs) were physicians. As such, the AMA observed significant confusion amongst patients regarding healthcare providers’ training and education.

This situation even caused some DNPs in the healthcare community to face fines and legal charges. For example, California-based healthcare provider Sarah Erny, RN, DNP, lost a case in which she had to pay nearly $20,000 in civil penalties for using the title “Doctor Sarah Erny” online and in other venues. While the San Luis Obispo District Attorney (DA) acknowledged Erny’s frequent self-identification as a nurse practitioner (NP), the DA also claimed that Erny neither informed people that she was not a medical doctor (MD) nor identified her supervising physician.

Medical writer Lisa Marie Basile notes that in June of this year, three DNPs—Jacqueline Palmer, DNP, Health Lewis, DNP, and Rodolfo Jaravata-Hanson, DNP—decided to address a similar situation and took legal action against California. According to the Medical Board of California, any practitioner’s self-referral using the words “doctor,” “physician,” or the letters “Dr.” puts that practitioner at risk of being guilty of a misdemeanor if they do not have a “valid, unrevoked, and unsuspended certificate as a physician or surgeon.” The three practitioners all had valid, unrevoked, and unsuspended doctors’ certificates, so they challenged the California state court, citing that state officials are criminalizing the honest employment of the title “Dr.” by medical professionals whose licenses are neither as physicians nor as surgeons. Furthermore, these three DNPs argued that California’s state law violates DNPs’ First Amendment right to “truthfully describe themselves and their credentials.”

Ethical Considerations

Although California isn’t the only state looking to prohibit the use of the title “doctor” by DNPs, states like Georgia allow it, provided DNPs clearly identify their non-medical doctor and non-physician status while at work. Policy differences amongst states can be quite confusing for both patients and healthcare industry professionals.

According to emergency medicine physician Gary Gaddis, MD, PhD, while DNPs in an academic setting could certainly refer to themselves as “doctors,” referring to themselves by that title in a clinical setting misleads patients and propels a fraudulent notion that inherently toys with patients’ trust. Doctor and medical writer Danielle Kelvas, MD, suggests that one way to avoid confusion would be for doctors to refer to themselves in more specific terms than simply “doctor,” like “doctor of medicine,” “doctor of nursing,” or “surgeon.” NYU Grossman School of Medicine’s ethicist Art Caplan argues that the title “doctor” should be viewed less as a title of increased respect and superiority and more as a distinguisher of one’s skills and responsibilities. Caplan argues that people need to learn how to respect the various ways healthcare professionals care for patients.

American Association of Nurse Practitioners (AANP) president Stephen Ferrara asserts that any form of doctoral preparation for a healthcare professional benefits the healthcare industry. Ferrara encourages people to consider the tremendous preparation and knowledge that accompanies doctoral studies, urging them to embrace all who seek doctoral achievement. As such, the AANP supports referring to DNPs as “doctors.”