Are Nurse Practitioner Doctors Real Doctors?

No longer are physicians the only healthcare professionals with a doctorate degree (i.e., MD or DO). Pharmacy recently transitioned to doctoral preparation, mandating that students earn a doctor of pharmacy degree (PharmD) in order to practice. Audiology (AuD), physical therapy (DPT), and occupational therapy (OTD) have also done the same.

Now, nurse practitioners arrive on the job with a doctor of nursing practice degree (DNP). When the entire healthcare team has a doctorate, the question arises, Who is the doctor? It seems simple enough — professionals with doctoral education go by “doctor.”

The public tends to associate the title “doctor” with the MD degree; however, they address other professionals this way, too:

• Osteopaths (DO).
• Podiatrists (DPM).
• Dentists (DDS or DMD).
• Naturopaths (ND).
• Optometrists (OD).
• Psychologists (PsyD).
• Chiropractors (DC).

The word “doctor” actually comes from the Latin term docere, meaning “to teach.” The Merriam-Webster Online Dictionary defines the word as, “a learned or authoritative teacher; a person who has earned one of the highest academic degrees conferred by a university.” By these definitions, the title belongs to any person receiving a doctoral degree in any field.

Of Course, It’s Not That SimpleAs pharmacists, physical therapists, audiologists, and others began requiring doctorate degrees, nurse practitioners followed suit. Today, the American Association of Colleges of Nursing (AACN) and the American Association of Nurse Practitioners (AANP) recommend that all new nurse practitioners earn a doctor of nursing practice (DNP).

Whether nurse practitioners may address themselves as “doctor” has led to a contentious debate between physician-led and nurse-led organizations. In 2006, the American Medical Association (AMA) published Resolution 211 (A-06) titled, “Need to Expose and Counter Nurse Doctoral Programs Misrepresentation.”

This resolution states, “Nurses and other non-physician providers who hold doctoral degrees and identify themselves as doctors will create confusion, jeopardize patient safety, and erode the trust inherent in the true patient-physician relationship.” The resolution also asserts, “Patients led to believe they are receiving care from a doctor who is not a physician, but who is a DNP, may put their health at risk.”

A group of nurse practitioner organizations responded with a unified stance: physicians do not own the title “doctor.” This group reassured physicians that nurse practitioners have no intention of misrepresenting themselves as MDs — or as a DO, DDS, DMD, DPM, OD, PsyD, PharmD, DPT, OTD, or AuD, for that matter.

In addition, these nurse practitioner organizations responded to the accusation that DNPs put patients’ health at risk. Ongoing research for decades has demonstrated that nurse practitioners provide high-quality, safe, and effective care. For example, a Nursing Economics systematic review abstracted on PubMed compared nurse practitioner care with physician care and found no difference in patient satisfaction or patient health outcomes.

This coalition of emboldened nurse practitioners also reminded the AMA about “restraint of trade.” In previous situations like this, the U.S. Court of Appeals ruled that the AMA’s behaviors violated the Sherman Antitrust Act. Unfortunately, this battle continues today as the AMA encourages and supports legislation that reserves the title “doctor” for physicians only.

The laws restricting nurse practitioners from addressing themselves as “doctor” vary across the United States. State medical associations representing physicians have immense political power. Six states have made it a felony for nurse practitioners, despite their doctoral education, to refer to themselves as “doctor.” Nine states require nurse practitioners to follow their introduction with a clarifying statement, such as, “I am Dr. DeCapua, a psychiatric nurse practitioner.”

United We (Should) Stand

These laws are embarrassing and counterproductive. I have never wanted to misrepresent myself as a different provider because I am proud to be a nurse practitioner. I move that we learn to respect each other’s accomplishments and value the unique contributions of each profession. We should use our distinctive backgrounds to the advantage of our patients, not as a means to divide us.

One of my favorite nurse practitioner authors, Dr. Lisa Astolos Chism, summarizes this issue perfectly:

“The advanced educational preparation of all members of the interprofessional team should be celebrated, not hidden. Indeed, it is this advanced educational preparation that will serve to improve healthcare outcomes and quality of care. Moreover, it is envisioned that someday soon, the entire healthcare team will be doctors. This team of doctors may include pharmacists, physical therapists, occupational therapists, nurses, and physicians who all strive toward the same goal, each with valuable knowledge and expertise that should be acknowledged equally.”

For more information on doctorate degrees and title protection, please see Dr. Chism’s The Doctor of Nursing Practice: A Guidebook for Role Development and Professional Issues (Chapter 11), as well as Dr. Michael Dreher and Dr. Mary Ellen Glasgow’s Role Development for Doctoral Advanced Nursing Practice (Chapter 19). Also, please check out the AANP’s annotated bibliography of all research pertaining to the safety, quality, and effectiveness of nurse practitioner care.

You can also read this awesome article on The Barton Blog, and check out their open NP positions!