Not That Kind of Doctor

I have a patient who recently sat in a clinic waiting room with stomach cramps. Eventually, a nurse called her name and led her to an examination room. "The doctor will be with you shortly," she was told.

Twenty minutes later, a woman in a white coat entered confidently with a smile. She introduced herself as a doctor… and on her white coat it said "doctor" followed by her last name.

The provider was friendly and thorough. As she was leaving, the patient stopped at the front desk to schedule a follow-up with the same doctor.

The clerk looked at her chart and told her she had seen a nurse practitioner, not a physician.

The patient blinked. But she said she was a doctor. The white coat said, “Doctor.”

This confusion over roles is unfolding in clinics across America as nurse practitioners become more common. Nurse practitioners complete one to three years of training beyond their registered nurse training. Most have a master's degree, but some are now granted a Doctor of Nursing Practice, or DNP, degree after completing an academic project. Both Nurse Practitioners with a Master's degree and those with a DNP have identical clinical skills.

In 2022, California's attorney general, Rob Bonta, filed an accusation against a DNP for "misrepresenting to patients that she was a doctor."

The State argued the title was misleading and existing laws forbid using the term doctor in a healthcare setting when you're not a physician. Three Doctors of Nursing Practice filed a lawsuit against the state in federal court, arguing that the First Amendment right to free speech allows them to use the title doctor.

This fall, Federal Judge Jesus Bernal ruled they do not have the right to call themselves doctors in a healthcare setting.

The judge found the title was inherently misleading when used in a health care setting. A survey by the American Medical Association shows that 39% of patients believe that a DNP is a physician. The medical training is vastly different — a physician spends a minimum of 7 years in training after college, compared to one to three years for a DNP.

Jamie Ostroff is the Chief Legal Counsel for the California Medical Association, which represents doctors:

"I think the judge made clear in the ruling that the fact that a Doctor of Nursing Practice would then have to explain to a patient that they are not a physician, that they actually hold a Doctor of Nursing Practice. This really underscores the fact that there is ripe for confusion."

The ruling means some hospitals and clinics will need to make changes — not only in how nurse practitioners introduce themselves, but also on office signs, business cards, and white coats.

"Those coats should not say 'DOCTOR' on them if they are not a physician,” says Ostroff.

Nurse practitioners play an important role in health care. There is no reason to avoid them. In fact, studies suggest they often have higher patient satisfaction scores than physicians. But, they just need to be clear — they are not doctors.

– Dr. Michael Wilkes with a Second Opinion

Further Reading:

• Palmer v. Bonta Opinion on Motions for Summary Judgment