Sometimes, It’s Just That Simple

A recent NYT article addresses the subject of doctoral-degree holders from other fields introducing themselves as “Doctor” to their patients. The word “Doctor” in the health-care setting carries a rich set of meanings and assumptions beyond the achievement of a doctoral-degree, and is essentially a synonym for “physician”.

If you’re not a physician, don’t introduce yourself to patients as “Doctor.”

I don’t call myself a “Doctor”, my parents (who hold non-medical doctoral degrees) don’t, and my classmates who have biomedical (but not MD) doctoral degrees also don’t. I constantly correct other folks who call me a doctor, and I explain what being a medical student means an average of four times per day (I kept count during one slow week).

Why do nurses need doctoral degrees? I don’t know – but as the article states, I doubt it has anything to do with things like providing higher quality, cheaper or a higher volume of patient services (a.k.a what our health care system needs). If anything, this prolongation of training will increase tuition costs (do the schools that turn a tidy profit on DNP programs care?), decrease availability of providers (as they spend more time in school), and generally erect new barriers to healthcare. I have yet to hear a coherent defense of the creation of this new degree (no, the “increased complexity” of health care doesn’t even begin to cut it). Dear reader(s), if you can articulate positive benefits of this DNP thing, please do so!

Maybe we should move to the German system, where each doctoral degree is used separately in the title. In Germany, MD’s are “Doktor”, MD/PhD’s are “Doktor Doktor”, and MD/PhD professors are “Professor Doktor Doktor” … although apparently their system has its own problems with plagiarism in doctoral theses.

At our institution, we have many DNP’s. They are great and they provide great clinical care to their patients. Many of our CNMs who operate autonomously, but conscientiously, under the umbrella of our OBGYN department are also DNP’s. For me, the most relevant part of this is the “NP” part, meaning that they have advanced clinical training and can better manage their patients autonomously, rather than the “D” part, which just means that they took a year of classes and wrote a thesis. Not sure how that thesis will help deliver a baby or manage a shoulder – maybe all those pages will help save us money on chucks and wipes?

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4 Responses to Sometimes, It’s Just That Simple

  1. Penelope says:

    It seems to me that there needs to be a balance towards honoring academic achievement and providing clear communication with patients.

    I would expect that a PhD-educated Nurse might introduce herself as “Hi, I am Dr. SoandSo, I am an Advanced Practice Nurse Practitioner who will be doing your assessment today”.

    Allowing medicine a monopoly on the title “Dr.” disrespects all of the many professions who train and study for years to attain a doctoral-level degree. Perhaps all professions need to learn how to respect the contributions of each other and not get so hung up on titles.

    As a patient, my ideal introduction from a physician (a term I actually prefer to “doctor”) Is an introduction, what name they prefer to be called, asking me how I would like to be addressed followed by an indication of what they will be doing with my care.

    For example. “Good Morning, I am Dr. Christina Yang, I am the surgical intern who will be sitting in on your procedure today, you can call me Christine, or Dr. Yang. I see your name is Penelope Harper….do you prefer to be addressed as Penelope or Ms Harper?

    Perhaps it is a little cumbersome, but I think it establishes clarity, mutual respect and roles.

  2. Penelope says:

    Just an aside – I am curious about your thoughts on the graduates of the MD/PhD program. Do you see this degree combination as useful, or as lost time to patient care? Do you think the MD/PhD program will lead to higher quality, cheaper or a higher volume of patient services? And should this be the focus when one decides to further their education?

  3. Hooray for controversy! Thank you for commenting and not just passing idly by.

    In the hospital setting, the word “Doctor” is indisputibly synonymous with “Physician.” The hospital setting is unbearably confusing for patients (what is a resident? what is an intern? what is an attending? what is the difference between a CRNA and an MD anesthsiologist?). Encouraging multiple professional training pathways to use the same title will increase confusion and ambiguity, to the detriment of patient decision-making and autonomy.

    Yes, to some extent, “Doctor” is a privileged title. As a synonym for Physician, it also carries specific meanings: graduation from medical school (not just a doctoral-level degree, which could have been awarded in art or french literature), passage of national physcian licensing exams, and certification by the state or locality as a practicing physician with all the rights and responsibilities of that legal status. It also carries unspoken corollaries: power, authority and status in an extremely hierarchical world.

    Does the DNP in the New York Times article want people to think she went to medical school, or is a licensed physician? I doubt it. An RN/PhD could say “I have a PhD in nursing” or “I am a nurse scientist” and that way he would feel rewarded and appreciated for his extra education. Why do they have to use a word that has a unique and privileged meaning inside the hospital – unless it is in fact the privileged status that they seek …

    As for the patients, I call everyone “Ms.” or “Mr.”. I don’t even ask. Even if they’re 9 (at least then, it’s good for a laugh). And I make sure everyone knows that I am a medical student.

    The MD/PhD vs. RN/PhD comparison is inexact (at best). There are no patient-care settings in which an MD/PhD dual degree is required to get ahead, while most if not all advanced nursing positions (clinical or clinical supervisory positions) reward or require candidates to have doctoral nursing degrees. Furthermore, there are only a few hundred MD/PhD graduates every year, while there are thousands of nurses who could be doing clinical work but instead choose to pursue doctoral degrees. The MD/PhD is not a bottleneck in the supply of doctors, while de facto mandatory DNP or RN/PhD degrees are a huge dam blocking the flow of nursing training.

  4. Thank you for writing this. Using the word “Doctor” in a clinical setting does carry implications of “I graduated from medical school.” Combined with a white coat and stethoscope, it’s incredibly confusing for patients, especially those with poor health literacy. If it’s unethical for medical students to be introduced as “student doctor,” how it is ok for a nurse to be introduced as “doctor”?

    The MD/PhD comparison is a little off because the vast majority of MD/PhDs are headed for a research-oriented career, where they may see patients as little as one half-day per week. MSTP programs are not geared toward “higher quality, cheaper or a higher volume of patient services,” — the goal is to further medical knowledge through research. I guess that’s “higher quality,” but not in that MD/PhDs have better clinical acumen than straight MDs. I’m not sure what the career goals are for DNP grads. Nursing research? Education? I just don’t get how it differs clinically from an NP.

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