Bills restricting or banning nurses with doctorate degrees from using “doctor”

[Susan Engle]

California AB 765 (Wood) Physicians and surgeons. This bill would enact the California Patient Protection, Safety, Disclosure, and Transparency Act. The bill would make it a misdemeanor for a person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon to use any medical specialty title, as specified, or any titles, terms, letters, words, abbreviations, description of services, designations, or insignia indicating or implying that the person is licensed to practice under the act.

Follow the bill https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB765

Florida bill aims to ban APRNs from using doctor.

https://www.beckershospitalreview.com/nursing/florida-bill-aims-to-ban-aprns-from-using-doctor.html

HB 583: Health Care Practitioner Titles and Abbreviations

Follow the bill https://www.flsenate.gov/Session/Bill/2023/583

Does your state of residence have any proposed bills that restrict or ban the use of doctor for those nurses who hold a DNP degree? If yes, please add the link.

• This topic was modified 1 year, 9 months ago by Susan Engle.

[Dr. Ron]

As I am sure we are aware, in California Legislation, there is a bill by Wood (AB 765) that is going through legislation that makes it a misdemeanor to use the tile “doctor” unless he/she is a physician or surgeon. There are a number of PhD, DNP, EdD nurses who have earned this title. A lot of nurses (not just DNPs) will be affected — what can we do?

“California AB 765 (Wood) Physicians and surgeons. This bill would enact the California Patient Protection, Safety, Disclosure, and Transparency Act. The bill would make it a misdemeanor for a person who does not have a valid, unrevoked, and unsuspended certificate as a physician and surgeon to use any medical specialty title, as specified, or any titles, terms, letters, words, abbreviations, description of services, designations, or insignia indicating or implying that the person is licensed to practice under the act.”

[Ana B]

Hello Susan,

Thank you so much for your post and sharing this California AB 765 Wood Bill. As a student on the pathway to enter CRNA school with the hopes to graduate with my DNP degree, I am learning more and more of the importance of staying informed and how being involved is vital to our profession. I read through the AB 765 Wood Bill and reprimanding an individual for using the word “Doctor” with a misdemeanor sounds very excessive and punitive. As healthcare workers we are all in this field to serve patients and advocate for them. When there are areas where there are not enough physicians caring for vulnerable patient populations and APRNs fill in those gaps; these nurses have earned the right to use the term if they so choose. APRNs have the credentials and experience to properly care for patients across various healthcare areas. I understand how patients want to know the credentials of the individuals who care for them, that is why it is imperative for APRNs to specify who they are and our importance when providing care. I too, would appreciate information how we can get involved at a local and state level since I am currently an ICU nurse in Bakersfield, California.

[Ryan]

Hello Susan,

I’m currently a DNP student in California. I think gatekeeping the title of “doctor” is frustrating, and not being able to use the title despite the education and experience being put into a higher degree is heartbreaking. From what I can see through the California legislative website regarding California AB 765, the bill is for amending current law. Most of the content of California AB 765 already exists under the Business And Professions Code, Division 2, Chapter 5, Article 3, 2054. This legislation was effective January 1, 2018. However, I am just delving into the topic, so if I need clarification on the bill, I’m open to learning more.

To add to my feelings on the topic, if the main issue, as implied by the bill, is the misrepresentation of position, it should be fine to follow up with our professional designation after our name on introductions, documentation, and badges. According to the 2014 Pearson report, that’s how it used to be in California. However, from the current legislation’s language, I wonder if it changed at some point. I wonder why policymakers and proponents of this legislation felt this needed to be changed if it has. I hope as healthcare continues to change in the future, this issue also resolves as interdisciplinary teams work to support each other.

[anjelica]

Hi Susan,
I’m currently a DNP student in California. After reading both Florida HB 583 and California AB 765, the Wood bill is short-sighted and doesn’t provide the clarification it intends. In the Florida HB 583 Bill, paragraph G addresses non-physicians with a doctoral degree. It provides a new abbreviation of “D.” instead of “Dr.” but allows the use of “Doctor” if their credentialing and specification are clearly denoted. This is a better compromise than excluding a doctoral degree from the title altogether. As healthcare professionals, we should be clear about our titles and credentials. Although I believe doctoral graduates should have unrestricted use of the title “Doctor”, I can understand how patients and people unfamiliar with healthcare can be confused. This bill restricts the term “physician” to doctors of medicine, which I feel is appropriate. Furthermore, it provides restrictions on who may call themselves “RN”, “LVN”, and other healthcare professional titles.
California’s AB 765 doesn’t address doctoral graduates whatsoever. It simply states that you must be a physician or surgeon to use the title. This is short-sighted for two reasons. First, as of 2025, a DNP will become the entry-level degree for all NP. Henceforth, as they start to open their own practices, they would be unable to use their “doctor” title in any form of advertisement, business card, ect without being penalized. Under this law, simply writing “Doctor of nursing practice” would be a misdemeanor offense and could potentially remove much-needed providers from the workforce. Secondly, the inspiration for this bill is based on patient survey data, stating, “ According to the American Medical Association’s Truth in Advertising surveys, 79 percent of patient respondents would support legislation in their state to require all health care advertising materials to clearly designate the level of education, skills, and training of all health care professionals promoting their services”. However, this bill doesn’t prompt clarification of education or credentialing whatsoever but only restricts the use of one title. This is misleading for the general public, leading them to believe this bill provides transparency for all healthcare providers. California’s AB 765 would only encourage more unnecessary healthcare legislation. It would be more appropriate to adopt legislation in the fashion of Florida’s HB 583 and require education and license designation for all healthcare professionals.

[Jeffrey]

Hello Susan,

I am a DNP student in Southern California in an FNP program. I agree with Ryan that restricting professionals other than Medical Doctors (MDs) from using the title “doctor” is frustrating. There are many professions besides nursing, with doctoral programs that are the terminal degrees of those professions. All of these professions deserve to be identified according to their educational level. The American Medical Association (AMA) states, “Patients deserve care led by physicians-the most highly educated, trained and skilled care professionals” (AMA successfully fights scope of practice expansions that threaten patient safety, 2023). It seems a little egotistical for the medical profession to say they are better than everyone else. Ultimately, the patient should come first, not the title you wear on your badge. Even as a bedside nurse, many patients misidentify me as a doctor. I explain that my role is different, however, because I do not want to be labeled as a physician. At my institution, the word doctor, or even MD, is not used to identify a physician; their badges say, physician.

This issue is mainstream and is even present in pop culture. In the movie, The Hangover is a dentist. When he says he is a doctor, he is corrected by his friends and a hospital physician. While he may not be a medical doctor, he is still trained as a dentist, with a doctorate with the title Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM), so why is it incorrect for him to identify himself as a doctor?

Reference:

AMA successfully fights scope of practice expansions that threaten patient safety. (2023, May 15). Retrieved July 14, 2023, from AMA: https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten

• This reply was modified 1 year, 5 months ago by Jeffrey.

[Jennifer]

Hi Susan,
I am also a DNP student in California in the PMHNP track. I personally chose a DNP program over a master’s was for two reasons. One, I wanted the most and best quality education possible as a PMHNP because I knew my knowledge and judgement will have significant impact on the mental/physical health of my patients once I become a provider. Two, I have a personal goal of opening my own telehealth business and I want to use the title of doctor when advertising my business. Of course, I have no intention of misleading my patients by using the title of doctor and I will always specify my credentials as a PMHNP, but I wanted the public to know that I have a terminal degree in my field. Jeffrey brought up a good point about the doctor joke in pop culture. The reality is no one refuses to call their dentist a doctor because they understand that the dentist is also a doctor. The dentists are not trying to pretend to be physicians, and neither are NPs! The AMA keeps using patients as an excuse to say nurses cannot use the title of doctor, but it is interesting that they seem to believe that patients are not capable of making distinctions among anyone with the title of doctor and therefore they must be the ones to “protect the patients” by not preventing nurses to use their own title.

[Hassan]

The controversy about the use of “Doctor” as a title was really surprising when I started my DNP journey, I never knew we really had the option to us this title. In the past I have seen people from various fields of study use the title, though never really felt anyway about it. I do remember the origin of the word literally means to teach in Latin, which I feel is often overlooked. The use of the word meant a learned person, and people respected a person who took the time to max out on all the knowledge they could. The term has literally no indication of being “owned” by medicine, and this seriously needs to be considered in all this back and forth. The knowledge we attain on the road to terminal degrees should be recognized, though I wanna stress ego needs to be left out of it. I am proud to be a nurse, and while I may eventually get my DNP the title of doctor for me is little but a formality. I will admit I am much more laid back with titles and labels personally, but if you feel people should call you doctor I support you! I have always enjoyed the thought of being called an NP, but again that is just me.

[Soh]

Hello Susan,

Thanks for your initial post and raising awareness on this issue. As healthcare is advancing and more nurses are increasing their scope of practice by pursing higher education, this seems to have become an actual issue. I am currently working in a small hospital in southern California. Our NPs here have master degrees so we call them by their first name. However, the teaching hospital I worked in Tennessee had many NPs who had doctorates and we would call them doctors. Although they are not physicians, they have earned the doctorate degree and they should be addressed as such. However, I believe that with the recent advancement of nursing practice, more education for the public is necessary. In the meantime, while in the clinical setting, the nurse should address that she/he should specify their certification as an APRN. This is in order to decrease possible miscommunication with our patients and other unnecessary confusion. This issue emphasizes more on how our nursing organization should be focused on educating the public and the importance of increasing our voice by having more nurses actively involved in professional organizations. Nurses are the largest profession in healthcare and we can have a stronger voice if we have more involvement.

[Dr. Ron]

Hi all,

As it turns out, it is not just NPs affected by this legislation or any related bills. Those who hold PhDs or EdDs may likewise be restricted from using it. What if a PhD does both academic and clinical settings? Should their students stop calling them doctor when they step into a clinical setting?

This has become more of a global Nursing issue rather than just NP (APRN) issue. The ANA and other Nursing organizations need to weigh into this discussion.

~Ron

[Wendy]

In order to fulfill the ever-evolving demands of the healthcare delivery system, the DNP degree was developed. DNPs do not offer the same level of care as doctors, according to American Medical Association Resolution 211, hence they should not be addressed as doctors. According to the resolution, referring to doctors as nurses and other healthcare professionals with PhD degrees could compromise patient safety. APRNs do not want to be mistaken for doctors; they deliver treatment using a nursing paradigm rather than a medical one. Although many people equate the term “doctor” with “physician,” anyone who has obtained a doctorate in any discipline qualifies as a doctor (Chism, 2023). Furthermore, the term “doctor” is not specific to any one academic field. Since they have received a doctoral education and should address people with the title that corresponds to it, DNP graduates should use the term doctor. Members of interprofessional teams should be encouraged to continue their education, not discouraged. The doctorate has become the entry-level or terminal degree for several additional healthcare professions, including pharmacy, physical therapy, and clinical psychology (Bellini & Cusson, 2012). In the near future, it is anticipated that every member of the medical staff will be a doctor, achieving parity among the group of advanced care practitioners (Chism, 2023). Education is the most important strategy for DNPs to address difficulties with their title. By initially being knowledgeable about the DNP degree, DNPs can overcome challenges with the title “doctor”. This is not the time for egoistic title fight, rather it is important as providers to work for better patient outcome through timely care.

[Aiden]

Hello all,

I am currently a DNP student in the PMHNP program in California. I chose to spend almost two more years going for a DNP program instead of an MSN program because I want to achieve the highest education in my specialty and have more autonomy when caring for patients. However, as soon as I began my journey in the program, I realized how restricting and frustrating it is to have the title “doctor” with my name after graduation. It is unreasonable and unfair for the title “doctor” to be used exclusively for “physicians and surgeons” per California law. Nursing students who earn a doctorate should also be allowed to use the term “doctor” accordingly. Nursing is the most trusted profession, and nursing practice has been considered the safest. There are no reasons for us not to be called “doctors” after graduation. I had a chance to speak to one of the DNPs in the hospital where I worked in the past. He shared his thoughts on this particular issue with me, as a “doctorate” is the earned degree for any individual in any profession. The government or the American Medical Association (AMA) should not legislate, govern, or own it exclusively. Many non-physician professions, such as dentists, podiatrists, pharmacists, or Ph.D., have used the term “doctor” for decades without legal issues until the DNPs come into place. It is disrespectful to our nursing profession when the AMA states that patients should only be cared for by the most educated and trained physicians. Patients can understand the differences if we introduce our roles. Patients need to have more advocacy about APRNs, especially DNPs. It is essential to make the public be aware of our profession as other healthcare professions. Medical doctors and surgeons can use the term “physician” exclusively if they want to distinguish themselves from others.

[Dr. Ron]

As an update, the AB 765 (Wood) Physician Medical Specialty Titles is on Hold in committee as of May 18, 2023.

HELD UNDER SUBMISSION — An action taken by a committee when a bill is heard in committee and there is an indication that the author and the committee members want to work on or discuss the bill further, but there is no motion for the bill to progress out of committee” (Leginfo.ca.gov)

[Alyssa]

I am currently a DNP student in California. I think it is so important to be informed on the laws, practice standards, and scope of practice regulations for the state you plan on practicing in. The bill states that is is considered a “misdemeanor for a person who is not licensed as a physician and surgeon under the act, except as specified, to use certain words, letters, and phrases or any other terms that imply that the person is authorized to practice medicine as a physician and surgeon.” I think that many patients hear the word doctor and automatically think physician. In reality there are many health care roles such as DNP or DPT where the individual has earned a doctorate. I think that there needs to be proper education so the public is aware of what a DNP is. I fear that this bill will not promote educational and informed discussions with out patients about the DNP role because everyone will simply just introduce themselves as the nurse practitioner. 

[Gabriela]

Thank you, for bringing up this important issue. The proposed California AB 765 legislation and similar bills in other states, such as Florida’s HB 583, highlight a significant challenge in how we define and recognize professional titles in healthcare. These bills aim to protect patients by ensuring transparency and clarity regarding who is providing their care. However, they also raise concerns about the recognition and respect for advanced degrees earned by nurses and other healthcare professionals.
As a DNP, I understand the importance of clearly communicating our roles and qualifications to patients to avoid any confusion. However, it is also crucial to acknowledge that earning a doctoral degree, whether it be a DNP, PhD, or EdD, represents a significant achievement and expertise in our respective fields. These degrees contribute to the overall quality of healthcare by bringing advanced knowledge, leadership, and a unique perspective to patient care. The key I think is to find a balance that maintains transparency for patients while also respecting the hard work and contributions of non-physician healthcare providers. One potential solution could be to allow the use of the title “doctor” with a clear indication of the professional’s specific field, such as “Doctor of Nursing Practice (DNP)” or “Doctor of Education (EdD),” to avoid any misunderstanding.
It’s important for professional organizations, nursing advocates, and legislators to work together to address these concerns. Engaging in open dialogue and advocating for policies that recognize the value of all healthcare professionals will be essential in navigating this complex issue. Additionally, keeping informed about similar legislation in our own states and participating in advocacy efforts can help ensure that the voices of all healthcare providers are heard.

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