DNPs are now called "Doctor" in clinical settings?

A have an old friend that completed a DNP in nurse anesthesia. I was shocked to see the following in the medical school’s medical directory near their name:

This doctor can admit and treat patients in the following hospitals:

University of X Hospital.



So now DNPs are being called Doctor in clinical settings? What do you all think about this? I think it’s flat out WRONG but apparently here to stay.

Folks with a doctorate in Psychology have been called “Doctor” in clinical settings for a long time.

Kate

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@lhedian wrote:

Folks with a doctorate in Psychology have been called “Doctor” in clinical settings for a long time.

Kate




As they should be. I also think Pharmacists should be addressed as “Doctor” too.



My problem is by that listing a nurse as a Doctor in the way I saw it done at one particular school, it imples a clinical capability on the same level as a Physician. And that’s not only misleading, it’s not the truth.



This makes me seriously reconsider specializing and leaving the Primary Care areas to the DNPs since it’s seems inevtable that they’re are going to take over this area in time.

If they are already a nurse-practitioner, and took further coursework to get the DNP, the D standing for doctor, I have no problem with calling them doctor, because that’s what they are. That’s at least three years of post grad, and probably four, anyway.



I might point out that many physicians brought back / insist on / prefer being called physician instead of doctor because of the issue you have raised. And it was when pharm schools started graduating doctors of pharmacy that MD’s started having the “doctor AND physician” attitude.

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That could work, MDs/DOs are called Physicians everyoe else Doctor.



So since the Dr title allows everyone to called a doctor, then Physical Therapists, Psychologists, and the woman that runs the clinical lab should be addressed as Doctor too. And while we’re at it, let’s add the hosptial attorney in for good measure, LOL!!

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In my opinion, people who have (rightfully) earned terminal doctoral level degrees should be able to have themselves called or call themselves with the title “doctor.” Besides MD, these terminal degrees include PharmD, JD, PhD, PsyD, etc. If my college professor can be called “Doctor,” why cannot these others people? Of course, the confusion here is that people who do not have medical degrees (MD,DO) will be able to appear to be physicians, and that can cause medical errors, disseminate incorrect information, etc.



Perhaps, one way would be for physicians and surgeons to start calling themselves “Physician” or “Surgeon” as a title. It may sound awkward at first,

but we’ll get used to it if it said enough times.



Another difficult task would be to try to convince the public of this change. Old habits (“the [s:278v8z4z]doctor[/s:278v8z4z] physician will see you now”) are hard to break.

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@ Doc201x,



DNPs do not deceive patients into thinking that they are physicians. They actually tell the patients that they are nurse practitioners—even if they introduce themselves with the ‘doctor’ title, so there is no confusion. There are legal ramifications to pretending to by a physician, and I can’t imagine that any NP would be so reckless as to risk losing his/her license and going to jail over that. When I was an NP student I had to take a whole semester of classes in ethics and the legal aspects of NP practice, especially within the context the Nurse Practice Act in my particular state. Every nurse practitioner program does this.



The physicians who used to belabor these semantics and nomenclatures are finding that they are fighting a battle that no one cares about. As a nurse for many years, what I have observed is that most patients don’t care if its the NP or the PA or the MD who shows up to round on them as long as they get good quality care. The reality of the nature of the relationship between NPs and MDs/DOs isn’t as adversarial as you seem to believe. Most of these NPs that I see doing rounds in acute care have good working relationships with the physicians and PAs. Not only are more physicians hiring NPs to work with them but the hospital group that I work for is actively recruiting more hospitalist NPs, too.

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RGP,



Good to know. However, this is sure to

Satori,



Respectfully, there is no confusion, or medical errors, or dissemination of incorrect information. I think that NPs generally get flack because there are some physicians and medical students still do the old turf war thing. I’m not sure where this is coming from or why people keep saying it, but there is simply no evidence to support these things. In fact, the 2010 report published by the Institute of Medicine about nurse practitioner practice proves exactly the opposite of this. Nurse practitioners do not make more errors or cause more harm to patients than physicians do. And patients do know the difference between a physician and a nurse practitioner. As far as I am aware, the state boards of nursing require that we legally identify ourselves with the ARNP, NP, or APRN title—even if we have a DNP degree. The rationale is simple: nurses with advanced training are still nurses, not physicians. I understand the desire of DNPs to proudly display and use their DNP title, but I don’t believe that any of us nurse practitioners who have DNP degrees would intentionally try to make a patient think that we are physicians. That would be unnecessary because we are practitioners in our own right.



I am a dude who wears a white lab coat to work every day, and a lot of patients call me ‘doctor’. I don’t have a DNP degree, but patients still call me doctor all the time—even when I was a bedside RN. I’ve never had a problem with telling them that I am the nurse or the nurse practitioner. But even though they know, most of the time they still continue to call me ‘doctor’ anyway. Its a sexist thing, I know. But I don’t care. I don’t think that the hospital systems or private practitioner offices that employ nurse practitioners care either. My goal is to educate patients and give them what they need. That’s all. But until I actually do med school I would never misdirect anyone to believe that I am a physician. I can’t tell you how many physicians are discouraging me from going to med school right now. Almost all the ones I work with are telling me not to do it. Many have said that they would have avoided the student loans and the stress if they had thought about nurse practitioner school, but I seriously doubt it. As everyone on this forum knows, there are limitations to being a nurse practitioner, and I want to be able to go whole hog in determining medical care plans for my patients. That’s why I’m here.



I don’t think that it will ever be necessary for physicians to call themselves “physicians” or “surgeons”. Everybody knows who and what they are. In acute care, every practitioner is required to wear an ID with their name and title on it. Nurse practitioners are primarily and very clearly identified as ARNP, or APRN, or NP. If they are DNP, then that may be displayed on their ID as a secondary title. Physicians are clearly identified as MD or DO. As an NP, what one can do is determined by the board of nursing. Even in states that grant independent practice rights to NPs, the NPs are fully cognizant of their limitations within the framework of the laws that guide their practice. Yes, like physicians, we can get sued for the simplest of things, but we know better than to set ourselves up for such lawsuits. And one of the biggest ways to get sued is to lead our patients into thinking that we are physicians.



My NP specialty is family practice, and one of the things that my clinical instructors told us over and over again when I was in school is to always be forthcoming and ethical in practice. So that, even if you make a little mistake your patient will respect your candor enough to forgive you. Another thing I was taught repeatedly is to know my limitations and know when to refer my patient to a collaborating or specialist physician who can better provide the needed care. Obviously, physicians receive more training and are better able to manage certain patients than nurse practitioners. I think its ridiculous that we are even having these discussions. But, for many issues in medicine, an NP or a PA can get the job done just as well, and many physicians employ us to save them some time and stress. NPs are colleagues, not enemies. And after I become a physician my opinion of this won’t change.

As a lawyer, I can tell you that the American Bar Association says we are allowed to use the title of Doctor with the single caveat that we don’t use it in a manner that would confuse parties and cause them to think we are physicians. So while I, a general practitioner could get away with it, I don’t think the hospital’s attorney would, haha.

@eirikr1 wrote:

If they are already a nurse-practitioner, and took further coursework to get the DNP, the D standing for doctor, I have no problem with calling them doctor, because that’s what they are. That’s at least three years of post grad, and probably four, anyway.



I might point out that many physicians brought back / insist on / prefer being called physician instead of doctor because of the issue you have raised. And it was when pharm schools started graduating doctors of pharmacy that MD’s started having the “doctor AND physician” attitude.




The problem is that the extra step required to get that DNP is, in many schools like my local U, pretty much superfluous and only serves the purpose of satisfying the credentialing requirements to maintain status as a doctorate level program. Some schools just restructure the way that NPs progress through the program and add a few extra courses and a nearly insignificant clinical internship. No disrespect to NPs, I work with one and she is a letter writer for my current program application, but a DNP with a 500 hour clinical internship and a few classes in clinical medicine is just not anywhere near the same level as a physician with a 3 year internship and 2 years of doctorate level hard science coursework.



The good NPs can end up on the same level as their physician counterparts, but this takes an entire career to achieve. I work with an outstanding NP who is regularly consulted on cards issues in clinic and sees heart failure patients in addition to her regular pc panel, but she also has over 30 years under her belt as a provider and pushes herself harder than most of the docs she works with. My wife recently saw a “mid-level” practitioner during a derm visit - when I asked her what this person told her about the moles over which she was concerned, my wife replied that the provider was fairly green and told her nothing she couldn’t learn from the Mayo Clinic website…yikes, lets hope those moles aren’t precancerous.



Anecdote aside, NPs/PAs are not doctors and should not be recognized as such, in any setting.

I was posting about DNP, not NP or PA; And not defending / condemning either of the three. I’ve met a few PA’s that were really good and one NP that seemed to be pretty good, too. But I’ve also met two NP’s (and an OD) who spent more time making sure they were treated on the same level as physicians, than spending time making sure they were making competent patient care decisions. (!) It depends on the person, and their drive. I guess the “mid-level provider” nomenclature is the best way to put it. Though, that term was invented and used from the physician side, not the NP side. Most of the lawyers at the facilities I’ve worked see it that way too…

The clinical capabilities of a Nurse Practitioner is the same as a Physician in a clinical setting. NPs do not practice as surgeons. They practice in Primary Care, Behavioral Health, Women’s Health and Emergency Medicine. NPs begin there clinical experience as Nursing Assistants’, Practical Nurses’ or Registered Nurses’ then continue on to become NPs. Physicians’ do not begin clinical practice for 6 years. Their undergraduate can be in Biology or Pre-med which DOES NOT include clinical experience. Nurses begin patient care years before Physicians’ see their first patient. Yes, they are equal to a Physician and deserve the SAME respect. NPs are not less than a Physician in any way shape or form. Nurses treat the whole person not merely symptoms like Physicians’. Nurses learn to advocate for their patient’s which is why NPs generally have better bedside manner than most Physicians’.

This is absolutely untrue. In almost all clinical specialties in most states there needs to be a supervisory PHYSICIAN to ok the plan and prescriptions. This is for good reason - ARNPs do not have the same education and clinical training as their physician counterparts. Literally look at the curriculum of both tracks. I say this as an RN that seriously considered the ARNP/CRNA route.

The problem with addressing ARNPs as “doctor” in the clinical setting is that it is confusing to patients. They often do not understand that there is a difference between “doctor” and “physician”. In the clinical setting “Dr.” is strictly used to address a physician. Patients need to understand what clinical provider they are speaking with and muddying the waters by calling mid levels “doctor” makes this harder for them.

People need to let go of egos and embrace the fact that there is a significant difference between a mid level and a physician. The quantifiable difference is in the required education and clinical hours. When the AANP decides they want to make a more uniform education that focuses more on clinical practice than “nursing theory”, then we can revisit the discussion.

The reality is Physician’s’ have dominated the clinical setting for centuries. This is the origin of the ego. Nurse’s have consistently been diminished by Physician’s throughout the centuries. Now Nurse’s have the ability to stand on their own without Physician’s—the “ego” of the Physician is in jeopardy. The laws offer support to the entity or persons’ of power. The laws do not not necessarily support what is right. The Medical Board has a lot of influence and power which is why it has been a battle for Nurse Practitioners who earn their Doctorate’s to receive the recognition and respect their deserve. It has NOTHING to do with lack of training or clinical experience. That is the narrative Physician’s tell to keep their ego’s in tact. Nurse’s are trained in the clinical setting during the first semester of their program while Physician’s maintain a classroom setting for the first 6 years without having had one real life clinical experience. Patient’s have better care experience overall with NPs because Nurse’s are trained to advocate for patient’s versus Physician’s are training to treat the symptoms and not the person. The real concern for Physician’s is they will lose money once patient’s realize that a DNP is no less than an MD. That is the real truth at hand.

I’m a nurse. I understand the curriculum.

The fact is that bedside experience =/= a good clinician. You need a combination of medical knowledge and hands on experience. This is why the road to becoming a physician contains a really heavy dose of both of these things.

Physicians have “six years without having one real life clinical experience”? Are you joking? Clinical experience is basically a requirement to have your application to medical school taken seriously at all. CNAs, RNs, NPs, RTs, EMTs, and Paramedics all apply to medical school.

Also I’m assuming you’re including the four years of undergrad in your “six years” it takes before a physician gets to clinical learning. Do you think all nursing students get clinical training in the first semester of their four year program? This isn’t true at all. MAYBE you get clinical LAB instruction with dummies.

Yeah med students don’t start their rotations till 3rd year - but that’s because they are downloading an entire encyclopedia of medical knowledge for the first two years of their training. Nurses don’t have to know HALF of that material. Nursing education is so bloated with bullshit nursing theory/diagnosis/care plans that there isn’t room for remotely comparable medical education. Also - foundational sciences aren’t even required! I didn’t even have to take Biology or Gen Chem for my nursing degree! Micro and a Chem for liberal arts baby. I only started taking these courses when I wanted to apply to med school. These are absolutely essential to understanding the basics of the health sciences.

Nurses and physicians have important but distinctly different roles. Physicians have extensive medical knowledge and many years of clinical training before becoming attendings. Nursing education doesn’t even come close. Let’s not try and make them seem equal when they are so obviously not.

You are a Nurse. I don’t believe that statement at all. A Nurse would never disrespect their profession the way you have in this forum. I stand to what I stated DNPs are equal to an MD in a clinical setting. I’ve observed senior Nurses’ guide Attendings’ on many occasions towards best practices for patients’. DNPs have extensive clinical experience while having to prepare for rigorous academic content during the same semester. Either way we will agree to disagree. DNPs are here to stay. More and more states will continue to recognize DNPs as equals and will allow them to practice autonomously.

RN9406898. State of Florida. Verify for yourself. What are your credentials?

It’s not “disrespecting my profession.” It’s an honest assessment of the differences between a nurse and physician.

Please look up the curriculum differences and clinical hour requirements to educate yourself. FNPs only require 500-1000 supervised clinical hours for practice. That’s less than a year of full time work. Physicians get 10,000-20,000 hours of supervised clinical work before becoming attendings.

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That’s not entirely true - NPs and CRNAs can practice independently, depending on their state of practices. PAs, on the other hand, cannot.