DNPs are now called "Doctor" in clinical settings?

Nontraditional Premed Discussion
22

I’m confused, was the attending new to the patient population or the hospital, are you talking about students? I don’t have any doubts that a new attending would take orientation from a senior nurse, that happens all the time. There is no one that knows a hospital and all of its BS more than a senior nurse. If you’re talking about an attending who had been there for years, and wasn’t able to provide to the standard of care, and nurses had to keep saving their butts, they should be reported before they hurt someone.

At the end of the day, there are bad apples in every bunch that need to be gotten rid of because they spoil a lot. There is too much medicine to go around to bicker about it. An NP or extra physician seeing patients for whatever, isn’t going to magically make the provider shortage go away. It’s not about “respect” or “ego” these are just narcissistic words. The more hands helping people get better and elevating health, the better. As long as we aren’t giving in to misrepresentation, I don’t care.

23

There is no misrepresentation. That is the narrative the community of Physician’s have chosen to portray when attempting to verbally minimize a DNPs credentials and experience. A DNP does not need a Physician to oversee his or her actions. They have had years of patient experience prior to obtaining their doctorate. They do not deserve to be belittled by the medical community because a Physician is not better than a DNP simply because they are a Physician. The community of Physicians’ have chosen to make an issue and the Nursing community has responded. Covid brought to light what the Nursing community has known all along; Nurse Practitioners can practice autonomously in a safe and competent way. More and more states are beginning to recognize Nurse Practitioners as autonomous providers in the medical community. This change is occurring despite the negative narrative and malarkey from Physicians’ portraying DNPs as unqualified to practice without their oversight. It simply comes down to monetary loss for Physicians and that is the real reason. It has nothing to do with patient safety.

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24

I haven’t seen this in practice anywhere, at least not in any serious ways in Georgia or California (small sample sure). Is this an internet thing? Are MDs making toxic “review” publications?

I don’t agree with this in secondary or tertiary care situations because the dynamics of care get far more complicated and generally need specialists anyway. I do absolutely agree with this in primary care. There is no reason DNPs or PAs cannot do primary care. It’s not like they’re going to be taking jobs from physicians anyway, I have no idea why anyone would be precious about this.

Again, we have a primary care provider shortage, we’re not losing anything by having more DNPs or PAs doing primary care. If somehow the market gets saturated with providers we can develop ways of getting these folks into positions where they can go through rotations or do the USMLE stuff on a fast track, so we can provide patients with the best of the best of the best in training. We just aren’t in that world right now and won’t be for a very very very long time (not in my lifetime or yours).

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25

lol okay. so ARNPs can just run the show and we can leave physicians at the door then. When you have a complex medical issue arise I hope you stick to your guns and see an ARNP instead of a physician. Heck, why don’t ARNPs just perform surgery?

Why are you even on a med school forum? The fact that you can’t acknowledge the difference in expertise between physicians and nurses really makes me wonder what even brought you here to this forum.

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26

I’ve worked with many doctors who are PA’s, NP’s, professors, administrators, etc. If you have a doctorate you have a doctorate. Period.

If the same energy that went into figuring out who “should and should not be called doctor”, went into actually solving real issues like healthcare affordability, access to care, and insurance disparities, the world would be a much better place.

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27

Agreed. My psych DNP is very knowledgeable about psych meds (especially genetics as she was the first to suggest genetic testing after years of not responding to meds) and cares about me as a person, not just meds. Almost all of the psychiatrists I saw before her are nowhere nearly as great, and she’s helped me way more than they did

28

Agreed, a doctorate is a doctorate regardless of field of study

29

This is such a freezing cold take… “Doctor” is an honorary title in some settings, but in a clinical setting “doctor” is a very specific role on a healthcare team.

For example, I called all my college professors, who hold PhD’s, “Dr. X” in the classroom. However, my English professor, when asked her job, would never say “I am a doctor”. She would say “I am a professor”.

The same thing goes in healthcare. While a DNP could theoretically be called “Dr. X” and rightfully should be in academic settings, they are not “a doctor”, instead they are a nurse practitioner. In the general public’s mind, when they’re in a clinical setting, doctor=physician. For an NP to introduce themselves as “Dr. X” without any qualifiers to a patient, it’s disingenuous and intentionally misleading.

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30

To refer to a doctorate degree as an “honorary title” is perhaps a bit misleading as in higher education some universities do bestow “honorary degrees.” However, unlike actual degrees an honorary degree holds no value in conveying real world expertise. On the other hand, anyone who holds a doctorate of any kind (Ph.D, Psy.D, DNP, Ed.D., JD, MD, DO, DVM, etc.) has worked their butt off to become an expert in their field and has rightfully earned the title of “Dr. X.”

However, knowledge is specialized and so titles should really only be used when addressing someone within their domain of expertise. For instance, I wouldn’t call any of my college professors “Dr. X” within a hospital setting. But neither would I refer to my physician as “Dr. X” if he were teaching my college English class. In both instances, the title is inappropriate as it misleads others to erroneously believe that the person is an expert in a field that they are not.

As @SCBorn points out, in healthcare settings, it becomes confusing because the term “Doctor” also refers to the role/position of a physician. Honestly, the easiest way to avoid this confusion is to just completely replace the term “doctor” with “physician” when referring to the role/position. I think it is totally fair for DNPs to tell patients “I have a doctorate” but they should also introduce their role as nurse practitioners as to accurately convey their training path.

More philosophically, to reference Dr. Adam Rodman (Bedside Rounds podcast, Ep. 61), the argument of “who gets to use the term ‘doctor’?” has been raging for over a millennia dating all the way to the medieval term “leech” and is fundamentally about “which group of people gets to use language to wield professional power?”

To prohibit DNPs from using the term “doctor” at all (even when referring to their credentials as the OP suggested) serves more to perpetuate the hierarchy of medicine than anything else. And, while it is important to distinguish between roles (because training is different) to subjugate an entire profession as “inferior” by denying them the ability to acknowledge their doctorate level credentials is problematic for healthcare teams, and ultimately patient care. To borrow a racing analogy, lets imagine a physician is a race car driver, while DNPs are the pit crew. On race day, a driver cannot win without the pit crew and likewise the pit crew cannot win without the driver. They succeed or fail as a team. The same is true in medicine. We all perform different, but equally important roles for the sake of helping patients. At the end of the day, we need to recognize that while DNPs are not physicians and shouldn’t represent themselves as such, they are still highly trained and experienced healthcare providers who provide immense value to their patients and workplaces and as such deserve a lot of respect.

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31

I love these threads, I wanna get some :popcorn: and watch the :fireworks:.

But in all seriousness…. Nurses and Physicians are complementary professions. We are dependent on each other, and there’s nothing wrong with that. I love my nurse collegues. The NPs I work with are amazing and very good at what they do, they also know when they don’t know something. I also know when to admit when I don’t know something , our professions require that we are able to identify that and then figure stuff out! Our curriculums are very different, nothing wrong with it, but it is what it is. Really the problem comes down to personality flaws, insecure people will act insecure, physician’s and nurses, and that makes interacting with that person difficult. When people are confident in themselves these posturing actions aren’t necessary. Anyway my 2 cents….

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32

Absolutely and unequivocally, INCORRECT.

IMO, DNPscshould introduce themselves as follows in clinical settings: “Hi I’m Dr. X, and I’m the NURSE PRACTITIONER on your healthcare team.

Or use Noctor, but definitely NOT doctor.

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33

This is a fun thread, holy cow. Full disclaimer, nurse here.

For those that say that DNPs have identical clinical capabilities to a physician, I’m sorry but what? That’s like saying that graphic designers at Pixar are equivalent to Leonardo da Vinci. Are they both seriously gifted? Absolutely. Nobody is saying that DNPs aren’t phenomenal at their role and generally a blessing to have on a care team. But you can’t compare apples to oranges. DNPs simply do not know what physicians know. Period. If you think otherwise, you are either delusional or at peak dunning kruger, and either way you are likely a liability to patient safety.

To answer the thread’s prompt, I think that in literally any setting outside of a clinical one calling oneself “doctor” is absolutely appropriate. You earned the degree, you deserve that recognition. However, in a clinical setting, people don’t think of PhD’s or other forms of non-medical doctor as a primary or even secondary role in their care; when they hear “doctor”, they think physician. Hell, in a febrile daze I may even mischaracterize a DNP who introduces themselves as doctor as my physician. Now, that is not to say that they can’t stipulate “NP” at the end of the introductions. But, why? Why actively confuse a patient then take more words stipulating who you actually are - I feel like the only real reason is ego, which is sad.

If you want to be called doctor in a hospital setting BY PATIENTS, go to med school (however most physicians I honestly enjoy talking to hate it when peers call them “dr. x”, it’s “just x”). If you want to continue a nursing career and become a top level nurse provider, become a DNP. Can DNPs ask that their peers call them doctor? Absolutely appropriate in my book. Just not patients. My two cents.

34

I didn’t say “at all“, I specifically referred to CLINICAL SETTINGS.

I know reading your own narrative into the comments of others makes the discuss more fun, but let’s not.

35

To be fair, the specification of “clinical settings” does nothing to resolve confusion around title versus role/position. Unlike PhDs or other doctorates, DNPs and MD/DOs field of expertise is the clinical setting.

Having said that, I recognize your point and agree that I shouldn’t have assumed something you didn’t explicitly say. I’m sorry for that.

In fact, based on your later post, I think we actually agree on this topic.

I totally agree with this. It allows the DNP recognition for the hard work they put into earning their title, but also clearly distinguishes their role as an NP, not a physician.

36

in clinical settings for a long time.

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37

I’m so so late to this thread but @doc201x I think you’re worried about something you’re not a part of. Especially since you don’t practice or have true clinical experience. I admire your dream of becoming an MD/PHD. But until you have either one of those titles I don’t think you can criticize the DNP profession and what they do. DNP NP, PA, MD, DO PharmD we are all here to provide the best care to our patients within our scope. Priority should always be the patient. Instead of wasting time on petty turf war or ego war.

P.S and last I checked you were still only taking gen education “what you call pre-med classes in 2020 in your blogs”

38

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39

You are focusing on the wrong question, which is mostly brought on via the bias of your culture (if you are a MD/DO, or med student).

A nurse is not a physician and a physician is not a nurse.

A doctorate degree can be earned in many medical fields: veterinarian, pharmacist, therpist, dentist, optometrist… and they all use the title “Dr.” in a professional setting.

The ONLY medical profession that can earn a doctorate degree but is discredited is the nursing profession.

So the more correct question to ask is, “why is that”?

Is it because it was predominantly populated by women? Afterall, women had to fight several times harder than men to get into med school…

Is it because DOs are also considered physicians? They lost that fight so now they are like, no more!?

Why is it acceptable to call Opthalmotrists, Dentist, and Therapist “doctor”?

The bigger problem is using the term “doctor”. I would think of all of these struggles, physicians would like to be held to their prestigious “Physician” title, one that nobody can share versus a degree that hundreds of other professions now share. So why go by a degree title that is shared and not Physician?

(Hint: its because the title of the degree earned is shortened to Dr. and is pronounced “doctor”. Therefore anybody that earns a doctorate can be titled Dr. and called “doctor XYZ”… and Physicians think they are the only ones that get doctorates…but shhh you didnt hear it from me :wink: )

Ultimately what it comes down to is, a nurse can obtain a “doctorate of nursing” same as a “doctorate of medicine, pharmacy, or physical therapy”… and the shorter title is “Dr.”… So addressing Dr. to a degreed nurse should not have a double standard.

Ill give you more food for thought too and address some less thought through posts here…

  1. “nurses just want it all”… What? How dare somebody want to go back to school and better themselves to help others!

I mean, its literally the definition of what a nurse is. The advocate for the patient. Nurses were literally started to ensure the physician didnt kill the patient by making sure they maintained hygienic techniques (youre welcome) and didnt experiment on patients (ergo the start of therapeutic communicate and patient education. Learning everything the physician does to be able to put it in words a patient can understand so the patient can give informed consent, ask questions, and give an educated response… again, youre welcome).

  1. “Physicians do more school and clinical hours”… Most definitely! There is absolutely a breakdown the advanced nursing degree needs to address. Nurses do need more science-based book work like physicians get! And more access to residency programs after graduation since nurses have a larger population than physicians.

This is a loaded one so bare with me… First, its already SUCH a research project to accuratly document the number of patient contact hours and clinical time to provide an accurate ratio representation because physicians are at such a disadvantage. While nurses are able to log thousands of direct care hours with an undergrad degree, physicians are not.

Side note: When there is a worker supply shortage and a college degree for the same field is optional vs on the job training- managers are often asked, would you rather have somebody with 4 years experience or 4 years of college/degree? They often take the one with experience, which at this point would be the nurse since the physician is still in a classroom studying books.

Second, residency. Nurses do have an undergrad residency option AND an additional graduate residency option. So it is possible to log as much. They just have the option… like a physician… hummm interesting.

Third and most important… if a physician wants so desperately to be distinguished as different from a Nurse Practitioner… why do they insist on overseeing the NPs work or training them to be like a physician, or following the same procedures? It seems more like the physicians are the ones that want the NP to be more like them.

Again, a nurse is not a physician and a physician is not a nurse

40

Physicians should be called physicians, not doctors.

The argument they are teaching med students is to advicate that midlevels (PA/NPs) should not be called “doctors” because its confusing.

Actually… now that I type this out, I agree.

It is entirely confusing for anybody to use the term “doctor” because it is confusing.

Physicians are physicians
Nurses are Practitioners
Physian Assistants are…another discussion (I genuinely dont understand how they can change their title or be independent. Its literally in their name… physician ASSISTANT but again, another discussion).