Not everyone who calls themselves “doctor” has the letters “M.D.” behind their name. More and more, the medical professional in the white coat who introduces herself or himself as “Dr.” may not be a physician but a nurse, pharmacist or physical therapist.
Nurses with doctorates can qualify for high-level hospital administrative positions and are seen with more respect. But physicians are, not surprisingly, loathe to give up the title that has been theirs for centuries and not only for matters of prestige. Right now, physicians command higher fees from insurers and also have more authority in prescribing medications. In the days of managed health care, the treatment of patients is increasingly seen as that of a “team,” with a number of specialists and practitioners including nurses — but physicians are arguing that it is they who should lead the team.
That is, who gets called “doctor” is a “proxy for a “larger struggle” about who plays what role in health care today. Physicians say that, due to their training — twice as a long as the six to eight years of collegiate and graduate education required for nurses, pharmacists and physical therapists to earn a doctorate — they alone should diagnose illnesses. Nurses point out that they are more than capable of identifying illnesses. In twenty-states, and in particular in areas where there is a shortage of physicians (the mountain West and northern New England), nurses can practice without a physician’s supervision or collaboration. Nurses have indeed long been lobbying for more states to pass such provisions.
Physicians, for their part, have also been turning to legislative efforts, as the New York Times notes:
A bill proposed in the New York State Senate would bar nurses from advertising themselves as doctors, no matter their degree. A law proposed in Congress would bar people from misrepresenting their education or license to practice. And laws already in effect in Arizona, Delaware and other states forbid nurses, pharmacists and others to use the title “doctor” unless they immediately identify their profession.
Dr. Kathleen Potempa, dean of the University of Michigan School of Nursing and the president of the American Association of Colleges of Nursing, says the new doctoral degree, doctor of nursing practice, is necessary to help nurses stay current at a time when “knowledge is exploding.” She does note that nurses with master’s degrees are as prepared to treat patients as those with doctorates. Studies show that “nurses with master’s level training offer care in many primary care settings that is as good as and sometimes better than care given by physicians.” Nonetheless, there is still no evidence that nurses with a doctoral degree provide better care than those with doctorates.
Photo by timefornurses
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