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.
We’ve taken our 14-year-old son Charlie to see a nurse practitioner at a multi-physician practice for years. We initially had some of the physicians oversee Charlie’s care but then, after a chance appointment with the nurse practitioner, now we always request her. She has been fabulous, giving Charlie shots, easily using her stethoscope, examining his ears and more. (Charlie is hyper-sensitive to being touched so performing these basic aspects of a physical examination can be challenging.) At Charlie’s neurologist’s office, a psychiatric nurse works closely in tandem with the doctor. The neurologist is excellent and a careful listener and has fine-tuned Charlie’s medications to a combination that is really helping him. But the nurse has an attentiveness to certain details and to some of the day-to-day realities of caring for Charlie (also because her daughter was developmentally disabled) that has been crucial in figuring out Charlie’s neurological issues.
Just to add one more complication to the question of who should or ought to be called “doctor”: “Dr. Chew” is how my students address me. I’m a professor of Classics at a small Jesuit college in New Jersey (which has started to offer a doctorate in nursing practice) and, while I really prefer being called “Professor,” the convention is to use “Doctor,” in part because some of those teaching at my school do not have a doctorate. Though I’ve been “Dr. Chew” for years, I still feel that someone being called that really should be wearing a white coat and have a stethoscope.
Should only physicians be called “doctor”? Or is it time to expand the definition of who can be called that title?
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Photo by timefornurses