Truth in advertising: When is a doctor really a doctor?

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

In an emergency, the first question people often ask is: “Is there a doctor in the house?” When you have a medical problem, the best advice is, “Ask your doctor.”  Most people automatically assume that “doctor” in this context refers to a physician with a medical degree.

Dentists, chiropractors, and podiatrists are well-educated professionals who may also be addressed as “doctor,” but there’s no question that their training and specialization is different.

Today, a wide variety of other health care professionals obtain doctorate degrees in their respective fields — nurses, pharmacists, physical therapists and audiologists, to name a few.

So how is a patient to know if people who introduce themselves as “doctor” are actually physicians?  It can be confusing, and it’s certainly understandable if the public has a hard time keeping track of the differences between the different types of education and degrees.

But the public deserves to know which of these different “doctors” are actually physicians who went to medical school, obtained medical degrees, and are licensed to practice medicine.  It’s a matter of truth in advertising.

That’s why more and more states are adopting or considering “truth and transparency” legislation, requiring health care workers to identify their professional training clearly to patients.  Many hospitals now require name badges with the appropriate designation:  physician, nurse, pharmacist, physical therapist, etc.  The intent is simple: Patients and families should know who is taking care of them.

This isn’t a matter of disrespect for non-physicians.  As a child, I was very much aware of my parents’ respect for our dentist, my orthodontist, and my mother’s chiropractor.  However, even without the advantage of a college education, there was never any question that when they spoke about “the doctor,” they meant our physicians.

Who’s flying the plane?

When we board a plane, we may not know the exact details of the pilot’s training or total hours of flight experience.  But we trust that the designation of “captain” represents the senior pilot on board and the highest level of training available.  In aviation, the FAA mandates specific standards.  There are no other flying-related professions that offer their own training programs to achieve their own designation as “pilot.” This is unlike the use of the term “doctor” in health care.  From the first-time flyer to the most sophisticated traveler, we all trust that there is only one pilot and that he or she is in charge of the plane.

The public should be able to have faith in the fact that their physicians go through an intense four years of premedical courses in college and earn admission to an accredited medical school.  After that, they begin three to seven years of residency training to become fully qualified physicians in the specialty they choose.  Only after successful completion of residency do they begin to care for patients independently.

In the last 20 years, the profession of nursing has created a new degree, the doctor of nursing practice (DNP) degree.  This is distinct from the research-focused PhD in nursing.  The DNP is a clinical practice degree that can be earned in three years after college.  An advanced practice registered nurse (APRN) who already holds a master’s degree may earn the DNP degree with one more year of training.

The American Association of Colleges of Nursing (AACN) has established the goal that all advanced practice nurses (nurse practitioners, clinical nurse specialists, nurse-midwives and nurse anesthetists) will obtain the DNP degree.  According to a statement from the AACN, “The title of doctor is common to many disciplines and is not the domain of any one health profession.  Many APRNs currently hold doctoral degrees and are addressed as doctors.” Even at their current master’s level of training they state that “APRN’S are prepared in master’s degree programs that often carry a credit load equivalent to doctoral degrees in other health professions.”

Health care consumers, families, and patients deserve to understand clearly that the word “doctor” today may mean something entirely different from what they assumed.   The APRN who uses the title “doctor” may not even wish to consult with a physician or work within a health care team, feeling adequately qualified to practice independently. Most physicians, on the other hand, recognize the merits of the health care team concept and appreciate the value of working with nurses, physician assistants, and other team members.

Protecting the patient-physician relationship

Patients may be caught in the middle of these trends, assuming that their doctor is a physician, and trusting that the health care system is protecting them with physician-led care.  They deserve to understand that the simpler days of the past — when your doctor was your physician — are gone. In health care, should everyone be allowed to use the title “doctor?”  In the future, you may not be able to count on “the practice of medicine” because it could become “the practice of health care,” where all health care professionals rightly or wrongly are considered equal.

A few years ago, when my daughter was in medical school, she and other women in her class wore T-shirts with this message:  “Becoming the doctor your mother always wanted you to marry.”  She was justifiably proud of all she had accomplished in order to become a medical student and ready for the work it would take to become a fully-fledged physician.

It’s been said before that everyone wants to practice medicine, but no one wants to go to medical school.  Luckily, that’s not entirely true.  There are still thousands of students every year eager to put in the years of study to become physicians.  Their goal is to make sure that the patient-physician relationship thrives today and in the future.

Daniel Campos is an anesthesiologist.

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