There’s a doctor in the house, and maybe also a physician: a view from osteopathic medicine

The Wall Street Journal’s decision to publish an attack on Dr. Jill Biden’s right to be called “doctor” has appropriately unleashed a firestorm. According to Joseph Epstein, the editorial’s author, Biden should drop the title because she isn’t what people often think of when they hear the word “doctor,” namely a physician. For Epstein, ‘Dr. Jill Biden’ sounds and feels fraudulent, not to say a touch comic.” The basis of his argument is that many people don’t know the difference between a doctor and a physician, so Biden should lose the doctor.

Naming in the health professions

Epstein’s attack’s sexist nature is well documented; go read Monica Hesse’s brilliant piece in The Washington Post for a deeper sense of the gender politics at work in the argument. Nonetheless, we think we can use Epstein to think a bit more clearly about the politics of naming within the health professions.

Epstein, of course, is not a physician. He holds a bachelor’s degree and an honorary – in other words, not real – doctorate. But his key contention links up with a familiar story.

Physicians have slowly transitioned over the last few centuries from a disorganized group of men, mostly drawn from the patrician class and often holding only a high school diploma, into an elite class of respected professionals. The less well-known part of the story is that this newfound legitimacy was often attained by devaluing others.

One of the uglier parts of this history is physicians’ strategy of consolidating their power by targeting vulnerable groups. Historians have documented the attack on midwives to claim the birthing process as physicians’ own newly “medicalized” domain. So-called “midlevel” practitioners or “physician extenders,” including nurses, physician assistants, and nurse practitioners, have also endured incredible disrespect along the way.

What is a doctor?

On social media and on opinion pages, it was good to see so many physicians hurry to Dr. Biden’s defense. Some acknowledged the historical fact that PhDs were “doctors” about six hundred years before physicians were, and are, in every sense, “doctors.” While Biden holds a non-PhD doctor of education, an EdD, her degree is part of the legacy that PhDs began.

It is also true that there are a lot of doctors in American society, and it can be confusing if one takes “doctor” to mean little more than “physician.” There are doctors of medicine (MDs), of course, but also doctors of philosophy (PhD), doctors of nurse practice (DNP), and doctors of chiropractic (DC) — and this is just the beginning. As has been noted, doctor just means “teacher” if one points to its Latin origins. A few commentators have noted that though American lawyers earn their Juris Doctors, or JDs, it is not accepted practice to call lawyers “doctor.” But JDs could lay claim to that title if they wanted. The point: Just because people misunderstand the meaning of the word does not mean that one should denigrate those who have earned the title.

What osteopathic medicine teaches us

As employees at an osteopathic medical college, we are well-versed in attempts to undermine credentials. Osteopathic medical schools train physicians who earn their Doctor of Osteopathy (DO) degree, which some refer to as a Doctor of Osteopathic Medicine. In our professional work, we have front row seats to the politics of naming, especially as concerns questions about MDs and DOs. When is a doctor a real doctor?

The history of the osteopathic profession forces the issue in unique ways. While many doctorates have long bestowed upon their recipients the right to be called “doctor,” osteopathic medicine’s roots are, in fact, grounded in a resistance by DOs themselves to the idea that they were doctors at all. Early osteopaths rejected the idea that what they practice should rightly be understood as “medicine,” a term that had a particular and often pejorative meaning at the osteopathic profession’s founding in the 19th century. At the time when osteopathy was founded, in fact, “DO” referred to Diplomate of Osteopathy instead of doctor. The founder of osteopathic medicine, Dr. A.T. Still – an MD before he was the first DO – seemed to care less about the title than he did the mode of care that osteopathy promised to deliver. Dr. Still, it should be noted, was ahead of his time, and ahead of the MDs, in insisting that women be allowed to attend medical school alongside the men.

For a while, the DOs were happy to remain in the iconoclastic arena they had created. Over time, however, the osteopathic profession has tilted the other way, working hard to earn recognition as physicians with the same training and skillset as MDs. With that came discrimination; in the eyes of many MDs, DOs were inferior and were not afforded entry into medical assembly such as hospitals and membership organizations.

Although DOs and MDs have achieved amicable parity, challenges are not yet a thing of the past. In the wake of the Olympic sexual abuse scandal involving Dr. Larry Nassar, DO, an editorial in the LA Times declared that Nassar “was not a doctor,” a point that the author, Virginia Heffernan made not as a commentary on Nassar’s crimes, but his training as a DO. More recently, when it became widely known that President Trump’s physician, Dr. Sean Conley, DO, was not an MD, the Trump critic George Conway (husband to Trump aide Kellyanne Conway) launched a series of high-profile Twitter bromides against the idea that the president’s physician could be anything other than an MD (Biden’s personal physician, incidentally, is also a DO, which further complicates the title of Epstein’s article). Unfortunately, when an MD commits a crime, it’s reported as just another bad physician doing a bad thing. When a DO commits a crime, a whole profession is besmirched.

Naming, respect, and power

The complexity of naming and its resultant inclusion and exclusion is further amplified when one realizes that white men in medicine can easily go by their first names without their authority or skills being called into question.  For women and people of color, this is not so simple.  Epstein’s suggestion that we might just call Dr. Biden “kiddo” is a reminder of this. It’s worth noticing the many dimensions of power at work in what we call others.

In its broadest strokes, the rule is pretty simple: If you have a doctorate, you are a doctor, and if you are a physician with a doctorate, you are a physician. As with all things, using language just a bit more carefully, and learning a bit of history, can yield dividends. The transparent bad faith of Epstein’s attacks on Dr. Biden could provide an opportunity to think more deeply about the relationship between credentials, training, naming, and respect.

Dan Skinner is a health policy professor. Stevan Walkowski is an osteopathic physician.

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