Home Health & Hospice Week

Watch out: Licensing boards could be paying more attention.

If your agency employs DNPs, you may want to pay attention to some legal action on how you refer to them.

Several clinicians have been fined thousands of dollars for using the honorific “doctor” despite not having doctor of medicine (MD) or doctor of osteopathic medicine (DO) degrees.

Background: The honorific “doctor” is used to address people who have terminal degrees in their respective fields, especially doctor of medicine in dentistry or doctor of dental medicine (DMD), doctor of dental surgery (DDS), doctor of veterinary medicine (DVM), veterinariae medicinae doctoris (VMD) MD, and DO degrees. People who have terminal degrees in other fields, like a juris doctor (JD) degree or doctor of philosophy (Ph.D.) or doctor of engineering (D.Eng) may or may not use the honorific “doctor” in their respective professional settings.

In a healthcare setting, the honorific “doctor” has evolved to imply that the person thus addressed has a MD or DO degree and the requisite clinical expertise. But terminal degrees exist for other healthcare professionals, like doctorate of nursing practice (DNP).

Industry stakeholders like the Medical Board of California are worried that people with DNP degrees who use the title “doctor” when advertising their services as clinicians are misleading patients.

Sarah Erny, a DNP, was referred to as “Dr. Sarah” by patients and colleagues but caught the ire of the Medical Board of California, the San Luis Obispo County District Attorney’s Office (via California’s truth in advertising law), and the Board of Registered Nursing. She has since been fined $20,000 and may lose her nursing license, say Caleb Trotter and Donna Matias, attorneys with the Pacific Legal Foundation. She moved her practice out of state so she could continue working. Two other DNPs joined Erny in a lawsuit claiming that their first amendment rights have been violated; their attorneys point out that people who have attained MD or DO degrees don’t have “Dr.” or “doctor” on their degree certificates.

While state medical boards may vary their enforcement, this issue may be more on licensing boards’ radars now that there’s a case making its way through the courts.

Physicians Aren’t Excited About Sharing Titles

Many stakeholders in the healthcare industry think “doctor” should be reserved for people with MD or DO degrees, saying that patients have particular trust in doctors due to their education and clinical experience, and letting others use the honorific devalues the title and misleads patients.

“The problem here is the clinical use of the term that’s intentionally line-blurring and not ethical. There’s a vast difference in training and expertise between an MD or DO and a nurse practitioner and [physician assistant or physician associate] PA and anyone who says they have a Ph.D. in something that’s not medicine,” says Terry Fletcher of Terry Fletcher Consulting Inc. and Code Cast, in Laguna Niguel, Calif.

One current advocacy goal of the American Medical Association (AMA) is protecting physicians from “scope creep,” which it says threatens patient safety and physician livelihoods. “Patients want and deserve clarity and transparency in who is providing their care as there are immense differences in the education, training, and qualifications among health care professionals,” says Jesse M. Ehrenfeld, president of the American Medical Association, in a press release.

In other words: Expect pushback at best and fines or licensing issues at worst if your DNPs go by “Dr.,” experts suggest.