Practice Management Alert

It’s easy to let certain linguistic quirks bleed into daily use, but language can really matter in the workplace, especially when the workplace is a medical practice.

In fact, 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. Now, at least one lawsuit is making its way through the courts, and healthcare industry stakeholders across the country are taking notice and weighing in.

Delve Into Some Context

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, 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, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California.

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,” said Jesse M. Ehrenfeld, MD, MPH, president of the American Medical Association in a press release.

Consider Published Study Findings

The AMA points to evidence that physician-led care is more valuable to patients than that of Advanced Practice Providers (APPs), including an article in the journal Mississippi Frontline pointing to the ways in which patients might receive better care from physicians.

“After nearly 10 years of data collection on over 300 physicians and 150 APPs, with over 208,000 patient response surveys, along with cost data on over 33,000 unique Medicare beneficiaries, the results are consistent and clear: By allowing APPs to function with independent panels under physician supervision, we failed to meet our goals in the primary care setting of providing patients with equivalent value-based experience,” said Dr. Bryan N. Batson, Dr. Samual N. Crosby, and Dr. John M. Fitzpatrick in their article “Targeting Value-based Care with Physician-led Care Teams.”

The doctors said that physicians performed better on 9 out of 10 quality measures, including double-digit differences for flu and pneumonia vaccination rates — and that the total difference of cost in care per member per month was $119 after adjustments for patient condition complexity.

You can read the study here, >https://ejournal.msmaonline.com/publication/?m=63060&i=735364&p=20&ver=html5.