The debate surrounding the use of the title “doctor” by Doctor of Nursing Practice (DNP) degree holders has recently surfaced in Florida, igniting discussions within the healthcare community and beyond. Florida legislators recently proposed legislation aimed at restricting advanced practice nurses with doctorates from using the honorific “doctor,” sparking a wave of controversy and highlighting the ongoing tension between different healthcare professionals. This move, framed by proponents as a “patient empowerment bill,” suggested that nurses with doctoral degrees identifying themselves as “Dr. Smith, nurse practitioner” could face disciplinary action. Fortunately, Governor Ron DeSantis vetoed this bill, preventing it from becoming law. However, this legislative attempt underscores a recurring sentiment among some physicians and lawmakers who believe that allowing doctorally prepared nurses to use the title “doctor” causes patient confusion. This article delves into the specifics of Florida law, the broader context of this debate, and why restricting the title “doctor” for DNPs is a misguided approach in modern healthcare.
The controversy isn’t isolated to Florida. In a 2022 article published in Missouri Medicine, Dr. Gary Gaddis argued that when advanced practice nurses request to be addressed as “doctor,” it “misleads the patient and perpetrates a fraud which defies their patient’s trust.” These viewpoints, while present, often overlook the historical context of the term “doctor” and the rigorous academic journey undertaken by professionals earning a DNP degree.
To understand the current contention, it’s crucial to revisit the origins of the title “doctor” itself. The term “doctor” originates from the Latin word “docere,” meaning “to teach.” Historically, it was first used in the 1300s to denote scholars, which is why individuals holding a Doctor of Philosophy (Ph.D.) are also addressed as “doctors.” For centuries, professions beyond medicine have utilized this honorific. It wasn’t until the 17th century that medical schools began associating “doctor” with their graduates as a mark of respect and prestige. In the United States, the Doctor of Medicine (M.D.) degree emerged as an early form of the professional doctorate, a degree focused on a specific vocation such as medicine, dentistry, pharmacy, physical therapy, and notably, nursing practice, in contrast to the research-oriented and academically intensive Ph.D. This shift from the Bachelor of Medicine, Bachelor of Surgery (MBBS) – still prevalent in many regions formerly under British rule – contributed to the common usage of “doctor” in a medical context.
Modern efforts by some physicians to monopolize the title “doctor” and label themselves as “the real doctor” diminish the scholarly achievements and extensive experience of other doctoral degree holders. Individuals with any doctoral degree, be it an M.D., Doctor of Osteopathic Medicine (D.O.), DNP, Ph.D., Doctor of Physical Therapy (DPT), Doctor of Optometry (O.D.), Doctor of Audiology (AuD), Doctor of Dental Surgery (DDS), Doctor of Podiatric Medicine (DPM), or Doctor of Pharmacy (PharmD), have dedicated significant years to advanced education and are entitled to use the honorific “doctor” in academic and professional environments. Restricting the title solely to physicians while other clinicians also hold doctorates fosters a divisive and hierarchical atmosphere that undermines interdisciplinary respect and collaborative practice. Such restrictions also reinforce outdated power dynamics, contradicting the modern healthcare movement towards dismantling paternalism and promoting patient-centered care.
In healthcare, ensuring patient rights and safety must always be paramount. There’s a growing emphasis on clinicians clearly introducing themselves and their roles to patients. Many healthcare organizations implement practices like providing name badges that explicitly state a clinician’s role to minimize confusion. However, patient confusion regarding roles often stems from factors beyond just titles. Patients may develop assumptions about whether a clinician is a doctor or a nurse based on unconscious biases and implicit associations. For instance, studies reveal that women and people of color are frequently presumed to be nurses, while men are often addressed as “doctors,” regardless of whether they are physicians or even possess a doctoral degree. Historically, women and people of color faced systemic barriers to accessing higher education and advanced degrees, particularly those associated with greater prestige and traditionally dominated by white men. Now, as more women and people of color attain doctoral degrees, moves to limit their use of rightfully earned honorifics appear not only misguided but also insensitive.
In professional medical settings where systemic racism and misogyny continue to be daily realities, the honorific “doctor” carries significant weight and should be utilized. However, healthcare professionals should move away from relying on honorifics as the primary means of communicating their roles to patients.
Ideally, in a patient-centered healthcare system, healthcare professionals with doctoral degrees would reserve the “doctor” honorific for academic and professional settings among colleagues, and refrain from using any honorifics when directly interacting with patients. In clinical environments, titles and honorifics can shift the power dynamic away from patients and families and towards the medical professional, potentially creating an unproductive hierarchy within the care team. Honorifics are typically used to show respect and deference, especially to individuals perceived to hold a higher social status. Fostering patient-centered communication, shared decision-making, and team-based care becomes challenging if one member of the team is implicitly or explicitly positioned as having superior social rank through the use of titles in front of patients.
This perspective isn’t new. In 2021, Kenneth R. Pike and M. Scott Moore argued in the Journal of Health Ethics that extending the “doctor” honorific to DNPs is “moving in the wrong direction.” While their conclusion differs, the sentiment regarding patient interaction is similar: neither DNPs nor physicians should necessarily use this honorific with patients. It is more appropriately reserved for academic discussions, conferences, and professional gatherings.
Ultimately, clear role clarification is the most effective strategy to prevent patient confusion, not selectively restricting honorifics for some healthcare professionals while permitting them for others. In an era marked by clinician burnout, staffing shortages, and increasingly complex healthcare challenges, collaborative teamwork is paramount to optimize community health. Debating who can use the title “doctor” in front of patients is a divisive distraction from the real issues at hand.
About the Authors
Stephanie W. Edmonds, Ph.D., MPH, R.N., is a principal research nurse scientist at Abbott Northwestern Hospital, part of Allina Health, in Minneapolis. linkedin.com/in/stephanie-edmonds-0a442020/
Alden A. Bush, DNP, MPH, PMHNP-BC, is a psychiatric nurse practitioner working in a semi-rural community-based outpatient psychiatry program in Clinton County, N.Y. linkedin.com/in/abushdnp
Ginny L. Ryan, M.D., M.A., is a professor of obstetrics and gynecology and the division chief of reproductive endocrinology and infertility at the University of Washington School of Medicine. linkedin.com/in/gryanbureshmd
