Many people readily accept the title “doctor” for physicians, dentists, and optometrists. However, its application to other healthcare professionals like pharmacists, physical therapists, and nurse practitioners often raises questions. This article delves into the evolving role of pharmacists, the significance of the Doctor of Pharmacy (PharmD) degree, and the ongoing discussion about whether pharmacists should be referred to as “doctors,” particularly in patient care settings.
Imagine a modern healthcare scenario: a patient recovering post-surgery is being reviewed by a team. A Doctor of Nursing Practice (DNP), a Doctor of Pharmacy (PharmD), and a Doctor of Physical Therapy (DPT) are collaborating on the best course of action.
“I believe Mr. Smith is ready to be discharged,” the DNP suggests.
“Doctor, just a moment,” the PharmD interjects, “Mr. Smith’s current insurance plan doesn’t fully cover his prescribed antibiotic. We need to consider an alternative to ensure he can continue his treatment at home.”
“Thank you, doctor,” the DNP responds, acknowledging the pharmacist’s crucial input. “I’ll adjust the medication plan accordingly.”
The DPT then adds, “Doctor, I have some concerns. I’m not convinced Mr. Smith has regained sufficient physical strength and mobility to manage independently at home.”
“You raise a valid point, doctor,” the DNP agrees. “Perhaps we should explore a short-term stay at an outpatient rehabilitation facility before discharging him home.”
In this scenario, while none are medical physicians (MDs), each professional, holding a doctoral degree in their respective field, addresses their colleagues as “doctor,” reflecting their advanced education and expertise. While this example is somewhat heightened to illustrate a point, it reflects a growing reality in healthcare. It also highlights a potential source of confusion for patients, who may not fully understand the distinct roles of each “doctor” involved in their care.
Patient confusion regarding healthcare provider roles is a documented issue. A survey by the American Medical Association (AMA) in 2010 revealed that only about half of patients (51%) felt confident in easily identifying licensed medical doctors from other healthcare providers based on titles and service descriptions. This lack of clarity underscores the importance of understanding the qualifications and roles of different healthcare professionals, including pharmacists.
Historically, a Bachelor of Science in Pharmacy degree was the standard entry point for pharmacists. However, the field of pharmacy has become significantly more complex. The intricacies of medication therapy, drug interactions, and the demand for comprehensive pharmaceutical care necessitated a more advanced educational standard. In response to these evolving demands, the Doctor of Pharmacy (PharmD) degree became the mandated entry-level qualification for all practicing pharmacists in the United States in 2004. This shift signifies the elevated level of knowledge and clinical skills now expected of pharmacists.
Alt text: A pharmacist carefully reviews medication labels in a pharmacy setting, highlighting the attention to detail required in their profession.
Similarly, other allied health professions have transitioned towards doctoral-level education. Physical therapy introduced the Doctor of Physical Therapy (DPT) degree, with full accreditation requirements in place by 2015. Nursing practice has also seen a push for the Doctor of Nursing Practice (DNP) as the entry-level degree for nurse practitioners. This trend across healthcare emphasizes the increasing need for clinicians with advanced training to navigate the complexities of modern healthcare systems.
When asked about the driving force behind this doctoral-level education movement, many in allied health professions point to the increasingly complex healthcare landscape. Pharmacists, for example, often cite alarming statistics regarding medication errors. The FDA reports that medication errors contribute to at least one death every day and injure approximately 1.3 million people annually in the U.S. This underscores the critical role of highly trained pharmacists in ensuring medication safety and optimizing patient outcomes. The advanced training received in a PharmD program equips pharmacists to play a vital role in minimizing these risks.
Furthermore, the growing shortage of primary care physicians further emphasizes the importance of advanced practice professionals. Teams comprised of DNPs, PharmDs, and DPTs are increasingly seen as crucial in filling healthcare gaps and acting as valuable physician extenders, particularly in areas with limited access to primary care physicians. These doctoral-level professionals can provide a wider range of services, improving overall patient access to care.
Public perception seems to acknowledge the expanded roles of non-physician healthcare professionals. While a significant majority (92%) in the AMA survey believed only medical doctors should diagnose and treat serious conditions like heart disease, a much smaller percentage (34%) felt a physician’s expertise was necessary for prescribing medications for common ailments such as sinus infections. This suggests a degree of public acceptance for pharmacists and other non-physician practitioners to manage certain aspects of patient care, particularly medication management.
However, the drive towards entry-level doctoral degrees in allied health professions is not without its critics. Some have suggested that “credential creep,” or the increasing requirement of advanced degrees, is driven by professional aspirations for increased autonomy, revenue generation, and direct patient access, rather than solely by the need for enhanced patient care. Concerns have also been raised regarding the cost and benefit of this advanced training. Critics question whether the additional training in doctoral programs demonstrably translates to superior patient care compared to practitioners with master’s-level degrees, citing a lack of conclusive data.
In response to concerns about the potential misuse or misrepresentation of the title “doctor” by non-physicians and the ensuing patient confusion, the AMA launched the “Truth in Advertising” campaign in 2011. This initiative aimed to clarify the roles of different healthcare team members and proposed legislation to protect the title “doctor,” reserving it primarily for medical physicians.
Alt text: The logo for the American Medical Association’s “Truth in Advertising” campaign, designed to promote clarity in healthcare provider titles.
The AMA argued that legislative measures were necessary to ensure patient safety and transparency in healthcare. They emphasized that patients deserve clear and unambiguous information about their healthcare providers and that misleading advertising or titles could potentially jeopardize patient well-being. As a result of the AMA’s advocacy, several states, including Arizona and Delaware, implemented laws requiring non-physician healthcare providers with doctoral degrees to clearly identify their profession when using the title “doctor.” The actual effectiveness of these legislative efforts in reducing patient confusion remains to be fully evaluated.
Instead of solely relying on legislation to regulate the use of professional titles, a more collaborative and potentially effective approach might involve professional organizations, including the AMA, partnering with allied health professions to address this issue through professional education and curriculum development. This could involve incorporating clear communication strategies and professional responsibility guidelines into the training of all doctoral-level healthcare professionals. Furthermore, outside of states with specific legislation, healthcare providers with doctoral degrees retain the autonomy to decide how they use the title “doctor” in their practice.
Within academic settings, addressing educators with doctoral degrees as “doctor” is common and often encouraged to foster professionalism and respect for advanced scholarship. However, the context shifts in direct patient care environments. Personal experiences, such as the author’s own encounters being mistaken for a physician as a student pharmacist, highlight the validity of the concerns raised by the AMA. This firsthand experience led to a personal practice of requesting students to refrain from using “doctor” when addressing them in patient care areas within the hospital setting, a practice initiated even before the AMA campaign. This decision stems not from legal mandates, but from a commitment to patient clarity and maintaining professional integrity in the eyes of patients.
Ultimately, the question of “Are Pharmacist Doctors?” is multifaceted. Pharmacists holding a PharmD degree undeniably possess doctoral-level education and expertise in medication therapy and pharmaceutical care. In academic and professional settings, the title “doctor” appropriately reflects this achievement. However, in patient care settings, the primary focus should always be on clear communication and patient understanding. While pharmacists are indeed doctors of pharmacy, ensuring patients understand their specific role within the broader healthcare team is paramount for optimal patient care and minimizing confusion.
References
- The American Medical Association. Truth in advertising campaign. https://www.ama-assn.org/ama/pub/advocacy/state-advocacy-arc/state-advocacy-campaigns/truth-in-advertising.page. Accessed June 9, 2014.
- Yang-Yi Lin. Evolution of PharmD education and patient service in the USA. Journal of Experimental & Clinical Medicine. 2012;4:227—230.
- American Physical Therapy Association. Physical therapist (PT) education overview. http://www.apta.org/PTEducation/Overview/. Accessed June 9, 2014.
- American Association of Colleges of Nursing. AACN position statement on the practice doctorate in nursing. http://www.aacn.nche.edu/DNP/pdf/DNP.pdf. Accessed June 9, 2014.
- FDA. Drug safety and availability: medication errors. http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm080629.htm. Access June 9, 2014.
- American Association of Retired Persons. How to beat the doctor shortage. http://www.aarp.org/health/medicare-insurance/info-03-2013/how-to-beat-doctor-shortage.html. Access June 9, 2014.
- Harris G. When the nurse wants to be called ‘doctor’. The New York Times. http://www.nytimes.com/2011/10/02/health/policy/02docs.html?pagewanted=all&_r=0. Access June 9, 2014.
- Jennings DL. The “doctors” will see you now: a pharmacist’s take on the “Truth in Advertising” campaign. Ann Pharmacother. 2015;49:127-129.
