Many patients wouldn’t question the use of “doctor” when addressing physicians, dentists, or even optometrists, but the title likely seems foreign when addressing pharmacists, physical therapists, and nurse practitioners. Imagine the following scenario where a Doctor of Nursing Practice (DNP), a Doctor of Pharmacy (PharmD), and a Doctor of Physical Therapy (DPT) are discussing the plan for a patient admitted to the hospital following an elective surgery. DNP: I think Mr. Smith is ready for discharge. PharmD: Wait, doctor. Mr. Smith’s insurance doesn’t cover his antibiotic. We need to switch him to another option. DNP: Thank you, doctor. I’ll make the switch. DPT: I’m not sure, doctor. I don’t think Mr. Smith is physically able to care for himself at home. DNP: You might be right, doctor. We may have to explore an outpatient rehabilitation facility. Although none of the characters are physicians, all of them have chosen to evoke their academic degrees and address each other as “doctor.” Even though this hypothetical scenario was intentionally exaggerated and might seem absurd, a situation like it could happen in the not-too-distant future. Imagine the confusion of the patient sitting in his or her bed listening to such a platoon of “doctors.” However, actual confusion among patients about the roles of their caregivers is real, as survey data from the American Medical Association (AMA) suggests that in 2010, only 51% of patients agreed that “it is easy to identify who is a licensed medical doctor and who is not by reading what services they offer, their title, and other licensing credentials.”1 Historically, the Bachelor of Science in Pharmacy degree was sufficient for admission into a career as a pharmacist. In response to the increased complexity of pharmacotherapy and advanced training required for adequate provision of pharmaceutical care, however, the PharmD became the new entry-level degree for all practicing pharmacists in the United States in 2004.2 Ahead of that, the physical therapy field enrolled its first DPT class in 1993, and the Commission on Accreditation in Physical Therapy Education will require all programs to offer the DPT degree effective December 31, 2015.3 Finally, the American Association of Colleges of Nursing has recommended that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree.4 Ask any representative of the allied health professions about the main factor fueling the movement towards doctorate-level education, and they will likely cite an increasing complex health care system that requires clinicians with more advanced training. A pharmacist might quote evidence from the FDA that medication errors cause at least 1 death every day and injure approximately 1.3 million individuals annually in the United States.5 If you’re looking for justification for the DNP degree, simply turn to the current shortage of primary care physicians—a problem that is predicted to grow in the coming years.6 A team of a DNP, PharmD, and DPT seems poised to fill this void and serve as valued physician extenders. The American public seems to find the idea palatable, at least according to the AMA survey data. While 92% of respondents agreed only a medical doctor should diagnose and treat heart disease, only 34% said a physician’s service was required to write prescriptions for common conditions like sinus infections.1 Not everyone perceives the drive towards entry-level doctoral degrees as purely altruistic. Indeed, some have suggested that the so-called “credential creep” is motivated by a desire among the allied health professions to generate revenue by circumventing the physician gatekeeper and gaining direct access to patients.7 Others cite that the additional training required for advanced degrees isn’t justified given the lack of data to support how those with doctorate degrees can provide superior care than their non-doctoral counterparts. Responding to the perceived infringement on the title “doctor” by non-physicians, the AMA launched the “Truth in Advertising” campaign in 2011. This initiative aims to assuage confusion about the roles of various members of the health care team by initiating legislation protecting the title “doctor.” The AMA insists that such measures are necessary based on the results of its survey. It stated that “patients deserve to have increased clarity and transparency in health care. There is no place for confusing or misleading health care advertising that has the potential to put patient safety at risk.1” As a result of the AMA’s legislative efforts, states like Arizona and Delaware forbid nurses, pharmacists, and other allied health care providers from using the title “doctor” unless they immediately identify their profession.7 The success of this initiative in ameliorating patient confusion has not yet been assessed. Rather than attempting to legislate the use of professional salutations, it may be more effective for allied health professions to partner with the AMA and address the issue as part of their respective graduate curricula.8 Even in the face of legislative efforts, allied health care providers with a doctoral degree who live outside of affected states can still make their own decision regarding use of the title “doctor.” Within the hallowed halls of academia, I permit my students to address me as “doctor,” if for no other reason than to help instill in them a sense of professionalism. However, as my patients have regularly mistaken me for a physician since my days as a student pharmacist, I’m familiar with the salient points raised by the AMA’s campaign. Because of this, whenever I’m at the hospital, I ask my students to refrain from addressing me as “doctor” in patient care areas, which I started doing before the AMA campaign existed. I do this not because of a law, but because it’s what I believe is best for my patients and my image as a professional. References The American Medical Association. Truth in advertising campaign. https://www.ama-assn.org/ama/pub/ad...-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. Source
