By Shawn Kennedy, AJN editor-in-chief
Last week, we posted here a piece by AJN’s clinical managing editor Karen Roush, decrying the use of the term “physician extender.” It reminded me of a recent article from the New York Times on nurses with doctorates, which reported that if some physicians have their way and their legal strategy succeeds, they will be the only group permitted to use the honorific “doctor.”
Degrees vs. licenses. This borders on the ridiculous, as the title is an academic title that signifies achievement in a field of study; it is not a license. Doctoral degrees are awarded in just about every field of study, from astronomy to zoology. Physicians are awarded a doctor of medicine, dentists are awarded a doctor of dental science, and so it goes. In health care, there are dentists, psychologists, social workers, physical therapists, pharmacists, and yes, nurses too, with doctoral degrees. Nurses have been earning PhDs and EdDs (doctorates in education) and the DNSc (doctorate in nursing science) for years, and now there’s a new nursing doctorate degree—a DNP, doctor of nursing practice—that’s specific to nurses in clinical practice. They are still licensed as nurses, as that’s what they are.
This parochial thinking is held by those physicians (not all, but far too many) who still adhere to the traditional view that they, and they alone, know what’s best for patients and for health care; they’re in favor of teamwork, but only as long as the team recognizes that they are the leaders and decision makers.
Both the media and the health care system bear some responsibility for this. The system itself is physician-centric rather than patient-centric—hospital policies, practitioner admitting privileges, purchasing (especially in the OR), and scheduling have often developed around physician preferences; reimbursements almost always must go through physicians, whether or not they’re actually involved in the delivery of care.
Most media portrayals, both fiction and documentary, focus on physicians as the only important providers in health care, relegating other health professionals to low-level supporting roles (or, as Roush noted,“extensions” of physicians).
And we all play loosely with the term “doctor.” It’s established that not all doctors are physicians, yet we use the terms synonymously. If we are referring to a physician, we need to be specific and not use “doctor.”
There are many health professionals besides physicians who are knowledgeable and skilled practitioners—if allowed to practice to the full capabilities within the scope of their education, expertise, and license, they can provide access and high quality care to the millions of Americans who need it.
Our health care system is far too complex for one group of practitioners to claim ownership of patients, the system, or an academic title. All who complete the arduous path to achieving a doctoral degree deserve the recognition warranted by their achievements—just as doctors of medicine do.
Great article! Despite being physician centric, the healthcare system is actually ‘haywire’! Most physicians only assess the patient’s condition superficially and have poor diagnostic capability. They dont prescribe comprehensive testing to diagnose correctly. Most symptoms are shared by a vast range of diseases. Without diagnosing correctly, just prescribing a symptom suppressor is nothing but slamming the message bearer who is alerting the danger! Most physicians are nothing but glorified, certified pill prescriptionists!! A true physician is one who knows how to diagnose before leaping to the prescription part!
Andrew Austin – inccorrect. A dentist is called doctor. In collegiate classrooms Dr. is used often for the professor of the department or course. A vetrinarian – doctor. Podiatrist – doctorPsychologist – doctor And now in 2022 I am a doctor of nurse anesthesiology. This is why the actual term has finally evolved. A doctoral degree in any specialty or field equates the title doctor to be appropriately bestowed. Now the American Society of Anesthesiologists ASA has now deemed physician anesthesiologist as the correct term for their membership. As I am now a certified registered nurse anesthesiologist and Doctor of Nurse Anesthesiology “Hello, my name is Dr. Schosky your CRNA today to provide your anesthesia and keep you safe under my care for your surgical (or obstetrical) procedure.” No physician anesthesiologist required in any state in this country by law. A physician (the surgeon) may be necessary, but never the physician anesthesiologist. They can do their patient’s anesthetic and I will provide to mine.
I call shenanigans.
“Doctor” is a protected title with regard to healthcare in most jurisdictions, similarly to how Nurses should have an apoplexy when medical assistants use their title. The precedent is well established that the title “Doctor” is reflective of the position of physician rather then educational level (considering MD is a masters degree and MBBS is a bachelors). Pharmacists, who are also bestowed with a Doctorate of Pharmacy (another masters degree), do not use the title “Doctor” in their practice, nor do any other multitude of providers who enter their field with a “doctoral”-level degree.
As nurses, we are wasting our breath on a privilege as to call ourselves “Doctors,” and wasting that energy that could be better applied to Things That Matter™. If you want to make a change, press for EQUAL REIMBURSEMENT for medical practitioners, Physicians, Physician Assistants, AND Nurse Practitioners. In many inpatient settings, the “physician review” of the extenders notes is strictly a rubber-stamp for billing purposes, and an unnecessary step that wastes the physician’s time and validates the “physician-centric” worldview you are railing against.
Medicine is neither physician-centric nor patient-centric. It is money-centric. The business of medicine is what the real fight is about, and while I personally deplore that reality, a reality it still is. All the privileges and “equality” you want will come once “Physician Extenders” (which is an appropriate title both historically and at present) are able to take some of the workload off physicians for the same level of reimbursement.