Florida legislators recently passed legislation to prevent advanced practice nurses in Florida with doctorates from using the honorific “doctor.” The state House and Senate bills proposed that nurses with doctorates who introduce themselves to patients as “Dr. Smith, nurse practitioner,” could face disciplinary action. Lobbyists who supported this measure referred to it as a “patient empowerment bill that allows them to understand who is treating them.” Thankfully, Gov. Ron DeSantis vetoed the bill.
But this was just one of many recent examples of state legislators declaring that referring to doctorly prepared nurses as “doctors” is confusing to patients. In a 2022 article in Missouri Medicine, Gary Gaddis, M.D., Ph.D., wrote that when advanced practice nurses ask to be called “doctor,” it “misleads the patient and perpetrates a fraud which defies their patient’s trust.”
Between the three of us, we have one doctor of medicine (M.D.), one doctor of philosophy (Ph.D.) who is an R.N., and one doctor of nursing practice (DNP) who is a psychiatric nurse practitioner. We believe that these legislators and physicians need a little history lesson — and a bit of a reality check.
“Doctor” is derived from the Latin verb “docere,” which means “to teach.” The term was first used sometime in the 1300s to refer to a scholar; hence persons with a Ph.D. were called “doctors.” The honorific has been used for centuries by professions other than physicians; it was not until the 1600s that medical schools started referring to graduates as “doctors” as a sign of respect and prestige. In the United States, the M.D. degree became the earliest iteration of the professional doctorate, which is tied to a specific vocation (medicine, dentistry, pharmacy, physical therapy, nursing practice, etc.) rather than the research-based and more academically rigorous Ph.D. This change from the bachelor of medicine bachelor of surgery (MBBS), still common throughout many locations colonized by the British Empire, contributed to the colloquialism of the term “doctor.”
Attempts by some physicians in modern times to restrict the honorific or call themselves “the real doctor” diminish the scholarship and experience of all others who hold professional or research doctorate degrees. Those with any doctoral degree, whether an M.D., D.O., DNP, Ph.D., DPT, O.D., AuD, DDS, DPM or a PharmD, have dedicated years toward their education and should be able to use the honorific “doctor” in academic and professional settings. Referring to only physicians as “doctors” when other clinicians hold doctorates sends a divisive and hierarchical message that erodes interdisciplinary respect and collaboration. It also enables power dynamics contrary to modern health care’s push to dismantle paternalism.
In health care, patient rights and safety should always be the priority. Clinicians are increasingly encouraged to introduce themselves and their role, and many organizations assign clinicians name badges that clearly state their role to avoid confusion. Importantly, role confusion among patients is often based on more than assigned honorifics. Patients may make assumptions regarding whether a clinician is a doctor or nurse based on implicit associations or biases. For example, women and people of color are often assumed to be nurses, whereas men are often called “doctors” when they may not be a physician or hold a doctoral degree. Historically, women and people of color have been excluded from higher education and graduate programs, especially those granted the most prestige by their dominant white male membership. Now that more women and people of color are achieving doctoral degrees, limiting the use of their hard-earned honorifics is misguided and inappropriate.
In professional medical settings where institutionalized racism and misogyny occur daily, the honorific “doctor” is significant and should be used. However, medical professionals should stop relying on honorifics to communicate our roles to patients.
In our ideal health care landscape, health professionals with doctoral degrees would use the “doctor” honorific in academic and professional forums among colleagues and peers only, and no one would use an honorific with patients. In clinical settings, titles and honorifics can transfer the locus of power from the patient and family to the medical professional and can create an unproductive hierarchy within the care team. Honorifics are used to show respect and esteem, particularly to a person of superior social rank. Patient-centered communication, shared decision-making, and team-based care are challenging if one individual is considered to have a superior social rank.
We are not the first to propose removing the honorific from patient care. In 2021, Kenneth R. Pike and M. Scott Moore argued in the Journal of Health Ethics that extending the honorific “doctor” to those with a doctor of nursing practice degree is “moving in the wrong direction.” We agree: Neither DNPs nor physicians should use this honorific with patients. We should reserve it for lecture halls, conferences, and social gatherings if desired.
Role clarification is the best strategy to avoid patient confusion, not eliminating honorifics from some but not all medical professionals. In this time of clinician burnout, staffing shortages, and increasingly complex medical challenges, we need to work together to optimize the health of our communities. Arguing about who can use the salutation “doctor” around patients is unnecessarily divisive.
Stephanie W. Edmonds, Ph.D., MPH, R.N., is principal research nurse scientist at Abbott Northwestern Hospital, part of Allina Health, in Minneapolis. 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. 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.