Monday, October 03, 2011

is there a "doctor" in the house?

Fascinatin' article in the New York Times today. Most of you probably know that nurse practioners will require a PHD to practice by 2015. They can call themselves Dr. so and so because of the doctorate and all. Some are doing so. And guess what? Them other medical Drs are not happy. What a shock...

They are concerned over who gets to be called "doctor". If they allow other people to use the doctor title, they could "lose control of the profession". There is so much concern about this that legislation has been proposed bar people from "misrepresenting their license". Various states have taken up the issue in their legislatures.

Why do NPs think they need a doctorate? They want to have parity with other medical professions that require a PHD such as pharmacists. They think it gives the clinical knowledge that will allow them to be leaders in clinical practice, research and teaching.

I think this is about one thing: independent practice. NPs want to be able to have their own practices that are not being supervised by an MD. This is a move in that direction. And why not? Whether we like it or not, NPs are the future of primary care. They are the ones that will be working in the offices and doctors will be the specialists. Its inevitable the way medicine is going.

I think the whole "doctor" thing is really kind of amusing. Its a non issue. Most NPs will not call themselves doctor. Most NPs identify what their profession is to patients. Doctors are scrambling around these days as they see there role changing. They are panicing about having to justify everything they do. Are medical schools still teaching them that they are the center of the universe? I think they are. The thing is doctors have become just like the rest of us: part of a team. And they don't like it.


Anonymous said...

I know pharmacists need a professional doctorate, a PharmD. And I presume it is something similar for nurses. That is just extra training to prepare them for the job.

They are not the same as a PhD, which is an advanced research degree that doesn't prepare someone for a job, but might mean they have expert knowledge of a very tiny field.

GB, RN said...

The ironic part is that "doctor" is an honorary title for physicians. In ye olden days, doctor merely indicated that they person was a "scholar" "teacher" and "leader of the church". In Europe, some physicians don't use the title of "doctor" for that reason.

Anyone who puts themselves through the trouble of getting a PhD, deserves every right of calling themselves doctor. That includes nurses.

Anonymous said...

Kinda sorta unrelated question ...what is the generally accepted term for patients to use when referring to an NP?

I have a chronic issue that I have been under tretment for for about 7 years (not Fibro). I have been treated by the same practice for those 7 years and have seen just about everyone there. However, 90% of the time, my appts are with one particular NP that I really like and who knows my history well. She never introduced herself as "doctor" or "NP" or any other title; Just "Hi, I'm Sally Smith". So, for all this time I've been calling her Sally and she uses my first name. (our appts have gotten to the point where we talk more about kids and husbands and work, etc than my problem since it's pretty static).

Anyhoo, I've always meant to ask her but forget until 2 seconds after she leaves the room. So, what title do patients generally use when talking to an NP?

Anonymous said...

I think the issue is not really one of titles, or respect, but whether or not the patient is being misled. And maybe a little ego.
I have seen, repeatedly, in the medical profession, people trying to conceal their actual title/training from patients. Interns don't say they are interns. Residents don't mention they aren't the attending. When asked where they are in their training, they try to duck the question. Once, a medical assistant when directly asked "Are you a Nurse Practitioner or a Physicians Assistant" answered "yes". When asked "Which?" she finally admitted she was neither. She was giving out medical advice at the time. Not good.
Generally, if the patient is told "This is Dr. so and so" they presume the person is a physician. Not everyone with a doctorate commonly gets referred to as "Dr."
If a nurse with a doctorate wants to have that title used, I guess he/she can - but I think if he/she isn't trying to "fool" the patient into thinking he/she is a physician, that needs to be made very clear in the first sentance practically - not just "Hello, I am Dr. so and so".
Because while they have the degree, it is a different degree, and they are not physicians. Not that that's bad, but the patient has the right to know the difference.

TheTracker said...

"Are medical schools still teaching them that they are the center of the universe? I think they are."

Based on what? Your general determination to think ill of physicians?

"Most NPs will not call themselves doctor."

You think. Neatly sidestepping the question of whether this is a good idea, or whether the physicians that are upset about this (I am not one) have some legitimate basis for concern.

"The thing is doctors have become just like the rest of us: part of a team. And they don't like it."

Interesting diagnosis. Seems like you have chosen a unfortunate metaphor, though. Because on any team, there are roles, and the team works best when those roles are clearly identified. Highly qualified and trained fullbacks do call themselves running backs to celebrate their new status, for example.

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