It seems many people believe the professional term “physician” is synopsis with “doctor,” which has lead many physicians to believe they alone are entitled to either term. I’ve written on this topic before, both here in our blog and on my own Facebook page, and will continue to do so until the phone calls stop coming into our office from angry physicians who feel clients or staff referring to myself as a doctor is inappropriate and misleading.
More recently we had a physician threaten us because he felt it was misleading to refer to myself as a doctor because his assumption was that I held a PhD and not a clinical doctorate, but alas, I do in fact hold a clinical doctorate in the profession of nursing practice. You see, physicians do not have a monopoly on that term. It is a title that refers to one’s level of education and while many professors may use the term “doctor” in the academic arena, they do not do so elsewhere because our community really has come to understand someone with the title of doctor as a clinician. However, they aren’t naive enough to always assume this is a medical doctor. They are quite aware when they call their dentist and he refers to himself as a doctor, and doesn’t specify he has a doctorate in dentistry, that he is not a medical doctor. This holds true for chiropractors, podiatrists, psychologists, audiologists, veterinarians, and nursing doctors.
Those of us in the nursing profession who have earned a doctorate in nursing practice can provide complete assessments, diagnose, treat, and prescribe. We are experts in clinical care within our own speciality. We are in fact, clinical doctors and have earned the title as any one of our clinical doctorate colleagues. Avoiding use of the title to avoid dissension doesn’t advance the nursing profession. You see, this controversy that gets physicians all fired up isn’t at all about clinical outcomes, or the cost of healthcare with advance practice nurses, or even consumer satisfaction – because we lead them in each of those areas – but rather about ego. Yes, I said it. While I adore many of my physician colleagues, there are a number of others whose ego has outgrown their britches.
Physicians are the most numerous primary care provider in our healthcare system and their practice, particularly in utilization of prescriptions, has influenced all other clinicians. States began enacting medical acts back in the 1920s to protect public safety and at that time offered protection to those individuals who referred to themselves as physicians and identified what requirements must be met for that title to be given. Although other disciplines were certainly in existence, it was the physician who were first to gain legislative recognition of their practice.
The statutory limitations were quite broad… so broad in fact that they gave the physician exclusive rights to diagnosis and treatment and created a healthcare hierarchy upon which they sat at the top.
Any person… who shall diagnose or attempt to diagnose, treat or attempt to treat, operate or attempt to operate on, or prescribe for or administer to, or profess to treat any human ailment, physical or mental, or any physical injury to or deformity of another person. (NC Gen. Stat No. 90-18 )
The breadth of these medical acts combined with making it illegal for anyone not licensed as a physician to carry out any acts included in the definition, made it difficult for other health care workers to describe their contributions. Nurses then had to redefine their tasks or functions as separate from the all-encompassing medical scope of practice. They too had to and continue to seek recognition of their own professional roles, no matter how traditional or longstanding their activities and successes might have been (Edmands & Mayhew, 2014, p 1).
“Dominance of the physician in the health care hierarchy created a virtual monopoly in health care. The medical sociology and professionalization literature is filled with extensive analyses of the factors that led to the development of the cultural, economic, political, and social authority and dominance of the physician, especially the growth and power of organized medicine,” (Edmands & Mayhew, 2014, p 1).
Physicians are not meeting the needs of those in need of primary care, nor those seeking maternity services. Advance practice nurses are beginning to fill that gap and doing so with better outcomes and lower costs, with higher consumer satisfaction rates. Of course they see us as threats and so attempt to control through bullying tactics and job restrictions. There are many though, who respect us as colleagues and valuable members of the healthcare team and therefore, work cooperatively in collaborative relationships. The MD and the APRN can be very complementary, neither replacing the role of the other, but rather enhancing the work of each other.
The term doctor however, is not legislated in Indiana as exclusively only to the physician. In appreciation of this controversy though and in effort to educate consumers about the nursing profession, our practice is very cognizant of clarifying my doctorate is in nursing (and I am proud of this fact!). Every page of this website, every form in our practice, every handout and podcast is clear that my doctorate is in nursing and my credentials are as a nurse-midwife. Will I continue to stay, “This is Doctor Lane, nurse-midwife” when I add the family nurse practitioner credential to my professional scope? Doubtful. It is simply too much to chew and quite frankly, my clients seek me out because I am not a physician. There has never been any desire or intention to mislead because I chose to be a nurse-midwife and family nurse practitioner. Had I wanted to practice medicine, I certainly had the intelligence to do so, but I wanted to be the one holding hands with the client and educating them, counseling them, and nurturing them. It is the science of nursing that I am called, not so much the science of medicine. Surgery isn’t so much my calling, or disease at the minute cellular level. I am not interested so much in pharmacology or diagnostic procedure. I enjoy talking to clients about their lives in hour or more long visits. I enjoy being with people. For now, I’ll continue to tread new path for the doctoral trained nurses that will follow me…