Calling the Nurse ‘Doctor,’ a Title Physicians Oppose

By Gardiner Harris

The New York Times

Originally published October 2, 2011

With pain in her right ear, Sue Cassidy went to a clinic. The doctor, wearing a white lab coat with a stethoscope in one pocket, introduced herself.

“Hi. I’m Dr. Patti McCarver, and I’m your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine.

It was something that will become increasingly routine for patients: a someone who is not a physician using the title of doctor.

Dr. McCarver calls herself a doctor because she returned to school to earn a doctorate last year, one of thousands of nurses doing the same recently. Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title “doctor,” but also the money, power and prestige that often comes with it.

As more nurses, pharmacists and physical therapists claim this honorific, physicians are fighting back. For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines.

Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.

But many physicians are suspicious and say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point?

Dr. Roland Goertz, the board chairman of the American Academy of Family Physicians, says that physicians are worried that losing control over “doctor,” a word that has defined their profession for centuries, will be followed by the loss of control over the profession itself. He said that patients could be confused about the roles of various health professionals who all call themselves doctors.

“There is real concern that the use of the word ‘doctor’ will not be clear to patients,” he said.

So physicians and their allies are pushing legislative efforts to restrict who gets to use the title of doctor. A bill proposed in the New York State Senate would bar nurses from advertising themselves as doctors, no matter their degree. A law proposed in Congress would bar people from misrepresenting their education or license to practice. And laws already in effect in Arizona, Delaware and other states forbid nurses, pharmacists and others to use the title “doctor” unless they immediately identify their profession.

The entire story can be read here.

What should I call myself?

Samuel Knapp, EdD, ABPP

Director of Professional Affairs

The names and titles that psychologists use, the clothes that they wear, and the decor in their offices are part of the “public self-disclosure” of the psychologist. That is, psychologists convey something about themselves and their relationships with their patients by the names and titles they use, the way they dress, and the way their offices are decorated.

How should psychologists refer to themselves in professional settings? Should psychologists who have doctorates always refer to themselves as “doctor;” should they refer to themselves by their first name; or should they use some other mode of address? Do psychologists who fail to insist on using the title “doctor” diminish the profession or fail to recognize the substantial academic and personal accomplishment involved in becoming a psychologist? After all, physicians refer to themselves as “doctor.” Or, does insisting on the title “doctor” reflect elitism, classism, or an assertion of power or privilege over another person?

Dr. Richard Small usually introduces himself as Dr. Small. When asked what he prefers to be called, he responds “either Rick or Dr. Small.” When she meets with adults for the first time, another psychologist introduces herself with her full name, but does not use her title (which is on her business card and on her office door). She asks patients what they would like to be called and follows a pattern of mutuality in titles. She says “If you would prefer to be called by your first name, you may call me by mine. If you would prefer that I use a courtesy title to address you, you may use mine.” Both of these approaches allow adult patients to use (and to be called by) whichever name or title appears comfortable for them, and recognizes that individuals vary in their comfort with titles, which often differ according to age, social background, or perceptions of courtesy. Sometimes when given an option, patients will adopt a middle ground and refer to the psychologist as “Dr. Sam,” “Dr. K.,” or some other polite variation. Giving adult patients options of what name to use also avoids the appearance of trying to establish a hierarchy of power or distance between individuals. The assumption is that the effectiveness of therapy will occur because of the quality of the relationship and the effectiveness of the therapeutic intervention.     

The use of titles and names depends a lot on context, and it is impossible to establish one rule for all situations. Although insisting that patients use the title “doctor,” in and of itself, is unlikely to cure many patients, at times it may be clinically indicated to do so. One attractive woman psychologist initially refers to herself as “doctor” when working with men to ensure that they do not misconstrue the use of her first name as an invitation to enter into inappropriate boundary crossings. However, she allows women or men she knows well who do not appear to have boundary issues to call her by her first name. Also, it is generally considered bad manners for children to refer to adults by their first name (other than relatives, such as “Aunt Sally,” or “Uncle John”), although this standard has become weakened in recent years. Some psychologists will allow children to call them “Dr. First Name,” which balances familiarity with respect for the adult.

Of course, patients who usurp the right to use first names may be showing clinical features of relevance. For example, a psychologist who conducts child custody evaluations notes that some fathers will use his first name at their first meeting or even the first phone call, which he interprets as an effort to create a male-to-male bond or alliance in the relationship. Rebellious adolescents may also use first names as a way to assert power or defiance of authority. The appropriate response may vary according to the situation and patient dynamics, but the overriding goal should be to respond in a manner consistent with overarching ethical values that promote professional goals in the context of a supportive but structured relationship.