As doctoral-prepared nurses become more mainstream, a debate between medical doctors and doctoral-prepared nurses, is growing more prevalent. The number of nurses with doctoral degrees has increased significantly in the past decade. For instance, in just four years, from 2014 to 2018, the number of nurses with doctoral degrees, either DNPs or PhDs, nearly doubled, from 3,065 to 6,090.

For example, let’s take a look at a recent informational video on our Instagram page featuring Dr. Charnelle, “Nurse Nelle,” a doctorate-prepared CRNA, that brought up an interesting question in the healthcare community: should doctorate-prepared nurses be called doctors? Or is the distinction too confusing for patients and even fellow staff?

Here’s a closer look at doctoral-prepared nurses, why there’s controversy over the use of “Dr.” in their title, and how nurses feel about the topic.

The Nurse vs. Doctor Debate

Our Nurse.org video features Charnelle, who goes by “Dr. Nurse Nelle, CRNA” on her Instagram account @iamnursenelle, explaining how she made the decision to pursue an advanced practice nursing degree as a CRNA. By the way, we love her reasons! But despite the fact that the video is geared towards nurses looking to advance their education, the comment section quickly fired up with a heated argument over Hayes identifying herself with her “Dr.” degree.

An Instagram user who described herself as a board-certified ER and family physician, DO--commented,

“So she is a Doctor Nurse? Please correct this she is a Nurse who has a Doctorate in Nursing...DOCTORATE DEGREE IN NURSING NOT MEDICINE. PLEASE RESPECT OUR PROFESSION AND REPRESENT YOURS...Again, this is a misrepresentation of the Medical profession period.”

Others, however, supported Hayes’ decision to use “Dr.” in her title, pointing out, “If she has a doctorate degree, her title is Dr. So yes she is a dr.” “If she was a professor that had a doctorate would you feel the same way?” wrote another. “As a physician I’m sure you have had plenty. I’m sure and everyone else in the room knows she isn’t an MD nor is she trying to be.”

After some back-and-forth, with many other people backing Charnelle, the original commenter reaffirmed her position, writing, “...A Medical Doctor will never be a Nurse and a Nurse will never be a Medical Doctor. It is confusing for patients.”

Charnelle provided the following response and goes into further detail here about the DNP degree,

"As a doctorate prepared CRNA, it is important that the patients that I care for know who I am and my role in their care. Physicians do not have exclusivity of the term "Doctor," as there are many fields that grant a doctorate degree from Public Health to Music. It is in our best interest to not misrepresent ourselves. While it is a major accomplishment to have earned a doctorate degree, using "Dr." as a non-physician in the hospital setting should always precede one's job position. This allows the patient to understand the level of care they're receiving as well as ensure that the correct profession is properly recognized and not mistaken for another." - Charnelle Lewis DNP, CRNA

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What’s in a Name?

In a large way, the growth of doctoral degrees in other healthcare specialties--including pharmacists, nurses, and physical therapists--represents the shift in healthcare in general. Gone are the days of a strictly linear hierarchical structure, with the doc at the top, serving as the end-all, know-all in all matters of a patient’s health. Today’s healthcare is teamwork-based, with many different care team members, including the physician, working together.

However, that being said, even if the team-based model is the modern face of healthcare, the insurance world hasn’t exactly caught up. One of the major considerations into who gets to call themselves “doctor” is also tied to healthcare insurance reimbursement practices.

When a physician sees and treats a patient, Medicare reimburses the physician at a higher rate than when an NP--doctorate or not--sees that same patient. Both the physician and the NP could spend the exact same amount of time with the patient, offer the same diagnosis, and provide identical treatment, but Medicare will only reimburse NP visits at 85% of the full rate. With the difference not distinguishable in care delivered, some see the move towards more doctoral-prepared nurses as a push for a more equitable reimbursement service as well--so what’s in a name might be more than meets the eye.

Who can use the title “Dr.”?

In sheer technical terms, anyone who has a doctorate degree can rightfully call themselves a doctor. But in the medical world, understandably, things can get a little trickier. To some degree, to a patient or caregiver, it could be argued that in a world where everyone wears scrubs, titles don’t matter so much as the job the person wearing the scrubs is doing. But for other roles, the degree on the badge is everything.

Some physicians even argue that advanced practice nurses who obtain their doctorates should not be considered on an equal playing field as physicians in terms of clinical care--so they certainly should not share the same title. “The average training for a nurse practitioner is 6 years compared to an average physician training of 11 years,” argues Starla Fitch, MD for Medpage Today.

“With all due respect to our healthcare team, I beg to differ that going through four years of college and completing an additional two years – sometimes online, no less – can truly be ‘just as effective…as I see it, though, putting physicians and our skill side-by-side, on equal footing, with those who are not physicians only serves to drive a deeper wedge between the healthcare folks who need, at this crucial time, to come together,” she added.

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Other doctors issue warnings of nurses allegedly purposefully trying to mislead patients into thinking they are physicians. However, studies have consistently found that clinical care with an NP is as effective, and in some cases, even more effective, for patients as physicians.

In 2011, when The New York Times broached the topic of if nurses should be called doctors, the piece broached the topic that some physicians worried that nurses were trying to “take over” the jobs of physicians. However, Dr. Kathleen Potempa, the then-dean of the University of Michigan

School of Nursing and president of the American Association of Colleges of Nursing (AACN), made her feelings on the matter very clear--she asserted that in no way, shape or form are nurses going for doctoral degrees as a way to “compete” with physicians or “take over” their jobs. In her eyes, nurses are not out to steal anything from docs and are just fine with their own roles, thank you very much.

“Nurses are very proud of the fact that they’re nurses,” she told the Times. “And if nurses had wanted to be doctors, they would have gone to medical school.”

What is the The American Association of Nurse Practitioners stance?

So, what’s the final decision on if nurses with doctorate degrees can use their Dr. title? Well, currently, there is no one decision. The American Association of Nurse Practitioners does not have an official position on if doctoral-prepared nurses should use “Dr.” in their titles. In their position statement on DNPs, they simply state:

“The transition to the new title must be handled smoothly and seamlessly to avoid negative impact on NP practice and sound patient care and to maintain parity.”

For now, it’s up to an individual nurse’s discretion if they would like to refer to themselves by the “Dr.” title and/or make any distinction regarding their scope of practice for their patients’ sake. And as the number of doctoral-prepared nurses will only grow in the future, the chances are, it is a decision that many will be forced to face sooner rather than later.