What Legal Issues Lead a Hospital to Deny DNPs 'Dr.' Title?

Carolyn Buppert, NP, JD


February 28, 2011


Can a hospital, through its bylaws, preclude individuals with an academic title of doctor from using it at their facility? What is the legal perspective on this issue?

Response from Carolyn Buppert, NP, JD
Attorney, Law Office of Carolyn Buppert, PC, Bethesda, Maryland

Yes. Why? Because there is no case or statute that says that the hospital cannot do this. No case or statute has established that an individual with an academic doctorate or a clinical doctorate has an inviolable right to use the title "Doctor." Furthermore, several state legislatures have enacted laws, which accomplish the same result as the hospital's policy.[1] Those statutes have not been found to be unconstitutional on the basis of first amendment or other constitutional rights.

The hospital may be supporting physicians to the detriment of other types of clinicians with doctorates, but the hospital also may be trying to prevent a public relations problem. Pharmacists now hold doctorates, as do physical therapists and nurses. Traditionally, in the hospital setting, a "doctor" has been a doctor of medicine or osteopathy. Patients and their families tend to expect and assume that someone who introduces him or herself as "Doctor" is a doctor of medicine or osteopathy. There probably is a further assumption that the individual has completed residency training in the specialty in which they are treating the patient. It is predictable that a patient who is unhappy with his treatment will be upset if he finds out that he was treated by someone he thought was a physician, and that person is not a physician. Perhaps patients should be more enlightened, and realize that other types of clinicians are doctors, but the time has not yet come when the average patient knows to ask, when meeting a "doctor" at the bedside, "Doctor of what?"

No prudent hospital or clinician wants to interject into the patient-clinician relationship any interaction smacking of false advertising. With pharmacists, it's not really an issue, because it is pretty clear to patients that a pharmacist is a pharmacist, because he or she is in the pharmacy. If a physical therapist comes to a patient's room and introduces him or herself as "Doctor," the patient may be misled. Because advanced practice nurses with doctorates perform functions similar to physicians, there is even more possibility of misunderstanding or erroneous assumptions. When a nurse practitioner introduces him or herself as "Doctor," a patient is likely to assume that the individual has a medical degree and has undergone residency training. If the patient later finds out that the individual is a nurse with a doctorate in health policy, I believe that the patient may lose trust in the hospital and the clinician may lose credibility. On the other hand, if the nurse practitioner with a doctorate introduces herself as "Jane Jones, Nurse Practitioner," and the patient later finds out that Ms. Jones holds a doctorate, I believe that the patient will be pleasantly impressed. If a nurse practitioner introduces him or herself as "Doctor Jones, Nurse Practitioner," that's just going to confuse the patient. Generally, that type of introduction is followed by a long explanation, which may be fine, but which could just as well be avoided, in order to get to the patient's current chief complaint.

Some nurse practitioners may argue that they are justified in introducing themselves to patients as "Doctor" because they hold "clinical" doctorates. However, few "clinical" doctoral programs for nurses turn out individuals who have completed doctoral level work in diagnosis and therapeutics, pharmacology, immunology, neurophysiology, pathophysiology, histology, pathology, and microbiology. Furthermore, most clinical doctorates in nursing do not include a full 2 years of supervised and evaluated medical diagnosis and disease management. Then there is the residency issue. Most nurse practitioners with clinical doctorates attended programs heavy on health policy, leadership, quality measurement, and data analysis.[2] So, patients who research the matter may conclude that they have been misled, if, for example, their heart failure doctor turns out to be a nurse practitioner with a doctorate in health policy. A patient who believes he or she has been misled may create a public relations problem for a hospital. Hospitals have the right to try to avoid public relations problems.

For the nurse practitioner who has completed a truly clinical doctorate (such as a heart failure nurse practitioner who has devoted all of his or her doctoral efforts to learning about management of heart failure), I think it is worth challenging the hospital's decision. To do so, present to the bylaws committee your curriculum alongside a local medical school's curriculum, and be prepared to argue why the curriculum you completed is as good or better than medical school at preparing a clinician to treat the types of patients you are treating. Bylaws are changed all the time, in response to well-presented arguments. Although the medical school model is firmly entrenched in our culture, no studies have proven that the medical school model is the only effective model for teaching clinicians how to properly care for patients.


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