"When I walk in to see a patient, I always introduce myself with, 'Hello, my name is Cyndy, I'm the PA working with the doctor today,'" says Cyndy Flores, a physician assistant (PA) in the emergency department at Vituity in Emeryville, California. "Sometimes, I can go through a complete history and physical, explain a treatment plan, and perform a procedure, and [the patient] will say, 'Thank you, doctor.'"
"I always come back and say, 'you're very welcome, but my name is Cyndy, and I'm the PA.'"
Flores is used to patients calling her "doctor" when she greets them. She typically offers a quick correction and moves on with the appointment.
With 355,000 nurse practitioners (NPs) and 149,000 certified PAs practicing in the United States, it's more common than ever for healthcare providers who don't go by the title "doctor" to diagnose and treat patients.
A recent Medscape report, Evolving Scope of Practice, found that more than 70% of physicians were "somewhat satisfied to very satisfied" with patient treatment by PAs and NPs.
But for patients, having a healthcare team that includes physicians, NPs, and PAs can be confusing. Additionally, it creates a need for education about their correct titles and roles in patient care.
"It's really important for patients to understand who is taking care of them," Flores says.
Education Starts in Your Practice
Educating patients about the roles of different providers on their healthcare team starts long before patients enter the exam room, Flores tells Medscape.
Some patients may not understand the difference; some may just forget because they're used to calling all providers doctors, and others may find it awkward to use a provider's first name or not know the respectful way to address an NP or a PA.
Practices can help by listing the names and biographies of the healthcare team on the clinic website. In addition, when patients call for an appointment, Flores believes front desk staff can reinforce that information. When offering appointments with a physician, NP, or PA, clearly use the practitioner's title and reiterate it throughout the conversation. For example, 'Would you like to see our nurse practitioner, Alice Smith, next week?' or 'So, our physician assistant Mrs Jones will see you Friday at 3 PM.'
The Medscape report also found that 76% of patients expressed a preference to see a physician over a PA, and 71% expressed a preference to see a physician over an NP, but offering appointments with nonphysician providers is part of the education process.
"Some families are super savvy and know the differences between nurse practitioners, physician assistants, and doctors, and...there are families who don't understand those titles [and] we need to explain what they do in our practice," adds Nicole Aaronson, MD, MBA, attending surgeon at Nemours Children's Health of Delaware. Aaronson believes there's an opportunity for educating patients when speaking about all the available providers they may see.
Hanging posters or using brochures in the clinic or hospital is another effective way to reinforce the roles of various providers on the care team. Include biographies and educational information on practice materials and video programs running in the waiting room.
"Patients mean it [calling everyone doctor] as a way to respectfully address the nurse practitioner or physician assistant rather than meaning it as a denigration of the physician," Aaronson says. "But everyone appreciates being called by the correct title."
Helping patients understand the members of their care team and the correct titles to use for those healthcare professionals could also help patients feel more confident about their healthcare experience.
"Patients really like knowing that there are specialists in each of the areas taking care of them," Flores says. "I think that conveys a feeling of trust in your provider."
Everyone Isn't a Doctor
Even when PAs and NPs remind patients of their roles and reinforce the use of their preferred names, there will still be patients who continue referring to their nonphysician provider as 'doctor.'"
"There's a perception that anyone who walks into a room with a stethoscope is your doctor," says Graig Straus, DNP, an NP and president and CEO of Rockland Urgent Care Family Health NP, P.C. in West Haverstraw, New York. "You do get a little bit of burnout correcting people all the time."
Straus, who earned his doctorate in nursing practice, notes that patients using the honorific with him aren't incorrect, but he still educates them on his role within the healthcare team.
"NPs and PAs have a valuable role to play independently and in concert with the physician," Aaronson says. This understanding is essential as states consider expanding treatment abilities for NPs and PAs.
NPs have expanded treatment abilities or full practice authority in almost half the states, and 31% of the physicians that Medscape surveyed agreed that NPs should have expanded treatment abilities.
An estimated 1 in 5 states characterizes the physician–PA relationship as collaborative, not supervisory, according to the American Academy of Physician Associates. At the same time, only 39% of physicians surveyed told Medscape they favored this trend.
"Patients need great quality care, and there are many different types of providers that can provide that care as part of the team," Flores says. "When you have a team taking care of a patient, that patient [gets] the best care possible — and...that's why we went into medicine: to deliver high-quality, compassionate care to our patients, and we should all be in this together."
When practices do their part explaining who is and isn't a doctor and what each provider's title and role is and what to call them, and everyone reinforces it, healthcare becomes not only more manageable for patients to traverse but easier to understand, lending to a better experience.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE Health.
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Cite this: Not All White Coats Are Doctors: Why Titles Are Important at the Doctor's Office - Medscape - Jan 19, 2023.