Advanced Practice Nurses Are NOT "Doctors"


I try not to get on the soapbox too often - the last one being 38 CFR Part 17.415 - Short for "VA Doesn't Care About Veterans" from more than a year ago.  Let's face it, there are plenty of media outlets for you to get your political discussion on and the last thing you want to read about on a medical finance blog is another Trump headline.  But today's topic is something I want to address - advanced practice nurses (nurse practitioners, clinical nurse specialists, nurse anesthetists, or nurse midwives) may have a doctorate degree, but they are not "doctors."

Why am I talking about this?

The article When Your Doc Is Not a Doc: Should Nurse Practitioners Be Autonomous? was posted in the Houston Press on July 3, 2017.  It was soon picked up by Doximity News and went up to generate plenty of comments.  It is a lengthy article which you can read in full on your own time but the reason I wanted to discuss this was because of this paragraph:

"A women in a white coat sweeps into the room, announcing that she is a doctor. She begins examining Johnson, using deft hands to check her motor skills and asking informed questions. It is only when Livy catches sight of the name tag pinned to the white coat and sees the letters APRN, short for Advanced Practice Registered Nurse, that she realizes her mother is being treated by a nurse practitioner — a highly qualified nurse who is trained to treat certain medical conditions and holds a doctorate but who is not a physician."

What this is NOT

This is not a discussion on whether or not APRNs should be allowed to practice independently free from physician supervision - which they currently do in 22 states and Washington D.C.  That is an extremely controversial topic and a discussion well above my pay grade and knowledge level.

What this IS

This is a discussion about intellectual honesty, medical ethics and the patient's right to choose.  I'm going to let the comments from the Doximity News article do the talking, starting with my own:

How often do midlevel providers introduce themselves as doctors? I was not aware of this trend. Is this even ethical?

Honestly it was a rhetorical question.  I never expected that anyone would support ARNPs introducing themselves to patients as doctors, but as evident by the responses to my comment, this wouldn't be the first time I was wrong...

[I have been informed that it is a violation of Doximity's terms of use to share comments publically so I have removed all comments from this post at the request of Doximity.  However I encourage you to head to the post on Doximity to see the comments for yourself.  To sum it up, there were some users who claim if an advanced nurse practitioner received a doctorate degree, then he/she is justified to introduce him/herself to the patient as "Doctor."  While I recognize the hard work these mid-level providers go through and the added value they provide, I respectfully disagree that they should claim to a be physician to the patient without further clarification.]

If you see something wrong, do something

I would be the first to admit that ARNPs and other types of mid-level providers are extremely valuable in the healthcare system.  I work with CRNAs daily and some are worth their weight in gold.  But just because they are educated and provide value does not give them the right to lie to the patient. Whether or not they have a doctorate degree, they should clearly explain to the patient that they are not an MD/DO physician.  Otherwise, they are no different from Malachi Love-Robinson - the fake teen doctor. I've never seen or heard a midlevel provider introduce themselves as a physician to the patient.  If you have, you should speak up and let the patient know they have the right to choose their provider.

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Future Proof, MD

Dr. Bo Liu is an aspiring radiologist-in-training and the founder and editor of the White Coat Money Blog.  He has an interest in interventional radiology and helping his medical colleagues get ahead in this mad world of medicine and money.  When he's not crushing the list at the PACS station or typing up your next favorite blog post, you can usually find him at the local badminton club, movie theater or the most recently opened restaurant.