Nurse Practitioners Sue California for the Right to Use “Doctor” Title

Three nurse practitioners who hold doctorates of nursing practice are taking legal action against the state of California, asserting their right to be addressed as “doctor.” They argue that a longstanding California statute, which exclusively permits California-licensed allopathic and osteopathic physicians to use the titles “doctor” and “Dr.,” violates the Constitution. This statute, in place since at least 1937, was initially intended to prevent patient confusion regarding their healthcare providers’ educational backgrounds.

Physicians, on the other hand, oppose this claim, emphasizing that the extent of physician education and practical training surpasses that of nurses. They argue that the law is essential to prevent patient confusion about the qualifications of those treating them. Furthermore, physicians contend that surveys corroborate patients’ preference to reserve the titles “doctor” or “Dr.” exclusively for MDs and DOs.

The Litigation Center of the American Medical Association and State Medical Societies, along with the California Medical Association (CMA), have submitted an amicus brief in support of the state’s request for the U.S. District Court for the Central District of California Riverside Division to dismiss the lawsuit, Palmer et al. v. Bonta et al. They urge the court to uphold the law’s constitutionality, citing precedent. A hearing on the motion to dismiss is scheduled for September 18.

The amicus brief argues, “Physicians today are educated and trained differently and more deeply and robustly than any other professional healthcare provider; and industry practice and the law continues to place physicians at the center of medical care.” It asserts that the public still perceives physicians as the cornerstone of healthcare and closely associates the terms “doctor” or “Dr.” with them.

Dr. Jesse M. Ehrenfeld, President of the AMA, emphasized the importance of clarity and transparency in healthcare providers. He pointed out that patients face increasing difficulties in identifying their physicians when non-physician healthcare professionals use titles traditionally associated with physicians. Laws such as California’s “truth-in-advertising” law have been instrumental in preventing confusion and protecting patients from potential harm.

Dr. Ehrenfeld stated, “It is imperative that we follow precedent and keep these laws in place to ensure patients have the basic information they need to make informed decisions about their healthcare.”

The AMA’s stance aligns with its commitment to combatting scope creep and preserving the role of physicians as leaders in patient care. The AMA emphasizes that patients deserve care led by physicians, who are among the most highly educated, trained, and skilled healthcare professionals.

Physician training includes leadership skills, the ability to coordinate healthcare teams, problem-solving for complex medical issues, the identification of critical diagnoses, and timely treatment decision-making. Physicians are trained not only for routine matters but also for handling intricate medical cases. Furthermore, most physicians undergo extended training, such as three-to-seven-year residencies, post-residency fellowships, or other subspecialty clinical training. They must also fulfill continuing medical education requirements and often meet the American Board of Medical Specialties’ criteria to maintain board certification.

In contrast, the amicus brief argues that nurse practitioners’ training falls short of a physician’s education and training. Nurse practitioner programs cover less material than medical school, are less science-oriented, and lack comparable depth.

The legal battle between nurse practitioners and physicians in California raises essential questions about the appropriate use of the title “doctor” in the healthcare profession. It hinges on whether nurse practitioners with doctorates of nursing practice should be allowed to use this title, as they believe they have earned the right to do so, or if the law should continue to restrict its use to allopathic and osteopathic physicians to prevent patient confusion. This lawsuit’s outcome will likely have significant implications for healthcare providers and patients in California and potentially beyond.