What’s in a name? Or a title? A lot, apparently, at least if you are a physician. The honorific title doctor has become contentious in medical settings. Beginning around the 14th Century scholars and teachers with university training were addressed using the title doctor. At some point in the next 300 years doctor began to be used by medical practitioners who had attended medical training at a university whether they had a doctorate. William Shakespeare used the terms physician and doctor interchangeable in his plays. The title was applied to physicians, not surgeons and did not apply to those who had gained their knowledge in the healing arts through apprenticeships. A third type of medical practitioner in England was an apothecary, sort of a cross between a pharmacist and a general practitioner. However, they were not addressed as doctors. Around 1860 the Royal College of Physicians decided the doctor should only be used by medical providers with an MD degree to stop the proliferation of quacks who used the title.
The title, doctor, carries a lot of prestige. Perhaps due to the prestige or to erect further barriers to entry, a few medical professions have elevated their training to a doctorate. Doctor of Pharmacy is now rather common for students graduating from pharmacy school. Doctor of Nursing Practice is the norm for new nurse practitioners. There is also a Doctor of Physician Therapy, Doctor of Audiology, Doctor of Chiropractic and Doctor of Psychology. What should these medical professionals call themselves? Should a nurse practitioner introduce herself as Dr. Smith, for example? Should her lab coat have Dr. Smith embroidered on the lapel? Or should her name tags in medical settings merely say Sarah Smith, DNP?
If you assume medical doctors welcomed their health care colleagues using the title doctor you would be wrong. When the American Association of Nurse Practitioners first proposed elevating the degree to a doctorate, I read a rather negative letter to the editor from a doctor saying, a nurse was a nurse, not a doctor. “We do not need a doctor nurse.” Some states regulate who is allowed to use the title doctor in a medical setting and under what conditions. Virtually all states protect the use of certain titles. The following is from a recent medical journal:
As new roles in health care appear and existing roles grow, there is concern that nonphysicians may appropriate physician titles. Protecting titles is essential to ensuring that patients understand the qualifications and training of their health care providers.
General physician titles and suffixes, such as “M.D.,” “D.O.,” “physician,” and “surgeon,” are broadly protected throughout a majority of the United States. Unlike general physician titles, specialist titles, including “dermatologist,” are only protected in 3 states and Washington, DC. Most states allow for the broad use of “doctor” by nonphysicians in clinical settings but require explicit clarification of the practitioner’s doctoral field.
Now there is new debate about what other medical professions should be called. Physician assistant is a mid-level medical professional that collaborates closely with physicians. The American Academy of Physician Associates (AAPA) is changing the title from physician assistant to physician associate wherever it can. A lot of physicians are not happy with the name change:
The American Medical Association, which represents doctors, has called the name change a “branding effort” that will only confuse patients. The A.A.P.A. says the A.M.A. is “fearmongering” over bills being proposed in several states. What’s in a name, it turns out, is a lot. “Assistant” versus “associate” might sound like a trivial semantic debate, but to many practitioners, and to the American Academy of Physician Associates (which changed its own name in 2021), it’s an important part of the expanding role of P.A.s in health care.
Apparently, it is more respectable to be an associate than an assistant.
“Assistant” versus “associate” might sound like a trivial semantic debate, but to many practitioners, and to the American Academy of Physician Associates (which changed its own name in 2021), it’s an important part of the expanding role of P.A.s in health care.
“If it’s ‘physician assistant,’ even the patient thinks, OK, if you’re just assisting, then when’s the real provider going to get here?” said Chantell Taylor, chief of public affairs and advocacy for the A.A.P.A.
The American Medical Association has lobbied against other encroachment on its titles.
The A.M.A. has lobbied against name changes in other medical fields, too. It has argued against legislation that would let a podiatrist go by “podiatric physician” or a nurse anesthetist go by “nurse anesthesiologist.”
There is another title in a few states for medical school graduates who have not completed a residency but are working under licensed physicians. They are variously called assistant physicians or associate physicians. What’s in a name? A lot, apparently.
Read more at MYT: Physician Assistants Want a New Name and More Power. Not Everyone Is Happy.