What’s in a Name?

When I first heard of advanced practice clinicians earning doctorates, I was opposed to them using the term “doctor” in a clinical setting. When most people think of a “doctor”, they think of a medical doctor, an MD. Over the last 100 years or so this has grown to include the doctor of osteopathy, or DO. But what about all of those non-physician healthcare providers that are rightfully called Doctor? 

Medical doctors, i.e. allopathic and osteopathic physicians don’t own the term ‘”doctor” nor “physician”. The title doctor denotes a level of education; it does not belong to any one profession. A doctorate degree makes a doctor while an internship (first year of residency) makes a physician (unless you’re referring to a chiropractic or naturopathic physician or podiatric physician or optometric physician).

What are some examples of other doctors that patients commonly encounter? Who are those other healthcare providers that have terminal or doctorate degrees? Your dentist is a doctor and you wouldn’t hesitate to refer to him this way. The same can be said for your optometrist, chiropractor, psychologist, naturopath, etc. All are doctorate-holding clinicians. The term is not limited to the MD or DO, but correctly applied to the OD, DC, PhD/PsyD, and ND respectively. 

Most people are aware that the term “doctor” is also used outside the clinic. For example, your chemistry professor might have been Dr. So and So. I think we could all agree that it would inappropriate for these individuals to use the term doctor in a clinical setting. So what should be the determining factor? Many would argue that it’s simply the presence of a “clinical doctorate”. What is a clinical doctorate then? That’s a great question! That is what I hope to highlight throughout the first few years of this blog. 

As an advanced practice clinician (PA) of 8 years, I am well aware of what I know and much of what I don’t know. I know my limits. I can also clearly see how and where my skills need to improve. In order to maintain active licensure and certification, I have to get continuing education credits each and every year. I can’t always pick exactly what I want to learn about and some of the time it’s determined by what’s available and what time I have. There is really no recognition for completing this type of education as it’s a basic requirement to stay licensed. Recently, I’ve felt like it was time for me to make a larger, more structured return to academia to improve my ability to care for patients. 

I have great respect for my colleagues, both physician, and advanced practice clinician, whether PA or NP. I’m concerned, however, that many available doctorate degrees for advanced practice clinicians do little to improve clinical practice and therefore would not rightly be called a “clinical doctorate”. I believe that the MD is the clinical doctorate. At the risk of causing offense, I believe that the DNP or Doctor of Nursing Practice doesn’t even come close to hitting the mark. Yet many DNP’s choose to refer to themselves as “Doctor” while some institutions have had to establish policies regarding the practice. 

The DMS or Doctor of Medical Science is quickly becoming the de-facto doctorate degree for PA’s. In the past, interested PA’s would go on to receive a PhD, DrPH, DHSc, or other. I don’t believe any have ever tried to refer to themselves as a doctor in a clinical setting. The designation of “clinical doctorate” is a little less clear with the DMS or what some programs style as DMSc. Looking at the published curriculums, only two programs are currently and clearly pointed towards improving the practice of medicine: Lincoln Memorial University and Butler University. Rocky Mountain UHP is developing a DMSc in Psychiatry, which is interesting, but the core curriculum is still largely non-clinical, in my opinion. And at this point in the game, opinions matter–The DMS/DMSc are not standardized and need to be weighed individually. And at any point, perception matters.

So what’s the verdict? 

I’m not quite sure yet. As a PA, I have never wanted to be confused with a physician and have corrected many patients, many times. If I were to refer to myself as “Dr. So and So”, I think there would be too many who might confuse me with a physician (MD or DO, though this is debatable as well). We do often fulfill the same role. What about, “Dr. So and So, the PA”? Eh, equally confusing and quite a mouthful. 

So, honestly, I’m not quite sure. I am perfectly happy with patients continuing to call me by my first name–something patients appreciate and most doctors would never allow. But if someone asks me who or what I am, I just might respond: “I’m a Doctor of Medical Science and a licensed PA”. 

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