Over the past hundred years, health care has changed dramatically. What used to be a physician-patient relationship has evolved to include multiple professionals trained in different disciplines. Now, this team of what once involved only two players has expanded to include nurse practitioners, physician assistants, dieticians, occupational therapists, physical therapists, pharmacists, and many other disciplines. Previously, the physician was the only health care provider required to earn a doctorate degree. However, with the rise in educational standards across the United States, many health care professionals now must possess doctorates in their respective fields before even beginning their careers. These non-physician health care professionals have earned doctorate degrees, but the question remains unanswered as to whether or not it is ethical for them to introduce themselves to patients as “doctors” in health care settings.
In the past twenty years, the educational bar has been elevated for many of those in the health profession. While this unlikely serves to mitigate rising health care costs, it has not been definitively proven that patient outcomes have been positively affected. Up until 2004, pharmacists were only required to hold a bachelor’s degree. Similarly, a bachelor’s degree was the standard for physical therapists until 2015. Both of these professions now require doctorate-level degrees. In total, pharmacists are required to spend at least two years pursuing undergraduate health-related coursework followed by four years of pharmacy school which can then be bolstered with one to two years of optional residency. Physical therapists are usually required to earn a bachelor’s degree before completing a two and a half to three year doctorate of physical therapy program. In total, pharmacists are required to have six total years of training while physical therapists may take up to seven years to complete their programs.
In contrast, physician education standards have been stringent since the thirteenth century. During this time, the first Doctorate of Medicine was granted by Schola Medica Salernitana which was a medical school in Salerno, Italy. Earning the degree required four years of didactic training followed by one year of supervised practice. Four centuries later, Columbia University issued the first North American Doctorate of Medicine in 1767.
The requirements to become a physician have remained relatively consistent for around six hundred years. Currently, physicians must complete a bachelor’s degree in addition to the prerequisite courses in English, chemistry, physics, biology, anatomy, and organic chemistry if not already included in their degree’s curriculum. This is followed by four years of medical school after which is three to seven years of residency training depending on specialty. If physicians choose to sub-specialize in a particular field post-residency graduation, they may apply for fellowship programs ranging from one to three years in length. Thus, the minimum number of years of education and supervised practice needed for a physician is eleven years while for some sub-specialties as many as eighteen years may be required.
Regardless of the differences among education lengths, physicians as well as other health care providers who hold doctorate level degrees have technically earned the right to be called “doctor.” In today’s society, however, the term “doctor” is usually synonymous with “physician.” At the end of almost every pharmaceutical advertisement on television, almost universally the phrases “Ask your doctor if you experience side effects while taking this medication,” or “Ask your doctor if it is okay to resume physical activity while taking this medication” are standard. Patients make appointments with their doctors, and parents jokingly encourage their children to marry doctors. In each of these situations, doctor is unquestionably used as a synonym for physician which is a term that only encompasses those who have earned either a Doctorate of Osteopathic Medicine (D.O.) or a Doctorate of Medicine (M.D.).
Thus, when people introduce themselves as doctors, the natural inclination is to assume that the so-called ‘doctors’ are physicians with either a D.O. or M.D. who attended four years of medical school along with three to ten years of graduate medical education. In reality, however; using the ‘doctor’ title and being a doctor can represent entirely different realms of clinical knowledge. A survey by the American Medical Association (AMA) in 2010 found that only fifty-one percent of respondents found it “easy to identify who is a licensed medical doctor and who is not by reading what services they offer, their titles, and other licensing credentials.” Because of this, the AMA enacted the Truth in Advertising Campaign which required all health care professionals to completely and accurately identify themselves in all communication.
One aspect that has made this topic debatable is the setting in which the doctor title is used. For example, when professors at various universities introduce themselves with the aforementioned dignitary, most people in the classroom are aware that their professors are not physicians but rather, well-educated individuals in their fields of study. However, in a health care setting, patients often assume that professionals who introduce themselves as a doctors are, in fact, physicians, and this is especially true in areas with a lower socioeconomic status where the average education level is less than a bachelor’s degree.
While it is understandable that non-physician doctorate degree holders want to be recognized as achieving the top degree in their field, the fact that non-physician health care personnel are introducing themselves as doctors leads to ambiguity of clinical responsibility and knowledge. For example, one should consider the following two introductions by a non-physician: “I am Dr. John Doe,” versus, “My name is John Doe, and I am a doctor.” Both are portraying the same information. Most non-physicians would never introduce themselves using the latter, as it would be a mischaracterization, ambiguous, and unethical; however, they may argue for use of the former introduction. Because of this, some states have made it illegal for non-physician healthcare providers to introduce themselves as ‘doctor’ without immediately clarifying their professions.
As a medical student, I can look at individuals’ badges and determine whether they are physicians. However, as current or aspiring health care providers, we often forget that the average patient does not know whether the physician is Joe Smith, PhD who introduced himself as ‘Dr. Joe Smith’, or whether it is Jane Doe, Pharm D., who introduced herself as ‘Dr. Jane Doe’, or Sarah Jones, DO, who introduced herself as ‘Dr. Sarah Jones’. The patient may believe that all three are capable physicians and would not think to ask for clarification.
Some may argue that patients should ask if they are unsure of their providers’ status; however, this is unreasonable. The burden of clear communication should not belong to patients. That burden lies with us, the health care professionals. We are responsible for their lives, and we should be responsible for clarity in communication. The question of which individuals should be allowed to introduce themselves as “doctors” should not be answered based on pride, but rather by carefully reviewing the medical ethics of the context with the highest emphases placed on patient education and safety.