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Which Doctor is “The” Doctor?

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, dietitians, 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 patients understand the roles of those providing their care.

Physician educational standards were first established in 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.

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. Upon completion of medical school, they too, have earned the right to be called doctors.

In the past twenty years, the educational bar has been elevated for many of those in the health profession. Both, pharmacists and physical therapists were only required to earn bachelor’s degrees until 2004 and 2015, respectively. Both of these professions now require doctorate-level degrees. There is now a Doctorate of Nursing Practice offered as an option for aspiring nurse practitioners.  These healthcare providers are essential to patient care, and they have earned their doctorates and the right to introduce themselves using the aforementioned dignitary.

Regardless of the changes in educational requirements, all healthcare providers who hold doctorate degrees have unquestionably earned the right to introduce themselves as ‘doctor.’ Unfortunately, the term ‘doctor’ is usually synonymous with ‘physician’ especially in healthcare settings. 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. In each of these situations, doctor is used as a synonym for physician.

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.

Many patients assume that all people who introduce themselves as ‘doctors’ are physicians. In reality, however; using the ‘doctor’ title and being a doctor can represent entirely different but equally important realms of clinical knowledge.  Because of this, the American Medical Association (AMA) performed a study in 2010 and 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.”

Based on the results of this study, the AMA enacted the Truth in Advertising Campaign which required all healthcare professionals to completely and accurately identify themselves in all communication.  Some states went so far as to make it illegal for non-physician healthcare providers to introduce themselves as ‘doctor’ without immediately clarifying their professions.  This is unfortunate as they have worked tirelessly and excelled academically to earn their doctorates, and they should unquestionably be recognized as achieving the top degrees in their respective fields.

Some may argue that patients should ask if they are unsure of their health professional’s status; however, it is not a patient’s responsibility to garner clarification. That burden of clear communication lies with us, the current and future health care professionals. We are or one day will be responsible for their lives, and we should be responsible for clarity in communication.  All graduates of doctorate programs have earned the right to introduce themselves with the ‘doctor’ dignitary, and the question of whether patients understand which individuals are providing their care can be answered simply: by clearly explaining roles, encouraging questions, and asking patients if they understand.

Current and future physicians, pharmacists, physical therapists, nurse practitioners, physician assistants, and those in other disciplines are responsible for providing comprehensive care to patients.  I am excited to be a future member of the healthcare team, one that encourages collaboration, teamwork, and communication and is comprised of a much larger variety of doctors and those of any and all educational backgrounds.

Lydia Boyette, DO, MBA (4 Posts)

Managing Editor Emeritus (2018-2019)

Campbell University School of Osteopathic Medicine

Lydia Boyette is excited to be a managing editor for in-Training Magazine. In May 2019, she graduated cum laude with a Doctorate of Osteopathic Medicine and summa cum laude with a Master of Business Administration. Lydia matched via the NRMP into anesthesiology residency at the University of Central Florida.

Throughout medical school, Lydia wrote stories about her experiences learning clinical skills and has had her work published by PubMed, KevinMD, and StatPearls, LLC.

Additionally, Lydia has spent a significant amount of time working for community health centers in rural areas. She served as a student physician ambassador for her medical school and previously held the position of editor-in-chief for the local community health clinic's newsletter.

In 2015, she graduated magna cum laude with a Bachelor of Business Administration in healthcare management and a minor in general science from Campbell University in Buies Creek, North Carolina. She also served as an English composition tutor and editor. While completing her undergraduate degree, Lydia was inducted into several honor societies including Phi Kappa Phi, Delta Mu Delta, Pre-Med Allied Health, and Who's Who Among Students Class of 2015.