And Then You Have This…

Once again I am bothered about this.  This is ALL about creating confusion for the patient.  It is a concerted effort by the lobbying groups behind the NPs.  It devalues me and my education. It confuses the patient.  And it is not good for our healthcare system.

So, to summarize, first you have this:

And then you have this:

Under this bill, an advanced practice registered nurse who has attained a doctor of nursing practice degree may use the prefix “Doctor” or “Dr.” as long as the suffix “DNP” follows the person’s name and an advanced practice registered nurse who has attained a doctor of philosophy in nursing degree may use the prefix “Doctor” or “Dr.” as long as the suffix “Ph.D.” follows the person’s name.

Your thoughts?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  16 comments for “And Then You Have This…

  1. Carol M Puopolo RN, BSN
    April 26, 2017 at 8:31 am

    It is a continued state of ” Degree Inflation”. an MSN used to be hard to get, and meant something- usually for academia or clinical nurse specialists;and a PhD, which we all know is a Doctor of Philosophy, was meant to head departments. The NP was originally meant to work in rural areas where there were not enough doctors, was in a way even harder to get, and they worked closely with doctors. they essentially now act as PA’s.
    The worst yet, are the programs like MGH’s Health Sciences “Direct Entry Program”, which in addition to turning out an RN with an MSN in 18 months (would have taken me 6 years), they encourage those graduates to have an entitled attitude, and a loathing of “just RN’s”- yup- they themselves are being told to view RN’s as “Just RN’s.
    As a graduate of a BSN program in the 1970’s, when that was unusual, I worked my way thoughas a NA at a major Boston teaching hospital with incredible RN’s who really taught me how to be one. Even then, my Alma Mater discouraged it, saying I would have an “aide’s mentality”. Hmm. What I believe is that it taught me how important CNA’s are, and how many look down on them. I guess I was taught to treat others as I wish to be treated. It also amazes people that while I have been everything from a NA to a “Head Nurse”( or unit manager,whatever), I loved acute care nursing, and practiced it on a high acuity major teaching hospital unit for almost 40 years, both at Lahey Clinic (for 35) and MGH (for the last 5). It truly amazed attendees at the International Council of Nurses Conference that I attended in Malta. I guess it’s still the same Bull Shit (BS), More Shit (MS), and Piled higher and Deeper (PhD)
    And to all those who are offended, I know many who have doctorates, yet never refer to themselves as “Dr”, or request to be addressed as such. Before the requirement at colleges to have anyone teaching have a PhD, I usually heard it in the academic community, where as soon as a professor got it, they ran to maintenance to have the name change on their door. I guess if you have a poor regard for yourself, or your profession, you have to keep screaming”Look at me Look at me”

  2. Jay Cooperman
    April 15, 2017 at 10:46 pm

    After practicing internal medicine for 33 years now, I experience the general erosion of respect like all the above have commented. This is not confined to doctors, but has seeped into our perception of every authority figure in society. Whether this is an inevitable consequence of democratic principles, or symptomatic of some insidious humanistic reaction to religious doctrine is unclear. Some of the behavior of authority figures, from politicians to celebrities, and yes, doctors as well, certainly hasn’t helped. By all means, we should be proud of our accomplishments, and take ourselves seriously. But that doesn’t mean we have to be a-holes. And lets face it, some of us are. But to the point about confusion arising in patients’ minds because of doctorate titles being used by non physicians, this happens regardless of titles. My wife, who has worked as a nurse practitioner for over 20 years, is often addressed by patients as doctor, no matter how often she corrects them. And she does every time. My conclusion: patients do this as a sign of respect, which has been earned by her professionalism, intelligence, and more important, results. If “physician extenders” practice by scripted protocols, wasting patients’ time and money and delaying necessary care, then they will not be respected. If they are well educated, intelligent, conscientious, and get good results, then patients will respect them just as they do doctors who embody the same qualities.

    • Pat
      April 16, 2017 at 12:48 am

      In essence you are accepting the premise that nurse-doctors can be on par with medical doctors. Then Jay, you are saying that those of us who spent the extra years in med school and residency wasted our time. My challenge is that the LELT’s should say that they are just as good forthrightly, instead of this degreed incrementalism.

  3. Dave Mittman, PA
    April 15, 2017 at 1:02 pm

    Doug: I don’t get it…
    You are barking up the wrong tree here. This is not a fight that is fair. This ship sailed a long time ago. I honestly feel people who get doctorates should be able to let their patients know they have them.
    Let me explain. Dentists are “Doctors” but that never bothered you. Many and all new audiologists who work in the same offices as ENTs are “doctors” but that never bothered you. Many and all new PTs are/will be “doctors” and they work arm and arm with rehab physicians but that never bothered you. Optometrists are “eye doctors” and that never bothered you. Podiatrists are doctors and podiatric “physicians” in many states (not to mention optometric “physicians” and chiropractic “physicians”) also, but you are not attacking them). Psychologists who could easily be confused with psychiatrists are doctors and not a sound from you. And my favorite, call a chiropractor’s office and see what they have been called for years. That’s not confusing? Even athletic trainers have started doctorate programs. But let an NP or my bet is you would feel the same about a PA, earn a doctorate and you feel threatened. Why don’t the other above professions threaten you also? I call unfair on this.
    Doctorates will abound throughout healthcare and at the end of the day, it’s better for patients. If people are going to be able to do whatever they do, let them get educated to as high a level as they can. We can debate the merits of that education later but these schools be they chiropractic, nursing, dental or podiatric are licensed by the same state that licenses all of us. Yes, we will all have to explain what our doctorates are in and yes, you are a physician with excellent training and knowledge. That will have to be enough in your eyes. Why is others you work with having a doctorate a bad thing? in any other field, your employees or co-workers having a doctorate would be a thing you would be proud of.
    As I said, why only nursing? Why if they have to also must identify themselves as an NP? Why not any of the others? Do they have to identify their profession? Ever been to a dentist who went out of his way to tell you he was not a physician? How about a maxillary SURGEON?
    As I said, this ship has sailed-and I don’t have a doctorate.

    The above reflects my personal opinion only.

    • Sir Lance-a-lot
      April 15, 2017 at 2:59 pm

      Okay, Dave, I’ll bite.

      In the English language the title “Doctor,” when used to refer to a health care professional, has a specific meaning that most ordinary people will conflate with that person’s qualifications, but which is actually separate from those precise qualifications.
      The etymology of the word “Doctor” actually goes back to a meaning of “Teacher,” but in current English usage it has come to mean two distinct, but usually combined things:
      The first is “Healer.” That’s actually a big, and a hard, expectation to live up to, and when used this way, the term is given to a person by others, sort of like when military Medics or Corpsmen, or paramedics are called “Doc” by their patients. It’s a term of respect, and I have no problem with it being used by patients when they address NPs, PAs, or medics, so long as the patient himself knows the actual qualifications of the professional in question.
      The second is as the most educated, most qualified, and most authoritative person within the group of medical personnel. The doctor has a medical degree. The doctor completed a residency (or more). The doctor is in charge. When different people are all “doctors,” then the patient doesn’t know who is what (sort of like the common state of affairs in most hospitals today, where the patient doesn’t know that that woman in scrubs over there is the cleaning lady, that other woman in scrubs is the aide, the guy in scrubs is the nurse, the other guy in scrubs is the resident, and that other woman over there is the attending), which leads to confusion and is wrong.

      To go through your list:
      Dentists are doctors. They are tooth doctors. The go to Dental School and Dental Residency. Nobody contests this.
      Podiatrists are doctors, just like Dentists are. They go through podiatric school and residency, and are often granted OR privileges at hospitals, where they perform surgery.
      Audiologists may have doctorates (first I’ve heard of it), and I’m glad if they do. If so, they, as experts in hearing aids, are the rough equivalent of Optometrists, who are experts in vision correction, and who are commonly called Doctor. I’d be annoyed about Optometrists if I were an Opthamologist, but since I’m not, I really don’t care, because each of these people, like the Dentist, performs a very specific function that cannot be confused with the practice of medicine.
      Chiropractors are doctors because of a legal quirk that goes back to the 1850s. Some of them are good at what they do (manipulative therapy), while some are just good at siphoning from the patient’s wallet, but their title goes back a long way and is well established, and there is nothing I can do about it now.
      Psychologists are doctors because they completed a rigorous academic program, with extensive practical rotations and supervision, and, once again, the work they do (psychometric testing or psychotherapy) is quite distinct from what Psychiatrists do (10 minute med checkups and astounding polypharmacy). Psychologists are also independently licensed professionals who can start their own practices, which have a limited and very specific and well understood scope, and can practice independently, but cannot prescribe medicines.
      By the way, I have no problem with Lawyers being called “Doctor” either (they do have JDs, after all), but you will notice that they prefer not to be, as they are lawyers, and calling them “Doctor” would be confusing.
      PAs and NPs, on the other hand, have, in a general sense, the exact same scope of practice as a doctor, and, to the patient, appear to be doing the same thing (taking a history, doing an exam, doing procedures, prescribing treatment and medications), but they have less training and cannot do as much, leading to the certainty that their roles and training will be misunderstood by the general public, and creating the absolute necessity that they not be permitted to mislead the public as to their training and qualifications be referring to themselves using the same terminology as that of others in the same field.

      In New York, it is against the law for anyone other than an RN to call himself a “Nurse.”
      This is because RNs do not like it when the LPN, CNA, PCA, office assistant, or janitor calls themselves “Nurse.” Somehow, though, it is okay, and not confusing, for those same nurses to call themselves “Doctor.”

      I have no problem with the people I work with having academic qualifications (so long as those people do not believe that their academic experience is equivalent to actual experience).
      What I do have a problem with is people I work with who are not doctors being allowed to call themselves doctors, as it confuses the patients.

      • Dave Mittman
        April 15, 2017 at 3:17 pm

        Some fair comments.
        At the end of the day, in 10 years, this will all be history. Things evolve and change.
        I agree fully that one should never mislead. Never. I know many of the professionals that we talk about now who do. I am sure some in every group will attempt to.
        I can’t tell you how hard it is to change thinking with patients. Even when I spent considerable time telling them I was a PA (and I ALWAYS DID), what I did, my education, they said, “Thank You Doctor” or after a number of times seeing them, they said, “I know you are a PA, but you’re my doctor to me!”. Yes, to many doctor does mean healer. My parents used to call the druggist “Doc”. Treated them before they went to see their GP. As a medic I was called “doc”. Never intended to fool anyone.
        Still, the doctorate ship has sailed many years ago. I think there are more important things for all of us to stick together on, than to worry about people telling patients they have doctorate degrees. You never addressed the three groups saying they are physicians who in my view are not. Is that not crossing the line also?

    • Pat
      April 15, 2017 at 4:29 pm

      Dave, I hope you will be stand-up enough to go to my piece yesterday and answer my question. Thus far none of your colleagues have had the guts.

    • Doug Farrago
      April 15, 2017 at 4:52 pm

      They are in the same “field”, which is primary care and it is a concerted effort to confuse the patient. That is the difference. And their education and training is not even close to being same.

  4. Steve O'
    April 15, 2017 at 9:46 am

    In my neck of the woods, a partial-year “residency” qualifies PharmD’s to be called “Doctor.” They change my prescriptions occasionally. Since they are “pharmacy doctors,” the weight of the decision defaults to the drug experts.

  5. Sudha Prasad
    April 15, 2017 at 9:15 am

    If it has devolved to a job for monkeys, face it-does it really matter who is pushing the buttons on the keyboard? (btw, my high school aged son is looking for summer work-related are you up for a vacation?l)….

  6. Fred powell
    April 15, 2017 at 8:14 am

    Anyone who can be called Dr in a clinical setting should be governed by the board of medicine and be held to the same standard legally as a physician.

  7. Thomas Guastavino
    April 15, 2017 at 7:22 am

    An economics professor once taught me that in times of financial stress work will flow to the person with the minimal requisite amount of training that is willing to do the job for the least. That is whats happening to health care now. The only defense is to get additional training and develop unique skills so that there is not a lot of competition. That is why the medical super specialists are thriving while the generalists will continue to take it on the chin.

    • Steve O'
      April 15, 2017 at 9:59 am

      Go ahead – let’s come out of the closet. Remove TITLE 21 CHAPTER I, SUBCHAPTER C PART 201 “LABELING.” I believe that’s the Federal law that restricts certain drugs to licensed prescribers. As long as they’re not controlled substances, let Joe at the Hardware Store – you know, the guy who tells you that statins are lethal for diabetics – let him put his money where his mouth is. You want fries with that statin? If it takes no more intelligence than googling “digoxin,” give it a whirl for Pops and his chest pain.
      That’s not meant to be sarcastic. We have no regulations on who can buy chainsaws, do we? The biggest cost to the Health Industry (insurers and hospitals and authorities, oh my!) is the cost of professional liability. That means doctors making professional decisions, which are now viewed as obnoxious to the customer who wants what he wants, now! Why should we make people queue up to by inhaled beta-agonists and antibiotics for viral illnesses? They don’t like it, we don’t like it.
      Call it “Freedom of Self-Determination in Healthcare!” That way, insurance companies don’t have to cover unnecessary doctor visits for patients to get prescriptions.
      Give ’em what they want.

      • Sir Lance-a-lot
        April 15, 2017 at 2:01 pm

        “As long as they’re not controlled substances…”

        Why limit it?

        I’ve been saying for years that currently controlled substances should all be OTC.

        Most of us are able to take a Percocet or two if we strain our backs or twist an ankle, and then not take any more. It’s only a small portion of the population that has a problem with drugs, and — Newsflash! — they’re getting plenty of whatever they want, whether pharmaceutical or home-grown, anyway.

        Leave it wide open, let the druggies do their thing (for a low retail price, so they don’t need to steal my hubcaps to get their next high), let the regular folks get what they need, and leave me and my license the hell out of it.

        • Pat
          April 15, 2017 at 4:36 pm


    • Pat
      April 15, 2017 at 11:04 am

      So why shouldn’t PA’s or nurse-doctors do the simple ortho surgeries? And aren’t they all pretty simple?

      Absurd as that would be, that is what I want to hear from the play- doctors: can they really do it all, and if not, what are the limits?

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