Recent state laws restricting the use of the “doctor” title to physicians have sparked increased awareness and discussion about the decades-long debate over who should be able to use this honorific.1-2 This article aims to promote a balanced understanding of this longstanding debate by putting current events in a historical context and providing insights from professional societies and experts. 

History of the Honorific “Doctor” Title

The English word “doctor” is directly derived from the Latin “doctor,” which means “teacher.”3 The Latin noun comes from the verb “docere,” meaning “to show, teach, or cause to know.” 

This term’s use as an academic degree title began in the late 1100s when the University of Bologna awarded its first doctoral degree in civil law.4 Degrees in canon law, medicine, grammar, and other fields followed shortly thereafter. Once German and English systems began applying “doctor” to more advanced degrees, other countries followed suit, and this usage became the standard. 

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Medical schools started using “doctor” to describe graduates in the 1600s to denote respect.5 The medical doctorate (MD) degree represents the first vocation-associated professional doctorate in the United States, as opposed to a doctorate based on research and academic expertise. 

Today, despite some variation among countries, the doctor title is typically given in most fields that require extensive postgraduate training, such as doctors of philosophy (PhDs), medical doctors (MDs), and Juris doctors (JD), among others.4  

Current Events

Recent legal events in the United States represent another chapter in the history of the title “doctor.” As of 2023, several states have tried passing legislation to prevent nurses — even those with a doctorate of nursing practice (DNP) — from using the title.6 Notably, California and Georgia have successfully passed such laws.7-8 Florida would have joined them, but Governor Ron DeSantis vetoed the bill in July 2023.9

Nurse practitioners who hold DNPs have pushed back against this legislation. In California, 3 DNPs are currently suing the state over their law, asking for the court to intervene and prevent its enforcement.2 Their lawsuit comes less than a year after California ordered a DNP to pay almost $20,000 for referring to herself on social media and her professional websites as “Doctor Sarah.”6 

California prosecutors argue that their law and its enforcement are intended to protect the public from misleading statements.9 Jacqueline Palmer, one of the DNPs involved in the lawsuit against California, argues that she has never misrepresented herself as a physician and that her patients know which doctorate degree she holds.9 She adds, “It’s not an ego trip; it’s not a power trip. It’s just validation that I worked hard to get where I am today.”9 

Although other states, as previously mentioned, have similar laws to California, the attorney representing Palmer and her co-plaintiffs notes that California’s law is the most strict in the country.9 In reading the law literally, it seems to also prohibit PhDs and university professors from using the doctor title.  

What Do Professional Societies and Experts Think? 

Where professional societies and experts land in this debate varies widely and, unsurprisingly, can depend on which profession they represent. Although professional associations agree that MDs should be able to represent themselves as “doctor,” the American Medical Association (AMA) believes this is the only group deserving of this designation.10

AMA Favors Restrictive Doctor Title

The AMA reasons that restricting its use allows patients to make more informed health decisions based on the license of their health care professional.10

Gary Gaddis, MD, an emergency medicine physician, shares this sentiment in an article published in 2022, stating, “Unfortunately, some [advanced nurse practitioners (ANPs)] who have achieved a DNP degree refer to themselves as ‘doctor’ in the clinical settings.”11 He further argues that although ANPs could call themselves “doctor” in the academic setting, using this title in the clinical setting misleads patients and “defies their trust.”11

AANP and AAPA Favor Restrictive Doctor Title

The American Association of Nurse Practitioners (AANP) and the American Academy of Physician Associates (AAPA) agree with the AMA regarding patient education, stating that patients have the right to know who is caring for them.10 However, both also support the use of the doctor title by “doctorally prepared nurses” and PAs with doctorate degrees and oppose legislation that would restrict its use to only those holding an MD.

Beth Lina, PhD, an epidemiology, infectious disease, and digital health expert, has weighed in on this debate.12-13 In response to The Associated Press Stylebook guidelines that advise users to reserve the doctor title for people holding a doctorate in medicine, dental surgery, optometry, osteopathic medicine, podiatric medicine, and veterinary medicine, Lina expressed her discomfort. 

Lina argues, “By refusing to use the titles scientists have earned, news outlets contribute to the delegitimization of expertise,” adding, “‘Dr.’ is not an ‘honorifi[c] or simple job descriptio[n]’ and ‘is earned only upon demonstration of a deep independent understanding of a specific narrow topic.”13 

Other authority figures have also shared their perspectives. Stephanie W. Edmonds, RN, PhD, MPH; Alden A. Bush, DNP, MPH, PMHNP-BC; and Ginny L. Ryan, MD, MA, collaborated on an article about this debate for STAT.5 In their ideal scenario, all health professionals with doctoral degrees would use the doctor title in academic and professional settings, among colleagues only. They argue that the term should be removed from the clinical setting, as it sets up an unequal power dynamic between physician and patient.

Is There a Resolution?

Based on historical accuracy, it seems that the term “doctor” most accurately describes anyone with an advanced degree who teaches. In 2023, this applies broadly to many people achieving doctorate degrees, not just physicians. That said, nuances should be appreciated, and respecting the history of the “doctor” title does not negate the importance of clear communication with the public and with patients. If those holding advanced degrees in conjunction with professional societies can come together and formulate an agreement that respects the expertise of all parties while emphasizing transparency, then we may see a resolution to this decades-long debate that works for all involved.

References 

  1. Blake J. Who should be called a ‘doctor’? Inside Higher Ed. Published August 16, 2023. Accessed August 21, 2023. https://www.insidehighered.com/news/governance/accreditation/2023/08/16/who-should-be-called-doctor 
  2. Taylor M. Nurse practitioners sue California over restricted use of ‘doctor.’ Becker’s Hospital Review. Published July 18, 2023. Accessed August 21, 2023. https://www.beckershospitalreview.com/hospital-physician-relationships/nurse-practitioners-sue-california-over-restricted-use-of-doctor.html 
  3. Doctor (n.). Online Etymology Dictionary. Updated October 13, 2021. Accessed August 21, 2023. https://www.etymonline.com/word/doctor 
  4. Doctor. Britannica. Updated August 21, 2023. Accessed August 21, 2023. https://www.britannica.com/topic/doctor-degree 
  5. Edmonds SW, Bush AA, Ryan GL. No one — M.D. or otherwise — should use the honorific ‘doctor’ with patients. STAT. Published July 17, 2023. Accessed August 21, 2023. https://www.statnews.com/2023/07/17/doctor-honorific-nurses-with-doctorates/ 
  6. Taylor M. States take on ‘doctor’ title debate. Becker’s Clinical Leadership. Published August 21, 2023. Accessed August 21, 2023. https://www.beckershospitalreview.com/nursing/states-take-on-doctor-title-debate.html 
  7. Cal bus & prof code § 2054. Casetext. Updated January 1, 2018. Accessed August 21, 2023. https://casetext.com/statute/california-codes/california-business-and-professions-code/division-2-healing-arts/chapter-5-medicine/article-3-license-required-and-exemptions/section-2054-use-of-doctor-physician-dr-or-md 
  8. Hollowell A. Georgia blocks nonphysicians from using specialty titles. Becker’s Hospital Review. Published May 3, 2023. Accessed August 21, 2023. https://www.beckershospitalreview.com/legal-regulatory-issues/georgia-blocks-nonphysicians-from-using-specialty-titles.html 
  9. Wu D. Should nurses with doctorates be called doctor? Lawsuit targets Calif rule. The Washington Post. Published July 18, 2023. Accessed August 21, 2023. https://www.washingtonpost.com/nation/2023/07/18/doctor-nurse-title-lawsuit-california/ 
  10. Dean BF. Who gets to go by ‘Dr.’? 3 medical associations answer. Becker’s Clinical Leadership. Published April 14, 2023. Accessed August 21, 2023. https://www.beckershospitalreview.com/quality/who-gets-to-go-by-dr-3-medical-associations-answer.html 
  11. Gaddis G. Nurses with a doctorate in nursing practice (DNP) should not call themselves “doctor” in a clinical setting. Mo Med. 2022;119(4):314-320.
  12. ‌Yu A. Who gets to be called ‘doctor’? WHYY. Published January 10, 2019. Accessed August 21, 2023. https://whyy.org/segments/who-gets-to-be-called-doctor-and-why-it-matters/ 
  13. Who gets to be called ‘doctor?’ Why the controversial question divides journalists, academics, and more. Advisory Board. Published November 30, 2019. Republished July 18, 2023. Accessed August 21, 2023. https://www.advisory.com/daily-briefing/2018/11/30/doctor

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