A California federal judge has ruled that nurses with doctorates do not have the right to call themselves doctors.
Here is what to know:
1. The case concerns a California law that allows only physicians and surgeons to use the word “doctor” or the prefix “Dr.” In June 2023, three nurse practitioners with doctorates of nursing sued the California attorney general, the medical board of California and the state board of registered nurses, arguing they have a right to call themselves doctors. The suit came after one of the plaintiffs was fined $20,000 by the state and another $2,500 by the state medical association for describing herself as a doctor on professional websites and social media.
2. In a Sept. 19 decision, District Judge Jesus Bernal of the U.S. District Court for the Central District of California rejected the claims that the state violated the plaintiff’s First Amendment rights by banning nurses with a DNP degree from using the title “Dr.” in healthcare settings. Mr. Bernal ruled that the use of “doctor” by nonphysicians in clinical settings is “inherently misleading” commercial speech and not protected by the First Amendment.
3. Mr. Bernal wrote that evidence showed that doctor titles for DNPs can confuse patients. He referenced an AMA survey that found 39% of patients believe a DNP is a physician.
“The Court finds that it is reasonable to infer that some consumers will assume that plaintiffs are licensed physicians or surgeons if they use ‘Dr.’ or ‘doctor’ in healthcare settings and in advertising materials promoting medical services, even if plaintiffs also identify themselves as DNPs,” he wrote.
4. The ruling also said that while using “doctor” in the healthcare setting is not a traditional form of advertising, the “specific product” the plaintiffs seek to advertise is expertise, knowledge and quality services, thus giving plaintiffs an economic motive “to solicit and retain a patient base and improve their professional brand,” he wrote.
5. The nurse practitioners’ lawyer said the plaintiffs were disappointed by the ruling.
“Instead of reining in the state’s power to censor professionals who accurately describe their credentials, the decision emboldens it,” Donna Matias, an attorney representing the nurse plaintiffs, told Medscape Medical News. “The First Amendment does not allow the government to silence truthful speech simply because some listeners may be confused — especially when disclosure can address any concerns short of a total ban.”
6. The California Medical Association welcomed the decision.
“This decision protects patients by providing clarity and transparency about the level of training and education of the person providing their care,” CMA President Shannon Udovic-Constant, MD, said in a Sept. 24 statement. “Allowing patients to make informed decisions is foundational to our healthcare system.”
The CMA and American Medical Association filed a joint amicus brief in the cases, stressing that misuse of the doctor title could erode patient trust.
7. Debate over the use of “doctor” for clinicians who do not hold an MD or DO have been ongoing for years. Some argue that clinicians should have the same right to refer to themselves as doctors much as their colleagues outside of healthcare who have a PhD, EdD or other doctorate degree can. Healthcare groups have remained firm that the doctor title should be exclusive for those holding an MD or DO to avoid patient confusion.
8. The California ruling could have broader implications for other states that are considering enacting similar laws to ban the use of “Dr.” for clinicians.
