From the Oxford Dictionary: Doctor.
a qualified practitioner of medicine; a physician. (a number of synonyms are listed, including “quack”)
a person who holds a doctorate.
Increasingly, non-physicians are using the term “doctor.” Clearly, a doctorate degree allows the holder to use that term semantically, contextual puffery or not. Nurses can obtain a doctorate degree through a rigorous peer-reviewed process of study. PhDs in various fields likewise. All MDs are doctors. Not all doctors are MDs. All physicians are doctors, but only MDs and DOs can claim the title of physicians. Everyone is a provider.
The term “clinician” can be used for anyone in health care who works with patients, diagnosing or treating illness. “Illness” is a key word (aestheticians may not fit that term; they deal with beauty, not disease). A clinician might be a physician or nurse, a psychologist, or a speech-language pathologist, a physical therapist, even a chiropractor, as examples.
Most states allow clinicians with a doctorate degree to identify themselves as a doctor as long as they immediately clarify their role and qualifications. Two states — California and Georgia — have banned the use of “doctor” for advanced practitioners who earned a doctorate degree. California fined a nurse who called herself a doctor, sparking a lawsuit from others wanting to use the title after earning DNP degrees. Two other states — Indiana and Florida — have introduced bills that would ban the “doctor” title, but the bills have been vetoed or have not yet made it through the legislative process.
Why does it matter? Medicine is a profession, and graduates of medical schools and schools of osteopathy (Dos) go through a rigorous course of scientific study lasting years, as well as years-long subsequent apprenticeship training (residency) under the supervision of licensed practitioners, typically in university settings. Using interchangeable terms by those not so educated and trained is demeaning to those who are.
But it is not about demeaning physicians so much as it is about the protection of consumers and patients (not always the same, as increasingly health plans can be “consumers”), and their understanding of the type and value of services being provided. I would also argue that the proper use of the term “physician” has a psychological value to the recipient of such services. Faith and trust in those services being at the highest level has a therapeutic value, even if a component is the placebo effect.
Payment for services distinguishes the vernacular “professional” from an amateur. But a legitimate profession has a sociological definition, legitimized by having a base of technically specialized knowledge. A profession’s validated knowledge rests on rational or scientific grounds; that is, an evidence base, or an accepted, certified body of knowledge (law). That knowledge and competence are continually validated by the community of peers, and its continuing education standards. Perhaps most importantly, that professional knowledge results in judgment, advice, and actions oriented towards a set of substantive societal values – health and well-being in the case of medicine. Service rather than profit is enshrined in its code of ethics.
Hence, the medical profession is cognitive, collegial, and moral. Because of this legitimization process, physicians achieve a coveted status of professional authority. Authority is a valuable asset. It increases the probability that people will obey a legitimate command or call to action and that a particular definition of reality and judgment of meaning and value will prevail as valid and true. For example, we heed doctors’ warnings about smoking, taking needed medication, and vaccinations for personal and societal benefit. Physicians’ authority also creates a dependency condition: Patients acknowledge the professional’s superior competence within a deep context of emotional and physical needs in the patient–physician relationship. A component of this dependency condition actually promotes therapeutic success. Therefore, professional authority is worth preserving and nurturing.
The term “provider” is a significant erosion of the cultural authority physicians deserve. Having non-physicians pose as “doctors” in the health care setting is countertherapeutic, and at worst, could harm patients. PhDs deserve the cultural authority that title confers in their particular disciplines, academic and others, including doctors of jurisprudence. I would submit that anyone who passes the Bar can call themselves a lawyer, even if they did not go to law school (in states where eligibility for the bar exam does not require a formal course of study), but the client deserves to know the distinction. The term “physician” requires no explanation. The term “doctor,” however, may.
The term “provider” should be stricken from the lexicon of health care, as it is meaningless. As we go into the annual open enrollment period for health care benefits, see how many physicians are in the plan you are selecting. I hope this essay “provided” some clarity.
Michael Brant-Zawadzki is a radiologist and physician executive.
