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Around one year ago, we blogged about “Who is Entitled to be Called Doctor?”
We deciphered California’s existing rule:
Introducing State of California Business and Professions Code §2054
2054. (a) Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that he or she is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that he or she is entitled to practice hereunder, or who represents or holds himself or herself out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor.
(b) Notwithstanding subdivision (a), any of the following persons may use the words “doctor” or “physician,” the letters or prefix “Dr.,” or the initials “M.D.”:
(1) A graduate of a medical school approved or recognized by the board while enrolled in a postgraduate training program approved by the board.
(2) A graduate of a medical school who does not have a certificate as a physician and surgeon under this chapter if he or she meets all of the following requirements:
(A) If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B) Does not otherwise hold himself or herself out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C) Does not engage in any of the acts prohibited by Section 2060.
(3) A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
What does this mean without the legalese?
1. You either need to have an active license or be covered by an exception.
2. One exception is if you are licensed in another state (or even another country) and you do not represent yourself as someone practicing medicine in California.
3. But if you are not licensed in another state (or even another country) or not in an approved postgraduate medical school program, you are at risk for being charged with a misdemeanor.
What a difference a year makes…
In November 2022, California District Atty reached a settlement with a California nurse practitioner, Sarah Erny. She also holds a doctorate degree in nursing practice.
Sarah Erny, R.N., N.P., earned a doctorate degree in nursing practice. Shortly thereafter, she began promoting herself as “Doctor Sarah Erny.” From October2018 until March 2022, Ms. Erny hosted a professional website and was active on various social media accounts wherein she identified herself as “Dr. Sarah Erny.” While in most instances Ms. Erny indicated that she was a nurse practitioner, she failed to advise the public that she was not a medical doctor and failed to identify her supervising physician. Adding to the lack of clarity caused by referring to herself as “Dr. Sarah,” online search results would list “Dr. Sarah Erny,” without any mention of Ms. Erny’s nurse status.
The civil judgment requires Ms. Erny to pay civil penalties totaling $19,750 and to refrain from referring to herself as “doctor” in her role of providing medical treatment to the public. It also requires Ms. Erny to identify and make reasonable efforts to correct information on internet sites referring to her as “doctor” or “Dr.”
So, while Sara Erny holds a doctorate in nursing, the state mandated she pay ~$20k in fines and muzzle herself – never labeling herself as doctor in her care of patients.
News of Erny’s prosecution spread faster than a California wildfire among the nursing community.
Three California NPs, who also hold doctorate degrees in nursing, just filed a lawsuit against the California Attorney General and the Medical Board of California seeking Declaratory and Injunctive Relief. They want to be able to be called doctor and not run afoul of California Business and Professions Code §2054(a).
The three NPs are:
(a) Jacqueline Palmer. She earned a doctorate in nursing practice in 2020.
(b) Heather Lewis. She earned a doctorate in nursing practice in 2023.
(c) Rodolfo Jaravata-Hanson. He earned a doctorate in nursing practice in 2023.
As alleged in the lawsuit, “Defendant’s Actions Chill Plaintiffs’ Speech:
News of the actions against Dr. Erny appeared in the media, where Plaintiffs learned about them. As Doctors of Nursing Practice who have used, use, or intend to use the title “Dr.” in their practice and on websites and social media, Plaintiffs fear that Defendants will take action against them similar to those taken against Dr. Erny.
At the family practice clinic where she serves primary care clientele, Dr. Palmer’s colleagues, including physicians, have never expressed concerns that she is referred to as “Dr. Palmer, FNP.” When she interacts with her patients at the clinic, she explains that she is a Nurse Practitioner and not a physician. Dr. Palmer’s clinician’s jacket has her name embroidered with “Dr. J. Palmer, FNP-C.” She has signed her name using “Dr.” and qualified with “FNP” on official clinic documents.
Dr. Palmer has never misrepresented to anyone, directly or indirectly, that she is a physician, nor have her patients or physician colleagues mistaken her for a physician.
Since learning about Defendants’ actions against Dr. Erny, Dr. Palmer no longer signs her name with the title “Dr.” She has hung up her clinician’s jacket embroidered with “Dr. J. Palmer, FNP-C” on the front. She has asked others in the clinic not to refer to her as “Dr.” and has refrained from referring to herself that way. Dr. Palmer fears that Defendants will open an enforcement action against her.
A recent DNP graduate, Heather Lewis intends to change her business cards, office name plate, and scrubs to accurately reflect her latest accomplishments, specifically to read “Dr. Heather Lewis, FNP-C, DNP.” On social media, Dr. Lewis truthfully describes herself as “Dr. Heather Lewis, FNP-C, DNP.”
Since learning about Defendants’ actions against Dr. Erny, Dr. Lewis now fears that Defendants may open an enforcement action against her.
The three NPs are alleging a violation of their First Amendment Right to Freedom of Speech. They want California Business and Professions Code §2054 declared unconstitutional under the First and Fourteenth Amendments of the US Constitution.
If they win, Dr. Phil, Dr. Dre, and Dr. Jill Biden will be able to rest easy.
What do you think?
Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.
"Can Medical Justice solve my problem?" Click here to review recent consultations...
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
Jeffrey Segal, MD, JD
Chief Executive Officer and Founder
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.
Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.
Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.
The wording of this rule is so narrow that even a doctor of Osteopathy (DO) who is in all ways equal in training and qualifications to an MD would be found in violation. A doctor of Optometry (OD) who is considered by Medicare to be a physician and equivalent under federal law for patient care (with the exception of invasive surgery) would also be in violation. I wonder if the state wants to choose this hill to die on.
Dr Murphy, OD, I doubt the state cares very much, compared to “you know who”. So I agree it is questionable if the state wants to defend the stance that was created in legalese by “you know who”.
Yet, it raises valid questions.
As primary healthcare providers, you and yours likely have felt it inappropriate for PhD holders to “call themselves doctors”. Right?
And you and others recognize the growth of mid-level providers. So the question goes back to the origin of mid-level providers, when many primary care providers said “if you want to be a doctor, go to “doctor school”.
Well… they didn’t want to go that route, and now it is coming around to “I used to be an auxiliary, then I became a mid-level provider, and now I want to be called “Doctor”.
I’m not sure, but I stand on the ground that their circuitous route did not cover all the ground necessary to be the primary diagnostician and primary prescriber of treatment.
I think they took the PhD route…where technically they have a case, but actually, they are circumventing the breadth and depth of training to be a Doctor in the healthcare sense. They have a doctorate in mid-level providership.
Dr. Bloom: You do realize that according to the above, neither you nor I can refer to ourselves as “Doctor.” We are not, technically, physicians. However, according to my father, Martin R. Schlissel, PhD, only PhDs can be referred to as “Doctor” because only they have written a dissertation. This has led to many joyful discussions in my household.
First, I know I am a doctor because my mother always introduces me with “meet my son, Doctor Bloom.”
Second, I know our degree says Doctor of Dental Surgery.
Third, I don’t know of any medical doctors who can do much doctoring in the mouth, reading dental xrays, treating dental diseases, etc…so I think they don’t mind that we call ourselves doctors, Doctors of the Mouth, Oral Physicians, etc. (As long as we don’t pretend to be more than that. I certainly do not.)
Last, we were never anybody’s mid-level provider.
What do y’all suppose will happen when “Dr. Jill” Biden goes to California? Think she’ll be charged with a misdemeanor?
Well ,as an MD doctor, Dr Peter Polack MD, who now has a son, Dr Peter Polack PhD, I can say we have had some interesting discussions around our family table. He is actually quite amused about it and doesn’t take himself too seriously. He knows I used to say that when I am at a doctor’s office as a patient, I like to be referred to by my first name Peter, and not Doctor Polack (in case there are some of my patients eavesdropping). But woe be to the staff in my own office if they don’t address someone with a PhD or DC as ‘Doctor’ so-and-so.
Our optometrists are referred to as Doctors as they went to a an ‘eye doctor’ school and are licensed to medically treat patients. Psychologists are referred to as ‘Doctor’, more than just an honorific, since they do treat patients.
The kerfuffle about Dr Jill Biden is mostly political. This is obviously just an honorific. Nobody has an issue calling a doctor of seminary Dr Samuel Johnson. And my high school principal had a doctorate of education and was referred to as Dr Boyd. The issue is really for people that hold themselves out as being a ‘doctor’ doctor, implying that they treat patients, when they don’t. And I don’t think Jill Biden walks around with a stethoscope around her neck.
It has gotten more complicated with the nurse practitioners, especially if they have a doctorate. Is ‘doctor’ just an honorific? Well, it would be, except they treat patients. Not really sure how to square that.
There was an episode of an old sitcom called Fernwood Tonight, where someone collapses and the director yells, “Is there a doctor in the house?!” A man comes running down from the audience and is asked, “Are you a doctor?” And he replies,”Yes, a doctor of botany!”
As I understand it, barber surgeons according to English tradition were known as Mr. This carried on to surgeons, later on.
Those who were in “medicine” as opposed to surgery, were called Dr., again according to English tradition.
Where the rubber meets the road so to speak, is when PhD’s call themselves Dr. and are trying to fool patients that they are physicians.
Physicians should include, Optometrists, Dentists, DO’s and MDs.
The expression from 30 years ago, is that nurses were trying to achieve by legislation what they had not achieved with education.
Most PhDs don’t try to “fool patients” into thinking they are physicians. If any do, that’s the exception rather than the rule. PhDs generally consider themselves as real “doctors” where as they don’t (facetiously) consider us to be, because they have their 4 years of post-grad under their belt, in addition to having written and defended a dissertation. How many of us healthcare professionals would be “doctors” if we had to write and defend a dissertation? It took my cousin 7 years to finally have his dissertation accepted before he finally earned the title, “Doctor.” IMHO, we should not be so high and mighty to deny PhDs their hard earned title. It’s the honorary doctorates that I really have a problem with.
Carl–
I don’t think anyone here is “high and mighty.” I think it has more to do with representing a credential to patients so they can make intelligent choices about getting medical care. If you called yourself Mr. Schlissel, I suspect that you wouldn’t have quite as many patients.
Writing theses and defending them are real, difficult accomplishments. I wrote one as an undergrad and, superficial as it was, even it was a pain in the behind.
So, bottom line: no one is denying non-medical PhDs their accomplishments. Just that if they’re going to call themselves “doctor,” it’s important that they don’t imply that they’re doctorates are in a medical field. That would, at minimum, be stealing valor. And endangering patients.
Agreed. (Although I’d be Mrs. 😉 )
Ooops! Sorry.
JH
Anybody who is a doctor can be called “doctor” as long as it does not lead to serious problems or perceived deception
This discussion isn’t really about PhDs, DDSes, DVMs, DPMs, ODs, EdDs, JDs, etc., These doctors rarely are perceived as trying to pass as physicians (MD, DO, MBBS, etc.) and the context almost always clarifies which type of doctor we’re referring to
When I take my cat to its “doctor” if she doesn’t have a DVM, I don’t care that she has a PhD in astrophysics and an MD
When I’m at my dentist and the secretary says “doctor”, I know she’s not talking to me
The term “doctor” in a medical clinic, will almost universally be interpreted as “physician”
DNPs are doctors (regardless of how many people may feel about the ‘doctorness’ of their degree). They are licensed to take care of medical issues, even without physician supervision in many states. Many patients call their NP “doctor” accidentally even if the NP has never used the word “doctor” to refer to themselves. Then, what’s the big fuss about DNPs calling themselves ‘doctor’ in the medical context? Two issues:
1-Anecdotically, most DNPs I know do not call themselves ‘doctor’, precisely because they do not want to be perceived as trying to deceive patients. (Sometimes I call them ‘doctor’ anyway non-ironically when there are no patients listening, to be collegial)
2-NPs do not require a doctorate (i.e. DNP) to practice
Hence, it is understandable that DNPs using the word “doctor” in the medical context are perceived as trying to pass as physicians, even if that’s not their intention when trying to showcase their credentials
I can understand a speeding ticket for 200 Benjamins to a non-medical quack trying to pass as a physician (or any other type of doctor), but doing that do a bona fide healthcare provider doesn’t seem like the best approach
I’m a surgeon. I spent 4 years in med school, 5 years in residency, and finally a year of fellowship. In the medical setting I have earned the right to call myself Doctor. Nurse practitioners, physical therapist, and other health care providers who did not go to medical school and the years of training that follow, do not have the right to call themselves “Doctor” in the medical setting. Patients should not have to make the distinction between a medical doctor and a PhD phony using a technicality to put Dr. on his or her white coat.
May I point out that the MD degree granted in the US is not a “doctorate”. In many places the clinicians’ degree is a bachelor’s degree (e.g.: MB, ChB). Similarly, law degrees are not JD but rather BLL. (LL = Legal Letters) There are degrees in medicine and law that are indeed doctorate and are designated DM and DLL. These degrees require a dissertation. The DNP, DPT, PsyD and EdD do not. They often have a “capstone” project which is less in depth and does not require or rest on original research. I hasten to add that there are true doctoral programs in nursing and education which award a PhD. I would hesitate to call any PhD a “phony ” as one writer has opined. Similarly, in a medical setting I would hesitate to not call a PhD Psychologist, DDS/DMD dentist or DO anything but Doctor. I will also point out for the benefit of the surgeon commenting above, that in much of the English-speaking world surgeons are referred to as Mr. or Ms.
Lots of egos here. Please check them at the door. Facts only.
The AMA states that all Physicians are Doctors but not all Doctors are Physicians.
If you didn’t match or didn’t complete residency, you do NOT have the right to put MD after your name. You are NOT a medical doctor. Obtaining licensure is a REQUIREMENT to call yourself a medical doctor or a physician.
You CAN say you have an MD degree and hang it on your wall for all to see, but you ain’t no medical doctor, Slick.
No residency means no license and that means no MD. You’re nothing but a charlatan if you call yourself a medical doctor. You’re no more qualified to diagnose a common cold than a Doctor of Interior Design is.
Pay your dues in residency, get your license and board certification, and then and ONLY then can you call yourself Doctor or MD or Physician. Until then, you can ONLY say you have an MD degree…which, btw, is the easiest step in becoming a physician. Child’s play compared to residency and Board certification.
The AMA isn’t the official arbiter of anything. It also endorses the concepts of the existence of implicit racism and numerous other fringe cults. Read JAMA if you don’t believe it. In fact, read the free online articles in it. They make them free so everyone will have access to what they consider Truth.
AMA also sees the need for extreme gun control, diversity, equity,* and inclusion in medical schools and their admissions policies, and the list goes on. And on.
An hour after you graduate from medical school you can legally put out a shingle saying that you’re a brain surgeon. If you’ve taken and passed a state licensing exam—which we took ~before~ we graduated—you are and can be called a doctor after you get your degree. No postgraduate training required.
Note: I know of no one who ever took that route, which makes it an untraveled road. But a road nevertheless.
* Equity in this sense means that any unequal outcomes—like grades—must be equal. And that unequal outcomes, regardless of talent and effort expended, is an admission of racisms, sexism, and/or anythingelse-ism. Enjoy the AMA.