CMA, AMA urge court to uphold prohibition on non-physicians' use of 'doctor'

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The California Medical Association and the American Medical Association have filed a joint amicus curiae brief defending a California law that prohibits the use of the term "doctor," or the prefix "Dr.", by anyone other than California-licensed allopathic and osteopathic physicians.

In the case, Palmer v. Bonta, et al., three nurse practitioners with doctorate of nursing degrees are suing state officials to block California Business and Professions Code section 2054 so the nurses can use the term "doctors." The nurses claim they are not misleading patients because they use "doctor" and the title "Dr." in conjunction with their nursing degrees.

Admitting that such usage is not permitted under the law, the lawsuit seeks to invalidate the law on the basis that it violates the nurses' First Amendment speech rights.

In the brief, CMA and AMA emphasized that courts have repeatedly found a legitimate government interest in California's 86-year-old statutory rule designed to protect Californians who come into contact with the state healthcare system.

"Courts have consistently relied upon a readily discernible goal of the legislature to prevent confusion and potential harm to members of the public who may be misled into believing they are dealing with physicians whenever those terms are used by non-physicians," the brief said. "The original purpose of [this law] remains as relevant and vital today as in 1937 when it was enacted."

WHAT'S THE IMPACT?

According to the brief, physicians are educated and trained differently, and more deeply and robustly, than any other professional healthcare practitioner.

"It should be no surprise that, in practice and under the law, physicians are placed at the center of the delivery of medical care and that there are special protections for the relationship between patients and their physicians," the brief said. "The rigorous requirements for physician education and training aim to not just create practitioners to handle routine issues, but leaders in modern healthcare who are able to coordinate healthcare teams and solve complex medical issues, identify critical diagnoses, and render timely treatment decisions."

The groups warned that a misrepresentation of a practitioner's level of licensing can jeopardize patient safety, as a patient may mistakenly believe that a mid-level practitioner, such as a registered nurse, possesses the same level of training and qualification as physicians licensed by a California medical board.

With the different focus and requirements in their education and experience, a nurse practitioner's approach to patient care can provide disparate outcomes from that of a medical doctor, the groups said. By way of example, they cited studies finding significantly increased levels of prescription of opioids and overprescription of antibiotics by nurse practitioners compared to physicians, especially when the nurse practitioner is not practicing under physician supervision.

THE LARGER TREND

When encountering the health care system, patients immediately confront an array of practitioners and acronyms that can cause confusion over the practitioner's level of licensing, education and training, according to the CMS and AMA.

In a review of more than 2,000 primary care providers' biographies, a published research article found 181 unique combinations of alphabetic acronyms next to the practitioners' names. Another survey found that 45% of adults did not agree that it was easy to identify who is or is not a licensed medical doctor by reading what services they offer, their title and other licensing credentials in advertising materials.

"Patients want and deserve clarity and transparency in who is providing their care as there are immense differences in the education, training, and qualifications among healthcare professionals," said AMA President Dr. Jesse M. Ehrenfeld. "In healthcare settings, patients find it increasingly difficult to identify who is or isn't a physician. The potential for confusion is especially heightened when non-physician healthcare professionals use terms that are customarily understood to refer to a physician, including 'doctor' or 'Dr.'"

The groups said research and empirical evidence confirm the state legislature's concerns that there is great likelihood for public confusion given the strong, widespread association between "doctor" or "Dr." and physicians.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com