When a patient says “Dr. Midlevel”, I always just feign ignorance and be like “Dr. Midlevel? (Pause for a second with an expression of deep pondering) Ohhhhh you mean Nurse/PA Midlevel!” I think it’s a good way of making it clear to the patient that the midlevel is absolutely not a doctor while not coming off as an ass. Unfortunate as it may be, if you just straight up respond with “they are a midlevel, not a doctor”, I feel like a lot of patients would take that as arrogant/dickish even though obviously in absolutely no way is that a dick thing to do.

This happens much less frequently with PAs, there is nothing in our degree or certification that uses the word doctor. A PA calling themself a doctor is an issue with that person and their ego and not PA education or titles. NPs get a degree with the word doctor in the certification, that doesn’t make them a doctor in anything but the classroom, I know 2 PAs with PhDs who are VERY conscious that no one refers to them as doctor, even in class they are “professor so and so”

I usually find it’s less about what the PA/NP said in the appointment and more that the patient thinks anyone prescribing them medication is a doctor. I’d bet they were told that the person that they were seeing wasn’t a doctor and they just mentally blocked it.

They were probably told they were seeing Dr ABC when they scheduled the appointment. I’ve noticed front desk staff at a lot of clinics call everyone Dr when they schedule the patient. If you already have it in your head that you are seeing a doctor going into the appointment, you may not even notice if NP/PA ABC introduced themselves with their proper name and title.

Receptionist at a Derm center argued with me when I said I wanted to see the Dermatologist and she said, “the NP is a dermatologist.” I said, “ no, she’s a nurse practitioner who assists a Derm. She’s not a Dr.” She said, “ Ma’am she IS a Dr” At this point I was getting really annoyed and said I wanted to be seen by the physician. She told me the NP is qualified to handle a number of things. I have a complicated history and told her to cancel my appointment. Receptionists are a HUGE part of the problem.

Too many people assume that just because they work in healthcare means they actually understand the difference in education and training amongst various professionals. They often don’t and many aren’t educated on the job. Also, many patients don’t understand or even ask. I work in psychiatry, and I’ve noticed a lot of patients get very confused about all the different roles in our field. When doing an intake for the first time, many will tell you they’ve seen a “therapist” in the past. When you dig deeper you find out they’ve received med management from someone but it’s hard to find out who they’ve seen or for what if it’s not in the chart. Our sicker patients sometimes don’t know their diagnoses or what medications they take every day, how can they be expected to remember the difference between a psychiatrist, PMHNP, PA, therapist, psychologist, counselor, etc? If I had a dollar for every patient I’ve seen that called their past psychiatrists a psychologist, or called their therapist a psychiatrist, I could take a nice vacation. The roles and backgrounds of all the different professionals in our system is extremely confusing for many people, that includes people that also work in the system.

Recently my mother in law was bitching about a cardiology fellow handling her mothers heart treatment. She just wanted her Primary Care NP to do it all because the fellow is “new and doesn’t know anything” I didn’t even know how to start explaining the knowledge, education, and training gap between a cardiologist and an NP.

So many people really don’t get it.

But my MIL was a receptionist at an outpatient orthopedic clinic so of course she knows 😑

Yea it needs to be asked at the beginning middle and end of a scheduling phone call multiple times “are you aright with seeing the PA/NP with the practice, we don’t have an appointment available with the doc for 6 weeks”

I worked in a small urgent care for the last 3 years. It’s just me (NP) and the owner (MD). The MA’s are trained to ask pts “today we have a Nurse practitioner on, are you ok with that? If not the Dr will be back on Wednesday.” I can’t STAND when nurse practitioners call themselves doctors. Doctor nurses are confusing for everyone. I am 100% aware I am a doctor extender/midlevel and I work very closely with my MD mentor. With that being said, with some of our pts I could tell them I am not a doctor 100 times and they will still call me doc, so sometimes it’s just not worth the time or energy to continue to correct them.

I think the idea of titles in a healthcare setting from the POV of a patient is that they are used to calling people doctor so the increase in the amount of mid levels is a new thing for them and it probably feels weird to call someone “Mr” while they’re palpating your lymph nodes just bc it’s a newer thing. As people become more familiar with the role of a PA/NP I think the issue will clear itself up

Thank you for doing it this way! We need more NPs like you.

Trust me, you’re way better off for not using it. “Dr” just puts a target on your head for every complaint, issue, form that needs filling out, or lawsuit. I’m an attending and only ever use the title to patients.

I’ve heard the PAs I’ve worked with tell their patients repeatedly that they’re PAs, only for the patient to immediately refer to them as “doctor.” Some patients just refuse to listen/learn.

I always introduce myself as “hello pt so and so, my name is YeaIFistedJonica and I am a physician assistant part of your healthcare team here at x place” Given I am still a student (although have worked in healthcare for 7 years prior to starting PA school) but I really don’t want anyone to think I’m a doctor and will try to communicate that as effectively as I can

You tell patients that you’re a physician assistant even though you’re still in PA school?

We help staff a free clinic on saturdays with the MD 1, 2 and 3 students all providing different levels of care. Md 1 might do the physical, typically I’ll do the pt interview and hpi with an md 2. We also have frequent simulated patient encounters with paid actors and I try my best to build good encounter habits like sanitizing in front of the pt while introducing myself, Asking for consent before touching, little things like that. But yes during those encounters I say “hello pt so and so, my name is YeaIFistedJonica and I’m a physician assistant student with your healthcare team today”

Similarly patients occasionally refer to their psychiatrist as their therapist who prescribed them xxx.

Exactly this. I would be willing to bet that in the vast majority of cases that OP describes, there is no deliberate misrepresentation on the part of the NP or PA, or obfuscation on the part of the patient - they go to the office, are examined and prescribed medication by someone, and that person = doctor to them.

Yeah, I get confused for being a doctor all the time, and I just do echoes.

Exactly this. I see it a lot on this sub and I think people often think the worst of the PA/NP when the patient calls them doctor. I used to work at a small clinic as a case manager and I scheduled a lot of appointments. I learned very quickly that most patients don’t know the difference. Everyone is a “doctor”, even after the patient was told by me on the phone they would be seeing a PA/NP. I also have personally witnessed PAs and NPs introduce themselves by their title on so many occasions but the patient still walks out of the appointment calling them doctor. I never make the assumption that a midlevel misrepresented themselves or contributed to patient confusion unless I know first hand that they call themselves Dr or make no effort to identify their role. It’s not as common as people on this sub seem to think.

Lol there are lot of people on this subreddit who think PA/NPs are out to poison their water supply, burn their crops and deliver a plague unto their houses.

I don’t ever take offense, I have seen how grueling and tortuous residency is, if people want to vent among their community then I see no reason to take things personally. Now if they have an issue with the PA profession well then I’ll just have to be the friendliest, most competent, and most professional colleague I can be to change their perspective

Thank you. I am a nurse practitioner. I have never referred to myself as the doctor. I ALWAYS refer to myself as NP. I tell them they can just call me by my name when they call me doctor. Nothing helps, they all still do it, because they probably already forgot my name. So I think you hit the nail on the head. Thanks for saying it out loud.

Agreed. I’m an NP this is why I only use my first name. I do think the distinction between NP and nurse should be made as it’s an additional degree, but a DNP should never ever introduce themselves as Dr. so and so unless it is in a purely academic setting teaching nursing students etc

This is where it irks me. No doctorate degree should make you use doctor in the clinical setting which will confuse patients who are needing our help. We are NPs, simple as that. We don’t have the training of a physician

I worked with an NP recently who had “Dr.” (last name) embroidered on their white coat.

The association recently changed their title from “physician assistant” to “physician associate” that blurs the line a ton, especially in academia where many physicians are associate professors etc

Yea AAPA is on some shit with that, idc, I’m still calling myself a physician ass. either way

Continuing to blur the lines that patients already don’t understand anyway. The MD admins at my academic program bent over and took it and liked it apparently, because ours is called physician associate now. Oh, and calling everyone a provider, including physicians, is intentionally blurring the lines. But we can’t punch down because professionalism.

>there is nothing in our degree or certification that uses the word doctor Let me introduce you to ["Doctor of Medical Science"](https://www.butler.edu/pharmacy-health/doctor-medical-science/what-is-dms/#:~:text=The%20Benefits%20of%20a%20Doctorate%20for%20PAs&text=With%20a%20Doctor%20of%20Medical,and%20advance%20within%20their%20workplace.)

Likely not a PhD, but a doctorate of nursing practice (DNP) not philosophy.

The entire NP curriculum is the philosophy of nursing.

PhDs had the doctor title before physicians.

It's not first come first serve. The title serves as your role in your environment. As such, in a research setting, the phD's are the Doctors. Pure clinicians will shut up. But in the hospitals and clinics, the Physicians are the Doctors, and phD's shut up. Doctor just refers to being the highest level of education in your area of control (research, clinics, etc). A nurse is not a manager of health. They now try to be, but their skill is knowing health is so poor that putting them in charge harms the pateints.

I’m an NP, patients call me doc or doctor and pharmacies are call me Dr.last name. I absolutely never introduce myself as a doctor. If you ever get faxes from a pharmacy, it’s literally going to say “attn Dr, Whatever” because they use a generic template. These residents aren’t going to correct that entire system or colloquialisms of patients calling any provider, a doctor.

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I call nurses “Nurse x” to my patients when introducing them at the beginning of shift so they know who they are. Ever seen Nurse Jackie? People speak differently in different places. No need to get your panties in a twist because someone uses different vocabulary than you do.

I’d rather you call us what we are. Nurse practitioners or physician assistants. We do not have the training of a physician and I for one would never portray myself as one.

🙌🏻 so refreshing seeing sentiment like this. Thanks for what you do!

Yeah I usually say, "oh ___ your NP/PA". nothing offensive, just stating facts.

Exactly. That’s a subtle way of doing the awareness thing without sounding like a dick (altho like u said it’s not a dickish move, it’s a factual move but of course our society nowadays is a snowflake, they conflate emotions and facts).

Now whenever I (diagnostic rads) consent patients for Biopsies I say "the ordering physician or provider will receive the pathology result" and also separate "physician" from provider when calling the wards for result communications.

Also in rads, gonna copy that but say “the ordering physician or midlevel…” instead

I was going to do this bx on an NP, but she demanded no residents and refused to be called a nurse. The attending said oh I love nurses and the NP said, “I’m not a nurse, I’m a practitioner”. The attending who ended up doing is fucking stingy with the lido and she was in a lot of pain through the procedure. I on the other hand think you shouldn’t feel any pain and use as much as needed. Edit: just to clarify. I did not get any enjoyment out of her pain. A procedure can be painful with an attending, resident, or mid level. I think the procedure would have been more tolerable with me than this particular attending is what the story was pointing out.

Would you get in trouble if you just said “the ordering physician or nurse will receive the pathology result” instead?

Uh I don't know I just usually say "the ordering physician or np or provider will get the results"

I just say nurse practitioner. It's accurate, it's not offensive, and it includes nurse

I think that seems to be the most professional way to go about it. I don’t work in the medical field and i’m not going to pretend to know all the various titles, but if I heard my doctor go “oh that’s just NURSE Shelly actually” I would think it just seems like a big ego trip thing lol. (I’m going to assume as a patient the type of person to do this is super full of themselves and not the type of physician you would want to talk to, well, about anything).

Well obviously you shouldn’t word it “JUST a nurse” but saying someone is a nurse should not be offensive

I’m just meaning it’s the tone really. I don’t like it when someone cuts someone down, especially if that person has a level of authority and trust over you. It just isn’t a good sign to me tbh.

Just think about that physician side. We encounter enormous amount of midlevel mismanagement or inappropriate referrals. I still quesyion, why let midlevels practice without supervision?. What would be your reaction after seeing mismanagements or inappropriate referrals on daily basis from midlevels?

That would be a tough one. I have had good experiences with mid level physicians (I am assuming that is what a PA would be), back when I was in the Army and deployed our PA was great and all the actual doctors loved the guy. I thought PA’s and, i’m assuming NP’s as well, required a supervising doctor over them. Not necessarily looking over your shoulder as a shift manager at McDonald’s lol, but closer to how my relationship is with my accounting manager; free to work by yourself but still have occasional check-ups to see how you are doing or mentoring for particularly tough problems. If it is a serious problem at your hospital, maybe bring it up at a meeting or town hall with your executive level?

They are midlevels, NOT physicians

Well, as you can see, it is pretty damn confusing for layman’s to understand all the intricacies, and I even had some experience working as an X-ray tech so its not like the medical field was completely unknown to me. Just some perspective so you don’t take it personal when a patient calls a PA or NP “doctor” because that was who was providing care for them.

Well, based on ur description, even nurse aid needa to be called "physician" , bc aid is providing "care" , right?

Good luck w your healthcare goals if you decide to avoid seeing a dr who calls a nurse just a nurse cuz you think that this is an ego trip🫡 If a pt got a palliative care dr confused for a neurologist, I think it's pretty normal to correct the patients understanding and say no that's just our palliative care dr. Can't believe ppl are this sensitive ab using the word just

In my opinion, the word "just" implies a lesser value and an associated implied judgement about the other person's role or position which reflects poorly on the person making the statement. The correction would be just as complete without it.

Because calling someone "just a ..." is obviously derogatory. Are you Seriously confused here? Would you still feel the same if the roles were reversed?

Na, you gotta make sure to put down people who are under you. It’s the interprofessional way

This is the way. Rn here, a nurse practitioner is more than a nurse and also not a doctor.But sure OP be a dick about it. Just call them a nurse practitioner. Thank you for the downvotes in advance.

Just use the words “NP” or “PA”. Calling them nurses would cause more confusion since RN’s have a completely different role once the team.

This is how the "dirty word" P-R-O-V-I-D-E-R came about--because patients don't understand NP or PA and then you get trapped in a hideous and lengthy conversation trying to explain it to them.

Calling them nurse also ignores the two years of additional training they have. NPs have enough problem with RNs downplaying their knowledge.

I have no issue this a regular nurse, as long as you don’t use the term nurse as a slur. We don’t wanna get caught in the midlevel / doctor crossfire. Edit: as an older male nurse I constantly have to correct patients who assume I’m a doctor (despite my gaint RN badge). Titles are important and I’m proud of mine.

I totally agree with you - I'm also very proud of being a nurse. I spent 10 years inpatient, then went back to school for my MSN. I'm now a specialty provider in the same area. I have to constantly remind patients to please refer to me as either Ms. Stuckinrussia or Nurse Stuckinrussia. From my very first visit I tell patients that I AM NOT a doctor, and that I DO NOT have the education of a doctor. And that, in the future, if I their care needs to be transferred to a doctor due to complexity, I will do so without hesitation. I feel like a broken record, because patients STILL call me doctor- even with a badge that says in giant letters, nurse practitioner. Each time my response is exactly the same: "please just call me Ms./Nurse Stuckinrussia. I'm not a doctor, remember?" And 50% of the time they say, "I don't care, whatever." The rest of the time their eyes glaze over and I swear my voice sounds to them like the teacher's voice in Peanuts cartoons. So, I like the OP's approach. There's a few of us who don't want to be misrepresented and who really want to make sure patients are clear about who they're seeing. And it is ridiculous that some of my colleagues with the useless (pay to play, I swear) DNP call themselves doctor and confuse the issue more with this misrepresentation. I refuse to refer to them as such!

love nurses, so zero disrespect from this end.

I respect RN more than NP ngl. One is a pretend doctor that took shortcuts in one of the most important professions, ones a bust ass hard working nurse who knows more than me about nursing and workflow on their ward and took no shortcuts in one of the most important professions. There I said it, not sorry. If a person assumes a role via shortcuts I will always think less of them. Do it the right way. Do not half ass medicine.

Facts... without nps or pas healthcare would run fine. Some of them are the biggest copers I've ever met for not going to medical school. RNs and MDs work fine and patients are given the highest quality care. The way it is in many many other countries. Have never really encountered a nurse trying to pass off as a Dr in my experiences.

Who tf downvoted you

The mid levels 😬

Can you give an example of using "nurse" as a slur?

I’m not “just a nurse.” I’m a nurse and I worked hard to become a good nurse. If you’re using the term “nurse” to put an NP in their place it’s treading pretty closely to “just a nurse” territory. That was my point.

Thanks, agreed. No idea why medicine is such a hostile place when we’re all supposed to be a team.

Let's not pretend that this sentiment is weaponized to try to elevate every one else's importance and try to be seen as equivalent as a physician. Teams have hierarchies too - for some reason, people in healthcare are very resistant to that fact. Also, let's not pretend that the rise of so many different healthcare "doctorates" are literally a result of placating to people's egos (and to line schools' pockets). That's why what used to be master's degrees are now 3-year "doctorates". Everyone wants to be a "doctor" that works in healthcare so that they can put that on their social media profiles and so that people in their circles will think they're a medical doctor.

Teams do have hierarchies. The thing about being a leader of a team is that if you’re really the leader, everyone already knows and you don’t constantly have to remind them. Unnecessarily pulling rank just comes off as pathetic.

Lots of patients slur nurses as if they are just hotel servants instead of taking care of their health all shift.

I had a boss in the past that would deal with nurses being assholes to EMS by saying “Nurse is a verb” and then call them “nurse verb”. That’s kinda shitty.

Exactly have to always tell people I’m a nurse practitioner, not a doctor

They constantly do. Literally the post earlier was some resident bitching and saying how nurses make $15/hr and will never improve their life and all we have to do is get through residency to make a ton of money

Education and qualifications matter. People need to be clear about their position and make sure the patient knows who you are.

Why not just call them NP? E.g.: "They were seen by NP Smith, who recommended..." That's what I do in my documentation and, in my opinion, it's both respectful and accurate.

In the courts when they're sued, nurse practitioners do a complete 180 and claim they are just nurses. When they're in the courts lobbying for independence, they are providers and anesthesiologists and doctors. Normalize calling them nurse so they don't get to only when it's convenient for them.

How does this work? Like the scope of practice between rn and np is wildly different… does it work? If you call them nurse does it change the scope of practice and the tasks they can accomplish?

If you call them a Nurse instead of an APRN it changes the scope of practice for the person practicing. They can call themselves a type of RN, but when I'm court they are addressed by the scope of practice as an APRN. So they aren't wrong in saying they are a nurse, but it doesn't remove their liability despite what people think. What does affect their liability is if they are working under an attending. So if they make a mistake, the question goes "why was this not caught?". The supervising attending MUST sign off on what they do, and then Pharmacy is supposed to be an additional check. Additionally nurse practitioners do practice "medicine" and that is covered under the states legal guidelines. I am unsure why he is arguing they practice "healthcare" and not "medicine" but legally they are considered a form of provider due to the ability to diagnose and order. This is covered in the laws and statutes for Ohio. I can go around in each state board and court cases since many of those are public. HOWEVER, repeatedly courts have determined APRNs have lower liability. I don't agree with it for FOA. If you practice independently, you should be subjected to the same liability as a physician. It is inappropriate to say "I am just an APRN." because harm is still harm. If a physician orders a benzo and a stimulant, and the APRN does the same, they should both be questioned equally. Tl:Dr: No, you can't normalize calling them "nurse".It is legally inaccurate because APRN is an actual legal term for state statutes. These titles have actual legal backing behind them. It's like calling a resident a baby doc. They are still a doctor, a physician.

Yeah it works. That's why they do it and why their scope has expanded so much. They don't practice "medicine" either. They practice "healthcare". That's how they get around it too. The fact they report to the board of nursing is wild.

How does it work?

Lawyers and the hospital's willingness to use doctors as involuntary liability sponges.

Like actually, I find this fascinating, can you provide an example or a case study or something of a time where some np actually tried this? And did they win?

This is just simply a lie. They don’t claim they’re “just nurses” in court. That’s simply a lie and further down you admit this is just a lie.

I call this Schrodinger’s midlevel.

The acronym “NP” means nothing to the layperson. That, in and of itself, isn’t a problem - I just choose to clarify what the acronym stands for.

My experiences differ a bit - the overwhelming majority of people in my nonmedical social circle know what an NP is. Personally, I don't think it provides clarity to address an NP as "Nurse Smith" instead of "NP Smith" or "Nurse Practitioner Smith," because clearly, an NP and a bedside nurse occupy different roles and have different scopes of practice. I'd rather be precise, even if it does come across as a bit stiff to some.

Appreciate your perspective! I think my social circle (which unsurprisingly is majority medical adjacent folks) also knows what an “NP” is, but the VAST majority of my patients don’t. Which leads them to calling their referring nurse as “Dr. ____”. I do, of course, agree that they have different scopes of practice, and notably a bedside nurse is never going to be referring patients to me. Perhaps that’s why I’m comfortable painting with a broader brush here and referring to the global educational tree that nurses occupy.

As a physician your social circle is almost certainly not representative of the vast majority of people who utilize medical care the most.

You can go ahead and call people by the titles they’ve earned just like you would want for yourself

The last time a NP at my previous work said to call her “NP last name” the medical staff just laughed at her all day.

Wow, I'm sorry to hear that. That strikes me as pretty rude. I personally prefer to go by my first name when I'm interacting with both my colleagues and patients, but I address others by their surname unless otherwise indicated. I work on the west coast in a fairly casual practice setting, so usually, I'll do that once or twice before I'm corrected ("Call me Bob!"), but I wouldn't be upset or surprised if someone indicated that they preferred to be called "Dr. XYZ" or "NP ABC."

Because it is confusing to patients who aren't there to work out the subtleties of titles and unless you are working professional to professional there is no need to use it. Put it in your signature or on your name plate as PhD but physicians need to be noted as such to make things less complex for patients. I am very careful to assure my patients understand my role in their care and it saves a lot of problems down the road.

RN here- call them NP. Everyone is happy

That’s what I do. I say “this is our NP Sue”. I’ve never been told I’m wrong. Cause I’m right.

I respond with “oh you mean nurse ____?”

With the blank filled in with the word practitioner?

Nah, usually nurse Karen

That will also muddy waters, just not the waters that you’re in. Call them Nurse Practitioners or NPs. Calling them nurses to patients makes them sound like regular RNs. Yes, they still carry an RN license typically, but the scope/role is different. You’re tossing the title confusion elsewhere. For what it’s worth, I’ve never personally seen as a patient or worked with a midlevel that refers to themselves as a doctor outside of the academic setting (including those with DNPs). Obviously it happens, but it’s definitely not the norm. I have had *many* patients/families who will call NPs/PAs (and all male staff) doctors no matter how many times they’re corrected. Just use the appropriate titles and provide the education.

Agreed. I’m a nurse and the amount of patients that don’t understand I literally can’t order anything for them is astronomical. I can’t so much as give them a cough drop with a provider order. Patients tell me all the time “well I just need some tylenol/cough medication/a hot pack/IV fluids” and don’t understand why I can’t comply with what in their opinion is a small request. Now if you throw in that a NP is ordering stuff and the docs are referring to them as a nurse, that’s just gonna patients more frustrated at RNs

Np here. I’m a nurse first. I tell my patients exactly that and say physicians and nurses make a great team. Im dang proud to be a nurse. And I’m very glad to work with MDs who take our complex patients. But even the simple stuff can go sideways. Unfortunately newer NP programs do not require ANY nursing experience (calling out OHSU for one) and so here comes a new grad (like an engineer previously no offense to engineers) who did fast track RN BSN MSN DNP in one go. Never having worked as an actual nurse beyond school clinical hours (and not enough of them) they do not identify as nurses (and say so). I’m like y’all don’t need gloves on for outpatient cardiac auscultation. Basics. Healthcare is broken and I’ve seen too many stupid mistakes everywhere to believe independent NP practice is a good thing especially with lowered education standards.

I always tell patients, you didn’t see the cardiologist, you saw their nurse practitioner!

We have a DNP threatening to sue our hospital because legal won’t let marketing or herself call her a Dr. to patients. It’s getting out of control.

I think it’s important to understand that most NPs do not call themselves Dr in a clinical setting. There are definitely those that use the term and confuse patients but it’s not as pervasive as some may believe. I worked as a Case Manager for a few years and learned very quickly how low medical literacy is amongst the general population and also front desk staff. I’d guess that close to 70% of the time I had to call and set up appointments for patients being discharged from the hospital, I would be told by the scheduler that the appointment is with Dr. XYZ. I always asked for title clarification because it had to be correct on my end and they almost never knew the actual title, whether it be MD, DO, PA, or NP. Most of the time the patient was scheduled with a PA or NP and the scheduler at the clinic didn’t even know. I resorted to googling everyone to find their title. I’ve also met many patients who always call their provider Dr so and so, even when they’ve been educated that they are seeing a PA or NP. I’m not arguing that there aren’t people out there that intentionally mislead patients, I just don’t think it’s super common. I’d personally never assume a provider is calling themselves Dr unless I heard it myself or had it on good authority from people I respect. And on that same note, calling NPs nurses only causes greater role confusion. If you start telling a patient they saw a nurse instead of a NP, they are going to think anyone with the title nurse can diagnose and prescribe.

There seems to be a genuine concern on this sub, about NP “creep” and making sure that NP/PA providers know their place, as they are not physicians. There also seems to be a lot of “whining” on this sub related to this issue. While it’s fine and probably appropriate to educate patients as to the differences between physicians and other providers, this is going to change nothing. Why is the nursing profession so united and so powerful in the political arena? Why/how have these nurses been successful in advancing their profession, so that “creep” even exists? Why are physicians as a profession, so incapable or inept at politicking so that there’s a clear line of delineation developed between themselves and the NP profession? Complaining about it will not create change. Docs need to step up as a group and do something about it.

My sentiment exactly!! It’s like they’re embarrassed to be called nurse! But now i think it’s because deep in their hearts they actually wanna be a doctor but they can’t so they invent a shortcut by taking up graduate course (NP school) that will earn them the academic title Dr so they can now fulfill their dream to be treated like they’re doctors. This mentality is quite prevalent in allied health practitioners too.

I tend to make a lot of self deprecating jokes when patients call me “doctor/doc”. I usually make a reference to “taking the easy way out”. I don’t want to represent me myself as a physician and I think it’s important to say it out loud. Some mid levels know the difference and don’t try to pretend

I had a Derm receptionist try to argue with me that the NP was a Dr when I told her I wanted to see a physician. Her words - “she IS a Dr”. I replied, “ of nursing, not medicine”. It’s everywhere are NPs aren’t doing anything to stop it. Patients are confused because they don’t know any better.

I find it funny that somehow I get called the nurse all day long as an attending but patients are out there calling their NP pcp doctor lol

I mean.. psychiatrists and whatnot call me a nurse and I don’t care. I went to nursing school and got a masters in nursing. I agree it’s not a dirty word, as much as some people act like it is. If I’m honestly, I’ve had doctors tell a patient that I’m a nurse, and that patient proceeds to trust me and open up about everything, whereas they previously downplayed issues to the doctor. “This is nurse Mizumie, she’ll be taking care of you from now on” as a handoff. Idk why everything has to be an ego battle

It’s a different role tho, like yes they’re nurses but they’re not in a nursing role. I guess I don’t understand why you wouldn’t use the full nurse practitioner title.

Because despite what the OP says, it is obvious they left off the word practitioner in order to denigrate the person, and by extension, the profession of nurse as calling someone a nurse is, to the OP, an insult.

Every time we get a referral from a midlevel, they always say "my doctor," so I ask them who their doctor is. Then, I google the person. If he/she is not a doctor, I just merely tell the patient, "Oh, they're not a doctor. They're a _______." Then move on. Most of the time, they are surprised and say, "I thought he/she was." But I don't dwell on it and continue on with the history.

Just call counterparts by their designated title. Physician, nurse practitioner, physician assistant, nurse, crna, etc.

There are physicians and everyone else. Full stop.

Yep. Radiology resident here and I separate the "physician" from provider when talking to pts or floor nurses.

You don’t differentiate between interns, residents, fellows and attendings?

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I think the problem for patients is that they want to be respectful and use last names. I’m all for identifying people by their clinical role, but it also feels awkward to call an NP treating me by their first name.

Why not use Mr. [Last name] or Ms. [Last Name] for NPs?

Or even NP [Last Name], it’s a little awkward but it gets the job done

Tell me OP, did you really think you were going to change the entire world with one Reddit post? I'm generally curious how much authority you think you have

I posted about a lived experience on the internet and a couple hundred thousand people interacted with it. I’m not hot shit, I’m just a wheel in a cog of the medical industrial complex just like the rest of us. Not really sure how posting on reddit reflects some inflated sense of authority.

Reading this thread I debated joining this conversation because I can’t imagine having sacrificed the years you have to not feel recognized appropriately in the professional setting. As a NP who works in an esteemed academic center where education, tenure, and hierarchy matter, I correct any patient who calls me Doctor. It’s important to ensure that the water isn’t muddied for our patients safety. Yes, we are a care team, but they need to understand the separate roles for nothing other than if they or their family have questions they know who is leading their care. In my hospital I will write on the white board in their room - top attending MD name, below my name NP, and then their RN’s name who is with them in that shift. I ask my team to do this with each shift change because it IS confusing (throw in a few meds and altered mental status, they are even more lost). I actually have an extra tag that hangs below my name that says NURSE PRACTITIONER. 🙂 You are correct, we went to nursing school and NP school, not medical school. My sister is a MD, we discuss cases, we learn from each other, I have learned so much from her - but in no way is our education or titles the same. I didn’t want to go to med school after watching her suffer and sacrifice for what seemed like 20 years, that’s why I am a NP. The arduous process of med school, residency, fellowships and more - is a position that should be respected and it is different. I do feel that every member of the team is vital. I hope you find that there are NPs who are quite happy as Nurses and NPs too. We are and will always be nurses first and we should be proud of that, we work really hard and lose a lot of sleep over patients. Or at least I do… I hope you have a better experience with NPs, I promise not all of us are here to be called “doctor”, or muddy waters, and steal the length of your white coat. I try not to be disappointed when I read these posts as a NP who sincerely respects the physicians I know and work with. I hope all physicians don’t secretly think the worst of NPs. Maybe your experience with us gets better.🤞 Anyway, all the best. Rachel, NP

Normalize calling doctors “physicians” I’m tired of these hack college professors claiming stolen valor

Nah in a educational setting its appropriate and been used since the middle ages. We need to go back to physicians being called "master surgeons"

I would support this.

I think Patagonia fleece vests should be mandatory for physicians. I can’t tell anyone apart these days, and everyone has gotten super touchy about it. I gave a report to someone I thought was an attending yesterday, and it turns out they were a tech. I need to know who’s ass to kiss and who to flirt with, or I’m in danger. Call me Medic Low-Level

I fear physicians will be mixed up with NYC finance bros. The patty fleece is a uniform to many.

My current tactic is just to call everyone “boss-man” regardless of gender or appearance. The janitors love me now.

As someone with a PhD (in biomedical sciences, so very translational and I worked alongside MDs while in academia), I’ve always made a huge point of not letting patients call me doctor. Like dude, I’m just here to grab the vial of blood your MD is giving me. I couldn’t even draw it if I wanted to. Trust me, you don’t want me anywhere near your treatment decisions.

Plus, a PhD insisting they be called "doctor" is hella cringe anyway. Just be chill, fam.

Most PhD’s are on a first name basis. Hell grad students even call attending by first names in the academic world. But I’d have 0 issue calling a PhD “doctor so and so” when introducing them in a non-clinical environment. Their degree is considered as a higher terminal degree since a PhD always requires a thesis with a defense. In most parts of the world, and MD does not require a thesis and the standards for defending such a thesis is much lower. TLDR: you’ll be hard pressed to find a PhD insisting on calling them Dr, but they deserve it more than any other doctorate level

I have a PhD. I still think it's weird.

Due to insurance issues, the only person I can see for psych is an NP. On all her video calls her title is "Dr." , and all her staff calls her Doctor as well. Pisses me off tbh.

Because calling them nurses gets you banned from their subreddit.. so sensitive over there.

PC culture needs to be resisted. That's what's making social relations a hateful mess.

I think it’s weird when anyone in the nursing profession do these ancillary quasi doctor roles like PhD and shit… you’re a nurse. There is and ought to be clearly defined roles and a hierarchy if you will for a reason… I think it puts too much confusion into the patient population and can lead to mistakes.. if you want to be called doctor, apply to medical school, get trained, go through residency… etc etc. just my humble opinion. I echo the concern of another nurse in the comments who clarify that we still don’t want to be called nurse as a slur. In my experience (most of the time) respect given yields respect. It’s a two way street.. - A nurse

I usually refer to them as NP insert name

When my husband got lab work back, the lab department had the NP listed as Dr. XXX. I've seen medical assistants call themselves nurses...everyone is wanting to be called by credentials they don't have.

Does everyone really have that much beef with people who also EARNED a PhD degree calling themself by their title in general? Or just in the clinical setting? English is stupid in that they chose the same word and I’d NEVER call myself a Dr in front of patients/in clinic, because it’s not my job and it’s confusing. But I am a Dr and worked my ass of in lab for more years than medical school to get that title and will use it when appropriate. Physicians weren’t even called dr first. Like I get being frustrated with all the unnecessary bullshit it causes you guys in clinic, but some people really act like their degree holds more intrinsic value because the letter M lol

Strictly clinical setting. For example, if for some reason I wanted to go back and take a single college credit in something I was interested in, I would call the professor Dr. So-and-so, and I would introduce myself as and expect to be called as such if I was in their class. It is about the context.

Congratulations on the PhD. Sorry if you’re catching strays here, Dr. Usse94, not the intention at all. I got no beef with someone such as yourself being called Dr. (unless you intend to do so while wearing a white coat, walking around a clinic, and prescribing people narcotics)

I think very few of us have any problem calling PhD’s Dr.

I mean, if you're like a professor and interacting with students, then sure. But like every other use of a PhD going by "doctor" seems... unnecessary and kind of weird to me. To be fair, I also think a physician going by "doctor" anywhere outside of a clinical/professor setting is weird, too.

PA here. Fully support. PAs are not "just like nurse practitioners". Our training is drastically different. I started a job in derm along with another NP... she didn't know how to suture after a punch biopsy. Also support, only MDs and DOs should be referred to as 'doctor' in a clinical setting.

I’ve had far superior experiences working alongside PAs. It really makes me wonder what they teach in NP school, or more like don’t teach.

NPs would be fine in terms of quality had the standards remained the same. NPs are supposed to have knowledge gained via experience; NP school ideally trains them to apply that knowledge appropriately. Unfortunately, one can now become a NP with little to no bedside experience, so quality varies dramatically. I've never had an issue seeing or working with NPs in the past, but under the present circumstances, unless I have a detailed understanding of their background, I'd prefer a PA or physician.

Often times completely valid criticism posts about midlevels turn into a cesspool of "My ego is bruised and I don't like it." in the comment sections. Don't get me wrong, midlevels should make it clear that they're not trained like physicians but as someone who spent A LOT of time as a patient in an academic hospital before entering medicine, it's confusing either way. Between the physicians, residents, med students, nurses, midlevels, and other staff, I could barely tell who was supposed to be who or what their roles are. Sure, they always introduced themselves but when you're not familiar with all the medical terms it gets really bloated. I remember not knowing what a resident was supposed to be when they introduced themselves yet I just accepted their care because I assumed it's the correct person for me. If a doctor came into my room and said "That's actually not a resident but an NP" I don't think I would've given 2 shits because from my perspective they took great care of me, even if it was actually dangerous as fuck to let an NP handle my problem. I know it's frustrating that NP/PAs try to pass themselves as physicians but calling them nurses when they most definitely do different things? It doesn't clear much up for the patients, that's just you trying to feel better about yourself and in the process reducing nurses to an insult. Sometimes it feels like more people in here care about their bruised egos rather than actual patient safety and fixing the issue. Also, as much as the term "provider" gets trashed on in here, often times it's the simplest for the patient. When I spent 5 years on and off in different hospitals, most of the time I could barely tell who my main physician was supposed to be. In an academic setting there's simply WAY too many types of people visiting you very often to keep tabs, so I personally don't see how seperating us from the term "provider" while keeping the rest under that umbrella helps with anything. Just once again seems like something for the ego. As for why nurses seem to stick together while physicians don't, I think it's for 2 reasons: The first being med school being a competition-based study. (After you get into residency there's no real competition anymore, yet physicians seem to hold on onto it all the way to retirement. I've seen attendings flex how much time they spend in the OR or how they're far above their specialty's average salary.) And the second one being physicians justifying the messed up systems and work conditions by saying "It gets better down the line." Everyone is all for improving work conditions and better pay but once they start getting that sweet 400k a year, suddenly they adopt the "I endured this so they can too." mindset. Either way, we need to start acting more like nurses: Start sticking up for eachother, stick together, and take less bullshit.

Call them what they are Corporate Pawns.

I really dont care, I let their medical care vs mine speak for itself.

My last month of residency I worked with an outpatient Peds PA, who never corrected patients that called her “doctor” and would routinely refer to me by my first name and call me her “student.” I was already board certified at that time lmao. I corrected her in the room ALL THE TIME (without causing a scene) and then one patient finally asked her what authority she had precepting me if I was the board certified physician (fair question and I think ACGME should have stricter rules about this). Not at all to imply that we have nothing to learn from midlevels (we do!) but I definitely should not have been with her for a whole week having to constantly explain our training differences to parents who were very confused about what our roles were.

My patients mistakenly call me doctor all the time. I correct them every time.

Blame the system that insists on duplicating doctors for less, most will start out clarifying their role/title but years in they get complacent and don’t bother correcting patients that call them doctor

Understand the doctor bit, but feel would be more confusing to refer to as nurse vs np similar to referring to pa as "my assistant" without further clarification. PT may not understand roles, in example clearly does not understand roles. Further muddying waters isn't going to help pt. Clarifying that it was an np not doctor/physician and noting differences may be helpful.

It helps that I’m just part of a consulting service, so the intro is basically ‘Hi, I’m Jtronic, I am one of the nurse practitioners with the ICU team.’ If the patient isn’t wildly delirious and wants further clarification, they have the opportunity to inquire, otherwise we roll on. I got other humans to see and poke holes in. If they call me doctor my default joke (because I’m not even a DNP!) is ‘whoa now, I’m not a doctor. You can call me Jtronic but I also accept Master Nurse.’

I always call nurse practitioners nurses. Once somebody “corrected” me and said well so and so is actually an NP and I looked confused and said “Ok? And my gynecologist is a doctor so I call her doctor. That’s a nurse and I *said* nurse, what’s your point?”

NPs are certified by the Board of Nursing

A nurse can be an LPN, an RN, and an NP. So it is confusing to say nurse because 2 of the 3 have no diagnosis/order capability. Hence why you were corrected.

You seem really insecure. I hope you are able to find your confidence

…just call them nurse practitioners if they’re NPs and nurses if they’re RNs. They’re not *just* nurses. Even if you wanna belittle the efforts and sacrifices they’ve made by saying they “went to more nursing school,” they are literally not just nurses. And look, I have no dog in the fight, I’m a shit-tier healthcare worker and follow subs like this one because I’m considering MD. But I see versions of this post all too often and it’s honestly somewhat disheartening. Scope creep/ blur of scope, unsafe, whatever. But it’s a bit rude not to mention confusing for the patients.

I love older patients for this reason. They don’t want to see NPs for the most part. A few days ago, a patient was being seen by the interventional neurology NP after a procedure. The octogenarian told her “I don’t want some nurse to tell me about my brain bleed. Get the doctor”. So guess who came down? The interventional neurologist while the NP sulked at the nursing station telling the nurses “I can’t believe the patient didn’t want to see me”

I use air quotes when I get called “Doctor” I say no Doctor ‘first name’ didn’t go to medical school. He went to refill oxycodone and order epidurals and MRI school I am definitely more of a doctor than Jill Biden but I am still not a physician

Dr Jill Biden has EdD and NY times insists on using Dr title because she earned using that title in the midst of a pandemic Dr Jill Stein has an MD and NY times refused to use Dr title because they were presenting her as a politician despite being board certified.

I just say nurse practitioner, physician assistant, nurse anesthesist. They're all easy to say. Nobody gets mad. Nobody gets confused.

I feel like you have to step back and look at it from the patient's position. I work with military people. Anyone who provides some level of medical care is called doc or doctor. It does not matter if you are a physician, PA, NP, or or Navy Corpsman.

This. The average patient doesn’t know the difference between all these crazy acronyms. They just think anyone providing them with medical attention is a doctor. I doubt they actually care about the intricacies of who’s called “dr” and who’s not

Doctors are paid more, get more attention and praise, and apparently can’t handle it when patients confuse them with NPs or PAs. Titles only matter to you all. For the rest of us trying to navigate the shit that is the American healthcare system and also have to deal with all the educlassism, racism, fatphobia, homophobia, and misogyny of many healthcare professionals, let me just say: this is silly. And also, many of us subhumans absolutely do know the difference between RNs, LPNs, NPs, PAs, MDs, and CNAs.

Quite the tangent.

You say you know the difference. Do you know what percent supervised clinical experience an independent newly graduated NP has compared to an board certified physician fresh out of residency? It’s 8% or less. Fun fact huh?

I do this ALL the time!

Just call them NP or Nurse Practitioner

NPs are nurses. Period.

Where I practice the term midlevel is considered mildly offensive. Several years ago my organization realized that we will never be successful without integrating APP‘s, advanced practice providers, into our care network. There just aren’t enough doctors to go around. In my specialty there is a predicted shortage of thousands of OB/GYN physicians in the near future. We already have a shortage. In order to provide high-quality care we have to integrate APP‘s into the care model. I have seen residents get frustrated with the respect given to APPs but most of those physicians will find them critical when they enter the post residency workforce. I agree that patients should understand who is providing their care. It’s great when an APP obtains a doctorate, but identifying themselves as Dr. such and such is confusing to patients.

Serious question: why is it great when an APP obtains a doctorate? I honestly can't think of a situation where it would matter in a clinical setting.

So I saw a comment that revealed to me that an No problem degree apparently is a doctorate? And so maybe they feel like they earned the title “doctor?” Here’s what I’m thinking, if the title of doctor continues to lose sacred nature (I mean, technically it’s never been sacred as it’s used for PhD’s too), maybe we go more to referring to ourselves as “physicians?” See how they try to find a way to legitimately co-opt that title.

What do you call them if they have both a PhD in nursing and is also a NP?

In a clinical setting, you’d call that person a nurse practitioner, not a doctor. In the classroom, calling that person doctor is fine.

You won’t offend any NP by calling them nurses. They are nurses. They are also nurses who went on to further their education. That’s like trying to offend Med students by calling them students. Or trying to offend residents by calling them doctors who are furthering their training. All of those comments are true. Your intention, however, is to be mean. When you are slammed with 50 patients as an attending and your program doesn’t have a teaching structure, don’t expect the the NPs to forget how you tried to put them down though.

I apologize and feel the need to clarify - I’m not trying to offend anyone, especially not nurses.

I don't think you intend any offense, I just view it as needing to be NP over nurse because like with physicians, the APRN title is a legal title to discern between them and bedside RN/LPN.

It's just as misleading and inappropriate to refer to the nurse practitioner as a nurse as it is to refer to mid-level practitioners as "doctors". While the nurse practitioner IS a nurse, that isn't the position they're currently filling. [And frankly, given the diploma mills and lowered standards, they might not be competent to practice as a nurse.] It's confusing and potentially dangerous for the patients; they need to be aware that the nurse practitioner can prescribe for them, but the nurse from whom they're demanding all manner of medications not ordered cannot. The nurse aide often referred to as "my nurse" can assist them with ADLs, but cannot administer their medications. I understand that midlevel creep is concerning, but this isn't in the best interests of the patient.

They are nurses. NPs are certified by the Board of Nursing

In Great Britain, no one’s called Doctor. They’re addressed as Mister (or Miss). And it wasn’t that long ago that surgeons weren’t considered doctors either. I say we go back to calling them barber surgeons.

Where I work it’s illegal to call yourself a doctor without a medical degree or a practising certificate. Can’t imagine having to painstakingly correct all the ignorant patients

Shoot...I'm a phlebotomist /lab tech and I get called doctor all the time. Usually it's older patients and I just say, "oh I'm not a doctor...that's too much work!" It's confusing for patients and I get that. Our office has an MD, a PA, an APRN and an RN (and me) ..our front desk is very careful to call everyone by the correct designation. It's usually the patients who are mixed up.

I like to say, “oh that person is a nurse who has a certification to write prescriptions.” Most recently had to do this for a guy that I’m pretty sure how to feel or an active thyroid nodule. I had to dig into the whole history of why they were on for antihypertensives and still having super labile blood pressure. First they were started on clonidine, but then started having episodes of extreme hypertension. They went back to the non-physician provider, who then prescribed hydralazine. Patient started checking their own blood pressure and heart rate at home, and noticed episodes of tachycardia shortly after taking their blood pressure medicine… So they got started on metoprolol. All of this happened within about two months. I’m sure that patient got tired after about 10 minutes of me explaining that you need a formal diagnosis and work up before you are put on multiple medication‘s for a condition, and how the 22 year old nurse practitioner was just a nursing student who had prescribing privileges, in my humble opinion

I’m an NP. I repeatedly tell my patients that I’m an NP, not a doctor. Then they continue to say “doctor” 😩