As a young PA, I was hesitant about introducing myself to new patients. Should I call myself Mr. Danielsen or just use my first name? Should I address patients as Mr. or Mrs.? Should I call all women Ms.? Should I use patients’ full names or just their first names?
I started by introducing myself as Randy and confirming my patient’s full name by reading it off the medical record. This worked well, and I believed that not using formal titles suggested we were equal partners in their health care. Plus, it gave patients some choices about what to call me.
Those choices were revealing. Some would choose—against my wishes—Dr. Randy, which suggested a preference for a “traditional” doctor-patient relationship. Others would call me Randy, suggesting a desire for a relationship on a more equal footing. The most telling were those who not only called me by my first name but also never missed an opportunity to fit it into our conversation. I soon recognized this practice as a sign that they hoped to use our “friendship” to ask for special treatment (or to sell me an insurance policy) in the future.
Most problematic were the patients who looked at me blankly. The telling look said, “I am pleased to meet you, but I am waiting for the doctor.” Even if they knew I was a PA, my reluctance to call myself “Doctor” apparently suggested that I wasn’t ready for the job of providing their care. These patients see “the doctor” as “the healer,” and since I didn’t use that title, these patients inferred that I wasn’t ready to fill those shoes.
As a seasoned PA with a few gray hairs to prove it, I usually begin an appointment by introducing myself as Randy Danielsen, a physician assistant, and then using the patient’s full name if he or she is younger than I am, and Mr. or Ms. if older. My patients deserve my respect, and they expect me to act the role of “doctor” whether I feel ready or not.
Now let me throw a wrench into the conversation. Enter a new kind of hybrid: either the doctor nurse wearing a name tag with the letters “DNP” or—dare I say it?—the doctor PA sporting a name tag with “DHSc” or “DSc.” Seen as one answer to the looming shortage of physicians, doctor nurses or doctor PAs take the NP or PA concept to yet another level. How, now, do our patients—and even our colleagues—understand what we offer?
Interestingly, many state statutes prohibit the use of the title Doctor by nonphysicians in clinical settings because it misleads the public that the person seeing them is a physician. Using Doctor or the abbreviation “Dr.” on a name tag or in a way that leads the public to believe the PA is licensed to practice as an allopathic or an osteopathic physician is considered unprofessional conduct in my state and will get you invited to come before the board.
Use of Doctor is also troubling because it could lead physicians to believe that PAs are seeking independent status. The issue for NPs is a bit tricky, as their desire to get the DNP is to have parallel status with physicians and to make an impact in primary care.
Where to go from here? How those new doctor NPs and doctor PAs will introduce themselves is just the tip of a controversial iceberg. Will these newly minted providers seek professional silos that separate them from “lesser” NPs and PAs? Could this be a stepping stone for PAs to seek independent practice? What about reimbursement schedules? And supervision? Will some of these new “doctors” be hiring or supervising other NPs or PAs? What about cross-profession interactions, such as a doctor NP employing PAs or doctor PAs supervising doctor NPs? The possibilities are endless—and confusing.
On top of this, there is some debate as to the role of academic institutions in the credential creep of NPs and PAs. I think our academic institutions are trying to build a better world, but sometimes—and this may be one such time—they are only doing the bidding of the tuition-paying client. When we consider the additional time needed to provide higher degrees to NPs and PAs, does that translate into less availability for patient services? Absolutely! We are taking a practicing provider away from patient care for additional training, when he or she could be seeing patients.
Doctoral degrees will not improve the quantity of health care provided; providers with these degrees will still see and take care of the same number of patients they cared for prior to their career expansion. However, advanced training will translate into additional costs for the health care component of the gross domestic product, which is already higher in the United States than in most other countries. And it will create a whole new cadre of doctoral educators who used to practice and see patients.