The Use of the Title "Dr"
Monday, July 20, 2020
Question: How should I use the title “Dr.” in verbal and written communications with a patient?
Response: The short answer is “don’t.” If the patient calls you “doctor” verbally or refers to you in writing as “doctor” or “Dr. Smith” you are ethically and legally obligated to correct them. Your job is to educate the patient on your appropriate education and licensure. You can gently inform or, more likely remind them you are an advanced nurse practitioner. I recommend to my clients that should that occur and you educate your patient, then it is something that you document in your medical record. You are doing so in the event of a complaint against you regarding the unlicensed practice of medicine. You want to be sure you are protecting yourself.
In Texas, there is a law that specifically states how one can use the moniker of “Dr.” The law limits who can use this title. It does not generally include nurse practitioner. The statute states:
“In using the title ‘doctor’ as a trade or professional asset or on any manner of professional identification, including a sign, pamphlet, stationery, or letterhead, or as a part of a signature, a person other than a person described by Section 104.003 shall designate the authority under which the title is used or the college or honorary degree that gives rise to the use of the title.” (§104.004 of the Texas Occupations Code).
If you have earned a doctorate in nursing the rules are a little different. The statute allows a person to use the title “doctor” as a manner of professional identification as long as the individual designates the authority or the college in which the degree is conferred. Therefore, if you earned your Doctorate in Nursing from, for example, the University of North Texas, this needs to be indicated in business cards, websites, advertising and the like. The designated authority of one’s doctorate is “DNP.” Upon earning your doctorate, you could and can legally use the professional designation “Dr.” under the law as long as those are appropriately indicated. Therefore, if one’s business card reads: “Jane Smith, DNP, ARPN, FP-C” this is appropriate.
On one’s website, the college or university where you received your doctorate needs to be obvious. I recommend on a banner on each page, you have “Jane Smith, DNP, ARPN, FP-C.” In the body of the website if it refers to you as Dr. Smith, that is likely appropriate if the context is clear and if there is no confusion that you are a nurse practitioner and not a physician. Basically, use good common sense and do not create confusion.
However, the Texas Medical Board very-well may and often does open investigations into the practice of medicine without a license on nurse practitioners. To date, as long as the advanced nurse practitioner with a doctorate abides by the above law and it is extremely clear that one is not a physician but rather an advanced nurse practitioner with a doctorate, such cases have eventually been dismissed, but after the expense of an investigation. One needs to be very careful on how they advertise their doctorate to ensure no reasonable person would consider you a practicing physician.
Jon Porter is a partner of the law firm of McDonald, Mackay, Porter & Weitz, L.L.P., Austin, Texas since 2003. Prior to this Mr. Porter worked in the Texas Legislature, then as a licensure investigator, prosecuting attorney and later the Director of Investigations and Compliance for the Texas Medical Board.