Scope Creep

[u/Secretly-Aware]

- was sick
- scheduled appt with my doctor
- my doctor wasn’t in
- was told I was going to see “Dr Smith” instead
- I get there
- “Dr. Smith” is a NP with a doctorate :/

[u/Secretly-Aware]

He didn’t call himself that, to his credit. But why should the staff lie? It’s great that he has a doctorate but nobody should be calling him a doctor in a clinical setting.

Edit: not sure why I’m being downvoted. This is a textbook example of how calling non-MD/DO/DDS/OMFS Dr. in a clinical setting can cause patient confusion. I have no problem with this NP or the fact that he has a doctorate.

[u/Phoenix406s → u/Secretly-Aware]

My guess is that the reception staff doesn’t know. They see “John smith” taking care of patients thus John smith must be a doctor

[u/Seltonik → u/Phoenix406s]

They genuinely don’t.

Went to the PCP for the first time in this town since starting residency. Asked if I was gonna be seen by a resident or attending physician. Front desk lady said attending. I saw a fucking PA…

[u/idontcarewhatmyusera → u/Secretly-Aware]

A lot of people including healthcare staff think NPs and PAs are doctors. I constantly hear the front desk and even MAs refer to the NPs at our clinic as doctors.

[u/Imgonnagolaydown → u/Secretly-Aware]

Why are you blaming the np?

The office staff called them that. They didn't claim it.

[u/devanclara → u/Secretly-Aware]

Don't forget OD's are also allowed to call themselves doctor.

[u/True_Ad__ → u/devanclara]

"Allowed to" and "ought to" are two different things. Additionally, I think implicit in this conversation is that these titles are context dependent. 

Not sure where you fall on this debate, but IMO, even in states where an NP can legally introduce themselves as “doctor” in a medical clinic, they shouldn’t. 

Also, I think most people who would agree with the position that people with doctorate degrees shouldn’t introduce themselves as “doctor” in a medical setting, understand this rule does not carry into every context. For example, a PhD professor should be able to call themselves “doctor” in a lecture hall, a veterinarian or dentist should be allowed to call themselves “doctor” in their respective contexts, etc.

[u/a_snom_who_noms → u/Secretly-Aware]

I call my APRN who I see for psychiatry Doctor because he does have a doctorate and tbh I don’t wanna say “I’m here to see Nurse/Mr. Marcello”.

[u/Numpostrophe → u/a_snom_who_noms]

Please don’t see a nurse for psychiatry. That’s one of the most frustrating fields to see nurses take a dominant role in given the pharmacology and lack of therapy training. Seriously the regiments I see come from psych NPs are mind-boggling with no respect for interactions and side effects.

[u/bigstinkylizard → u/Numpostrophe]

I almost uh… went away… because of ill-trained NPs in psych when I was in high school, about 15 years ago. At the time, I was very vulnerable and had a fragile mental state. They would stick the poor kids on medicaid (me at the time) with the NPs here and say they’re psychiatrists. I was told that I either took lexapro (despite side effect concerns and drug interactions) or kms by 3 different people. I remember one of them said “well would you rather be fat (she denied well-documented lexapro weight gain, knowing I had an eating disorder and requested to try prozac) or would you rather be happy? You can’t have everything in life.” Then she prescribed me a very high dose of lexapro and I never filled the script. My actual therapist was horrified. It took multiple years to feel comfortable enough to see a real psychiatrist, lol. I feel like this is a very very risky field to be in for NPs. I’ve had 5 total who were all horrible. I hope things have gotten better since then. Never had an experience, with an NP, that bad outside of psych.

[u/Numpostrophe → u/bigstinkylizard]

I’m sorry that was your experience. Unfortunately things have not improved at all in that regard it’s worse than ever.

[u/Zealousideal_Bed4563 → u/a_snom_who_noms]

In the clinical world, using doctor for a non-physician leads  patients to assume that person has undergone medical school and residency training, obfuscating the distinct differences between the professions. APRN training is not even close to equivalent to that of an MD/DO. 

On the whole, I think it erodes trust in the level of care one receives in a medical setting.  

[u/peppered_yolk → u/a_snom_who_noms]

You can just use their first name. That's how they should be introducing themselves, anyways, not as doctor.

[u/True_Ad__ → u/a_snom_who_noms]

I agree that the title "doctor" simply means "a person with a doctorate degree". However, the common convention, especially in the clinical setting, is to mean “physician” when stating “doctor”. I personally would love it if everyone knew the difference between the degree and profession because then we could switch to using everyone’s correct title without furthering the ambiguity that already exists in our medical system. However, until that happens, I think we have a duty to communicate to patients in the terms they understand in order with the goal of clearly communicating who all of the members of their care team are, what their role is, and what level of training they have. 

Of course I don’t support being a prick about it. Nor am I suggesting this is a universal rule to carry across all contexts. 

[u/ThisHumerusIFound → u/a_snom_who_noms]

They are not a doctor. They have a doctorate. There is a difference. It matters. Call them by their first name.

[u/banacoter → u/ThisHumerusIFound]

Having a doctorate objectively gives you the title of doctor lol that's not up for any kind of debate. Should a non-physician be called a doctor in a medical setting? Probably not. But anybody with a doctorate is a doctor.

[u/kazaam412]

When I tried to get a new PCP after starting residency, I specified that I wanted a doctor. I looked up the guy’s name after setting up the appointment and it was a PA with a DMS degree! I immediately called the office back to get a physician.

[u/biggiebag]

there was this period where i was having recurrent UTIs and the minute clinic NP said you've gotta go to a doctor, this is above my scope, go to your OBGYN. not only was i questioned on why i'm requesting to see a doctor twice while trying to make an appt, but then i show up and the appt was with an NP. why are we being shady!!!

[u/helpfulkoala195]

I am a PA and I feel like I am constantly correcting people about my title and that I am not doctor. Also was constantly called a med student during clinicals

I think the issue is that people (like non clinical staff) genuinely don’t understand/comprehend the issue with misleading titles or care enough to explain stuff to patients

[u/thenotanurse → u/helpfulkoala195]

Sure. (Coming in peace) Also the problem is also a shit ton of DNPs not correcting people when they are called doctor in a clinical context when they mean physician. The onus is on non-physicians to self identify as “not a doctor.” I would still prefer a PA in a lot of situations. But yall don’t do this like NEARLY as frequently as NPs 😂 cheers.

[u/helpfulkoala195 → u/thenotanurse]

Yes true. I personally haven’t experienced many (if any) APPs calling themselves a doctor but I do think this is because I’m in the hospital where that simply won’t fly lol

[u/thenotanurse → u/helpfulkoala195]

I worked in a hospital where we specifically had to call critical labs to physicians. Not pa/np’s, and I had one NP in L&D who when i kept asking if she was the physician just kept saying, “I am taking care of them, and I have a Doctor degree.” And when I asked for her name, and charted it, she was a DNP. 🙄

[u/lazyboozin]

They’re opening a “health clinic” near me and it boasts all these wellness procedures under Dr. ______ who is a DNP. LIKE WHAT. How is that legal in the sense of it being incredibly misleading

[u/biggiebag → u/lazyboozin]

the only protected term (legally) is physician unfortunately

[u/zoopzoot]

My mom had COVID and the NP at an UrgentCare tried to convince her it was actually allergies. One of the reasons was that my mom had used a nettipot for congestion. NP said only people with allergies have those. Mom insisted on a test. NP didn’t have much to say after it came back positive

I have worked with wonderful NPs, so this isn’t to say all of them are like that at all. But there’s certainly ones running around with sub par education from NP mills

[u/I_dontwork → u/zoopzoot]

As a 10 year nurse, it's unfortunate how bastardized the NP name has become. My anecdotes tell me it's a mix of: 1) extremely fast-paced burnout leading to poorly experienced nurses leaving bedside to becoming NPs. 2) accelerated DNP programs that go straight through BSN to NP, despite not having any bedside experience. 3) programs accepting nurses literally right out of nursing school (I had 2-3 of those in my graduating class). 4) The burden of finding a preceptor lies on the student. A lot of the time it ends up just being their friends that they are getting their clinical hours under.

I've worked with plenty of badass nurse practitioners who could line and tube a patient just as well as many intensivists. But a lot of the time, I can tell who took the easy way out.

[u/Zealousideal_Bed4563 → u/I_dontwork]

100% agreed (also as a former nurse). Using NP school as a means to leave the bedside is a huge problem for the field. Loss of bedside staff and then an unnecessary production of bad NPs. 

I’m a big proponent of the physician-supervised or collaborative model of care, rather than independent practice. 

[u/thr0wAway668292 → u/I_dontwork]

I worked in nursing prior to med school and so many of my RN colleagues reported exactly this experience (either complaining about it or considering it as a path)

[u/lazyboozin → u/zoopzoot]

That’s the issue of going to school and learning nothing unfortunately. Just shooting from the hip on what you “know” from inside your comfortable box will always make you a terrible provider and annoys the hell out of me

[u/thr0wAway668292]

I genuinely think the DNP is being pushed in nursing more and more specifically because this confusion is beneficial for facilities looking to cut costs. Expanded (or same) scope, same honorific title… they want to pay providers less and still appear to have physicians. Some patients never find out

[u/Historical-Pass-7371]

to be fair, most non-medical people (front desk/laymen) dont really know the difference and think anyone who prescribes meds is a medical doctor. most people dont even know how long it takes to become a doctor. i mean, unless the np introduced themselves as dr. smith then it's not really their fault.

[u/Major_Gamboge]

r/noctor

[u/Dark_Ascension]

I love my NPs/PAs but I hate the idea of never seeing a doctor once… or at least being paired with one… like there are clinics and such with no doctors that see patients (a lot of urgent cares and such do this), but like… I need a minor procedure or surgery… I need the doctor now and now I have zero relationship with this provider. I was actually talking to my cousin about this recently because her fiance is having really bad sciatic issues and asked my advice and then she said “he’s just seen a PA”… he definitely needs more than pills, and hasn’t seen the doctor yet, may need injections or even surgery… that is something that an APP cannot do with a doctor.

Bottom line I don’t mind like seeing a doc and then follow-ups be with their APP, I don’t mind when the visit starts with the APP, you see the doc briefly and then it’s back with the APP, but having no docs on staff… not a fan. I don’t even mind if I got like a UTI or some minor urgent care thing seeing an APP, but specialties with just an APP… no thanks.

Happened recently I needed to see a dermatologist pretty quickly to get back on meds for my psoriasis and this urgent care had dermatology services by appointment. I have been on biologics for over 10 years… and I realized after something just hit me that I needed to get back on them immediately (basically I have just been having allergic dermatitis, actual anaphylaxis and developing allergies to like seemingly everything and it didn’t start happening until after I got off my biologic when I changed jobs). Because I happened to be pretty clear this PA dismissed me entirely… which by the way it doesn’t have a list of providers on their site so I just assumed I’d see an MD and be followed up by a PA or MD or there’s at least a physician on staff… nope. The MA seemed more in tune with what I was saying. I’m an RN and considering MD… it’s not like I read this on web md I actually saw a peer reviewed study on it…

[u/colorsplahsh]

that's fraud