Dr. DNP vs. Dr. MD

[W19]

Geez. Hmmm. Sounds like you work in a hostile environment... I hope we, as professionals, can find a language that is respectful and reflective of each person involved in the medical team. No matter what your degree though, it's never okay to berate or demean someone and I'm sorry if any nurses ever made you feel inferior as a medical student or physician.

I deal with berating, dismissive, demeaning comments every shift I work from drunk patients, a-hole doctors, and everyone in between...

IMO, physicians should not try to find 'respectful and reflective' language (whatever the rest of your sentence is)... until everyone understands what their role on the team is. I have never seen a physician try to pass him/herself as a pharmacist even if physicians are legally allowed to dispense medications in virtually every single state...

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[gallons]

The inferiority complex some nurses have is just staggering. Some is key here, most do not. Yet, you should still respect persons which on their preferred designation, no matter how silly it seems.

 

[@Hazel-rah]

I like this M.D.'s take on the issue:
http://www.kevinmd.com/blog/2016/01/will-real-doctor-please-stand.html

In the system where I work, our name badge has a large tag underneath denoting our role--RN, Physician Assistant, Nurse Practitioner, Physician. It is unmistakable. I've never seen anyone intentionally conflate the roles...

I agree that a DNP requesting to be called doctor in a clinical setting is misleading and unethical. But according to their diploma, they did earn a doctorate in their field... So in any non clinical setting, I think they deserve to be addressed Dr. ___.

All jokes aside, though (noctor, etc.), how do you think PA's and NP's should be addressed? Anything special or just by name?

Our convention is to call midlevels by their first name: "Hi, I'm Sandy, Farouk, etc., one of the nurse practitioners here..." Or I'll say, "Dmitry, the physician assistant who is managing your care, has ordered a CT scan." Physicians introduce themselves as Dr. Surname and I've never heard one be called by first name. Even I, as a nurse call the physicians "Dr. Surname (although some others are comfortable using first names).

From a sociolinguistic perspective, this is an interesting recent conundrum we English-speakers have encountered and it seems the convention may vary by region, perhaps influenced by the independent practice rights of midlevel providers in each state. I'll be watching and listening more closely to this issue in the future.

 

[masaraksh]

Thank god for radiology.

 

[Spectre of Ockham]

I find these discussions fascinating. I am a nurse. This particular statement you made is haughty and inaccurate. Nurses learn a completely different (and less rigorous) side of patient care that is vital to the success of the healthcare team. That is one reason I want to go to medical school and not NP. However, it makes me sad that medical students and doctors are so ill-informed of what nurses actually DO know and can do. In my facility I have never heard nurses "brag about how they school doctors."

#1 We work salve beside you for the duration of our training , we know you well.

#2 Your facility is not representative for the entire medical world.

#3 Bragging about "That doctor learned it all from me" is not to rare from RNs , EMTs and techs such as ambulance drivers.

Also the NP with a doctorate is just a NP PhD. Before anyone disagrees let me know how a MD with a doctorate should be addressed ?
Doctor doctor ? Double doctor ? Doctor exponent ? Doctor square ?

In that last case I know a MD with three doctorates . Should he be called doctor tessaract ?

 

[Psai]

#1 We work salve beside you for the duration of our training , we know you well.

#2 Your facility is not representative for the entire medical world.

#3 Bragging about "That doctor learned it all from me" is not to rare from RNs , EMTs and techs such as ambulance drivers.

Also the NP with a doctorate is just a NP PhD. Before anyone disagrees let me know how a MD with a doctorate should be addressed ?
Doctor doctor ? Double doctor ? Doctor exponent ? Doctor square ?

In that last case I know a MD with three doctorates . Should he be called doctor tessaract ?

Lol most nps with "doctorates" have 2 year joke degrees, not a phd

 

[Spectre of Ockham]

Lol most nps with "doctorates" have 2 year joke degrees, not a phd

NP 1/2 PhD ? NP Funny PhD ?

 

[AlbinoHawk DO]

All jokes aside, though (noctor, etc.), how do you think PA's and NP's should be addressed? Anything special or just by name?

I had a roommate that was a PA student. He said the supposed proper way to address a PA is something like PA LastName. I think saying something like Nurse Practitioner (or NP) LastName would be fine.

 

[Dires]

To each his own, but I just played the game. Medicine is a joke in terms of all of the players vying for prestige and power. Be an ass when you have an axe. As a med student you're a peon, and the extent of your influence is annoying your residents/attendings by causing conflict with mid-levels.

Suck it up and respect people you don't respect for a couple years.

 

[Dr. Janitor]

Thank god for radiology.

Until the machines rise up and demand to be called doctor.....

In fact, it's already happening:

 

[GypsyHummus]

What about the podiatrists?!

 

[OrthoTraumaMD]

I agree 100%. OP, or any student on here, should just suck it up and call the DNP whatever they prefer, in my opinion. It's only 2-8 weeks for that rotation, and any negative impression made can hurt.

When I was a student and somebody did that to me, I would find ways to avoid addressing them directly. Otherwise, I felt that they would pick up on the mental eyeroll I was making.

 

[OrthoTraumaMD]

Most doctors don't care about being called doctor because after about a month you don't even realize it anymore. If you are making a point to have someone call you doctor you have some pretty bad self esteem issues and probably don't even lift.

I can't "like" this post enough.

 

[OrthoTraumaMD]

No venture brothers fans here huh? I can't believe no one has mentioned "Dr Girlfriend" yet.

 

[Psai]

I had a roommate that was a PA student. He said the supposed proper way to address a PA is something like PA LastName. I think saying something like Nurse Practitioner (or NP) LastName would be fine.

Tell your roommate to stfu
Every PA and NP is "first name"

 

[vm26]

Tell your roommate to stfu
Every PA and NP is "first name"

Even nurse Ratched?!

 

[username456789]

Even nurse Ratched?!

She wasn't an NP.

 

[SurfingDoctor]

I don't even introduce myself as doctor. Giving oneself a title doesn't mean they give themselves expertise.

 

[JB50]

Just ask how many zeros are behind their paychecks. Something I think @Psai would do

 

[Matthew9Thirtyfive]

Just ask how many zeros are behind their paychecks. Something I think @Psai would do

Doesn't really work when they're making more than you as a resident.

 

[Psai]

Doesn't really work when they're making more than you as a resident.

Even the regular nurses make double your salary wi the less than half the time and way less responsibility.

 

[JB50]

Why are residents paid so ****ty

 

[Matthew9Thirtyfive]

Why are residents paid so ****ty

Indentured servitude. Your salary is government funded.

 

[Taddy Mason]

Even the regular nurses make double your salary wi the less than half the time and way less responsibility.

Hyperbole much?

 

[Matthew9Thirtyfive]

Hyperbole much?

When my wife (a peds heme/once nurse) worked full time, she made almost twice a resident's salary. She's great at her job, but she's still getting paid almost double the average intern who has twice the education and more responsibility.

 

[BurghStudent]

Why are residents paid so ****ty

Because we agree to it.

Just look at the response to Dr. Sunshine's (seriously his name dho) article in Slate. Explain to a working stiff why $60K isn't enough:

http://www.slate.com/articles/healt...n_training_are_organizing_for_collective.html

 

[Taddy Mason]

When my wife (a peds heme/once nurse) worked full time, she made almost twice a resident's salary. She's great at her job, but she's still getting paid almost double the average intern who has twice the education and more responsibility.

My wife is a nurse as well and we have a number of friends who are nurses who have worked throughout the US (including high cost of living areas like Cali). Resident salary averages between $50-65K. I've never heard of a floor RN's base salary being in the $100-130K range. I'm aware of floor RN's making just south of $100K, but that's after factoring for cost of living, overtime pay, and incentive pay for picking-up extra shifts.

 

[Matthew9Thirtyfive]

My wife is a nurse as well and we have a number of friends who are nurses who have worked throughout the US (including high cost of living areas like Cali). Resident salary averages between $50-65K. I've never heard of a floor RN's base salary being in the $100-130K range. I'm aware of floor RN's making just south of $100K, but that's after factoring for cost of living, overtime pay, and incentive pay for picking-up extra shifts.

I was going off $50k which is about the average of what I've seen. My wife, working straight full time with no overtime or incentives, made just shy of double that. She works in an outpatient clinic.

 

[username456789]

When my wife (a peds heme/once nurse) worked full time, she made almost twice a resident's salary. She's great at her job, but she's still getting paid almost double the average intern who has twice the education and more responsibility.

To be fair, an average intern has more than twice the education as an RN.

 

[Matthew9Thirtyfive]

To be fair, an average intern has more than twice the education as an RN.

For the most part, yes. My wife has two bachelors degrees though, so she's a bit more educated than most RNs. Just to be clear though, she gets paid the same as the other nurses who don't have the extra degree.

 

[Taddy Mason]

I was going off $50k which is about the average of what I've seen. My wife, working straight full time with no overtime or incentives, made just shy of double that. She works in an outpatient clinic.

If you're not in a high COL area or leaving out any details, then your wife's salary is definitely a big exception (and I can say that with A LOT of confidence). Especially if she's working outpatient and has no administrative/management/supervisor roles.

 

[Matthew9Thirtyfive]

If you're not in a high COL area or leaving out any details, then your wife's salary is definitely a big exception (and I can say that with A LOT of confidence). Especially if she's working outpatient and has no administrative/management/supervisor roles.

We are in an area where nurses make higher than the national average. But even back when I worked in the OR in a lower COL area, most of the OR nurses were making more than the residents (that included call pay though). I'm sure it's not that way everywhere. I also worked in TX, and the nurses' salaries were a lot lower.

 

[slatermd]

First of all, I love nurses and NPs. Quite literally, as I'm married to one. Second of all, in my institution, plenty of floor nurses with 4-5 years' experience make over $100k. The day 1 starting base rate is $25/hr. You get yearly raises, shift differentials (+$2/hr for evenings, +$5/hr for nights, some additional differential for weekends as well). You also get extra money for working charge shifts, time and a half for holidays (all floor nurses work some), etc and so forth. If you've been there 4 years, work nights weekends and holidays, have trained to work charge shifts, you can definitely make double a resident salary. Doesn't really matter though.

At my institution there are also some extremely badass NPs. The kind of clinician whom no med student has any chance of embarrassing. They have skills I will never possess, and vice versa, and we have a healthy understanding of our different roles and the ways we can work together, instead of spending time on ego-fueled pissing matches. They introduce themselves (to patients as well as to hospital staff and medical students) by their first names, and if additional clarification is needed they say "I am Dr. So and So's nurse." I've never seen or heard of them trying to humiliate medical students. That is something I've seen floor nurses and scrub nurses do in my hospital, and it's generally written off as a normal part of the process, **** rolls downhill, etc. The only nurses I've seen in my hospital requesting to be called doctors are the Ph.D types that are no longer clinical and exist only on the academic side as nursing school faculty. I'm not at all suggesting this "call me doctor" stuff doesn't occur, because I know it is rampant. I'm pretty fortunate that in my institution most of the DNPs don't have that chip on their shoulder.

That being said, the agenda to minimize the differences in training and qualifications between physicians, NPs, and PAs is real. I thought this was an interesting position on that:

http://www.aafp.org/about/policies/all/provider-term-position.html

 

[3member]

They have skills I will never possess, and vice versa, and we have a healthy understanding of our different roles and the ways we can work together, instead of spending time on ego-fueled pissing matches.

Could you elaborate more on this? Genuinely asking

 

[slatermd]

Could you elaborate more on this? Genuinely asking

Yeah first when I say skills I "never will have," for the most part I don't mean "skills I never could have." A lot of what they do I could learn to do, but I never will because we're on completely different trajectories and serving different roles. That's the fundamental issue that the OP brings up. Nurses and physicians have completely different clinical roles - why try to equalize them by insisting that we all carry the same title? We have different training, different skill sets, different expectations and responsibilities. Nurses are trained to assess patients differently than physicians are trained to assess patients, nurses are trained to communicate differently than physicians are trained to communicate (in my wife's nursing school she didn't have a single simulated patient or OSCE). Nurses (especially floor nurses) spend so much more time face to face with patients. And the jobs are so different that people with different innate skills self-select into the two different careers. So part of what I mean is these NPs have innate abilities that I don't have, that's why we chose different careers. Part of what I mean is that we've received fundamentally different training in order to fulfill different roles.

The last thing, though, is that the particular NPs to whom I'm referring are fairly specialized. One works for our peds CV surgeon who is an animal. Another one works with pulmonology, another works with an ortho spine surgeon. Each of them has skills the other NPs don't possess, just by virtue of specialization. And they all have skills I won't possess, starting with the foundational nursing skills I've never been taught and have no desire to learn, and ending with the specialized things they've picked up from their supervising docs, a lot of which I would actually enjoy learning, but won't have the time.

 

[W19]

If you're not in a high COL area or leaving out any details, then your wife's salary is definitely a big exception (and I can say that with A LOT of confidence). Especially if she's working outpatient and has no administrative/management/supervisor roles.

It's not a big exception IMO... I was making ~45k/year working 24hrs/wk 4 years ago... My spouse is making about the same working 24 hrs/wk as well. We don't live in a high COL area. Most of my friends are making ~80k/year working 36 hrs/wk and some of them have an AS degree. Nursing is great gig for people who can stomach that kind of work.

 

[Taddy Mason]

It's not a big exception IMO... I was making ~45k/year working 24hrs/wk 4 years ago... My spouse is making about the same working 24 hrs/wk as well. We don't live in a high COL area. Most of my friends are making ~80k/year working 36 hrs/wk and some of them have an AS degree. Nursing is great gig for people who can stomach that kind of work.

1) That's not $100-130k/year (i.e., 2x what residents make - the comment that led to this discussion). I'm not saying nurses don't hit that range, but if they do 99% of time it's secondary to COL and/or busting their balls (picking-up extra shifts, overtime, shift differentials, working as a charge nurse, etc.).

2) You've dropped enough hints over the years as to what state, and where in said state you're located. Relatively speaking, you're not in a low COL area.

 

[3member]

Yeah first when I say skills I "never will have," for the most part I don't mean "skills I never could have." A lot of what they do I could learn to do, but I never will because we're on completely different trajectories and serving different roles. That's the fundamental issue that the OP brings up. Nurses and physicians have completely different clinical roles - why try to equalize them by insisting that we all carry the same title? We have different training, different skill sets, different expectations and responsibilities. Nurses are trained to assess patients differently than physicians are trained to assess patients, nurses are trained to communicate differently than physicians are trained to communicate (in my wife's nursing school she didn't have a single simulated patient or OSCE). Nurses (especially floor nurses) spend so much more time face to face with patients. And the jobs are so different that people with different innate skills self-select into the two different careers. So part of what I mean is these NPs have innate abilities that I don't have, that's why we chose different careers. Part of what I mean is that we've received fundamentally different training in order to fulfill different roles.

The last thing, though, is that the particular NPs to whom I'm referring are fairly specialized. One works for our peds CV surgeon who is an animal. Another one works with pulmonology, another works with an ortho spine surgeon. Each of them has skills the other NPs don't possess, just by virtue of specialization. And they all have skills I won't possess, starting with the foundational nursing skills I've never been taught and have no desire to learn, and ending with the specialized things they've picked up from their supervising docs, a lot of which I would actually enjoy learning, but won't have the time.

Great explanation. Thank you

 

[Psai]

Could you elaborate more on this? Genuinely asking

I've found that I suck at putting diapers on kids, can't put a crying kid to sleep, bad at putting in IVs and too inexperienced to boost patients properly.

 

[BeddingfieldMD]

During a clerkship, I got "chastised" for not addressing a DNP prepared nurse practitioner as Dr. X. Why is this a thing? I have had attendings introduce themselves by their first names to me. Obviously, I address them as Dr. X and I ask residents how they want to be addressed and its usually by their first name only. Most of our PT guys are doctrate prepared and all our clinical pharmacists are doctorate level, but they never want to be called Dr. X. So why the big push by some DNPs to be called Dr.? Things that make you go hmmmm.....

Don't worry...you've only got a couple more years of this type of thing. Once you're a resident, I doubt you'll get that kind of flack. And definitely not once you're an attending.

In the meantime, just suck it up, call him/her doctor, and bide your time. You're not in a position presently to do anything with this.

 

[evilbooyaa]

What about the podiatrists?!

Podiatrists to me are doctors in the clinical setting. Sure, they only deal with feet, but having reviewed the podiatry curriculum (when I had a podiatry student on service as an intern) it legitimately is pretty comprehensive. One of the smaller hospitals that didn't have a ton of vascular coverage, they were key for doing all the nasty foot stuff (and even amputations up to about the ankle) that vascular did at the mothership. I think if you are legally allowed to amputate something by yourself and have a doctorate, I'm OK calling you a doctor.

Same boat as dentists, IMO.

 

[W19]

What about the podiatrists?!

Podiatrists are DOCTORS in clinical settings... They are surgeons. I don't get why people continue to group podiatrists with DNP. You wouldn't put dentists in the same level as DNP!

 

[deleted564680]

It's definitely been true in my experience that the NPs that want to be called Doctor are the ones that are teachers/professors/academic types. They are the ones that are pushing the policy from their pantsuits on high. The 90% of clinical NPs are just trying to do their job and not feel overwhelmed or embarrassed most of the time. They usually wanted to be an NP because they were already a nurse and it's frankly way easier to do so. The problem is the lax curriculum, inconsistent standards, etc. but not the people who become NPs. This is discussed even between nurses and you can see it on allnurses.com routinely. Even they know the NP stuff is getting too lax and oversupply is real.

 

[Matthew9Thirtyfive]

Podiatrists are DOCTORS in clinical settings... They are surgeons. I don't get why people continue to group podiatrists with DNP. You wouldn't put dentists in the same level as DNP!

A lot of podiatrists seem to be upset that they aren't considered physicians by a lot of people. Dentists don't really seem hung up on that (save for The Hangover).

 

[3member]

I've found that I suck at putting diapers on kids, can't put a crying kid to sleep, bad at putting in IVs and too inexperienced to boost patients properly.

me too re: diapers

 

[NurWollen]

A lot of podiatrists seem to be upset that they aren't considered physicians by a lot of people. Dentists don't really seem hung up on that (save for The Hangover).

Dentistry is a respectable profession that performs a service that is very much needed by society. Every dentist I know very much wanted to be a dentist and could have easily gotten in to DO school if they had so desired.

I think, based on convention, that it is perfectly appropriate to address a dentist as Dr. _______. Yet, also by convention, it would be inappropriate for them to say "I'm a doctor." And I don't know any dentists who would do that.

NPs, in my experience, rarely introduce themselves as Dr. ______, and when they do (in my limited experience) the qualify it by identifying themselves as NPs.

Podiatry is a bit more of a gray zone for me, because their training is so similar to ours, and the role they play in the healthcare system is so like that of physicians. I think it's maybe a little tacky for a podiatrist to describe themselves as a physician without specifying that they are a podiatrist, but honestly, the pretty much function like physicians.

Compare that to chiropractors who regularly describe themselves as physicians, with no specifics or qualifiers. Totally disingenuous. Same goes for NDs.

 

[Matthew9Thirtyfive]

Dentistry is a respectable profession that performs a service that is very much needed by society. Every dentist I know very much wanted to be a dentist and could have easily gotten in to DO school if they had so desired.

I think, based on convention, that it is perfectly appropriate to address a dentist as Dr. _______. Yet, also by convention, it would be inappropriate for them to say "I'm a doctor." And I don't know any dentists who would do that.

NPs, in my experience, rarely introduce themselves as Dr. ______, and when they do (in my limited experience) the qualify it by identifying themselves as NPs.

Podiatry is a bit more of a gray zone for me, because their training is so similar to ours, and the role they play in the healthcare system is so like that of physicians. I think it's maybe a little tacky for a podiatrist to describe themselves as a physician without specifying that they are a podiatrist, but honestly, the pretty much function like physicians.

Compare that to chiropractors who regularly describe themselves as physicians, with no specifics or qualifiers. Totally disingenuous. Same goes for NDs.

I agree with most of this. Every dentist I've met wanted to be a dentist and introduces themselves as a dentist. I've also never met an NP who introduced themselves as Dr. ______.

I have seen a nurse introduce herself that way, but she was a same day surgery nurse who had her DNP. When she would get a patient, she would introduce herself by saying, "Hello, my name is Dr. _______. I'll be taking care of you today." That is VERY inappropriate in my opinion. She was called on it by some of the doctors, but the nursing staff and union had her back and basically just talked her into keeping it on her lab coat and not saying it out loud.

Podiatrists are podiatrists. I equate them more to dentists than physicians, though I think they do practice more medicine. That said, they are extremely limited in their scope of practice and therefore I don't think should be introducing themselves as physicians. I DO think that it's totally appropriate for them to be called Dr., and I called the pods I worked with in the OR Dr. without any hesitation.

 

[NurWollen]

I agree with most of this. Every dentist I've met wanted to be a dentist and introduces themselves as a dentist. I've also never met an NP who introduced themselves as Dr. ______.

I have seen a nurse introduce herself that way, but she was a same day surgery nurse who had her DNP. When she would get a patient, she would introduce herself by saying, "Hello, my name is Dr. _______. I'll be taking care of you today." That is VERY inappropriate in my opinion. She was called on it by some of the doctors, but the nursing staff and union had her back and basically just talked her into keeping it on her lab coat and not saying it out loud.

Podiatrists are podiatrists. I equate them more to dentists than physicians, though I think they do practice more medicine. That said, they are extremely limited in their scope of practice and therefore I don't think should be introducing themselves as physicians. I DO think that it's totally appropriate for them to be called Dr., and I called the pods I worked with in the OR Dr. without any hesitation.

That should be illegal, IMHO

Sent from my SM-G930V using SDN mobile

 

[Matthew9Thirtyfive]

That should be illegal, IMHO

Sent from my SM-G930V using SDN mobile

I think it is in some states. I've worked in three hospitals, and it was against hospital policy in all three of them. The union was strong with this one.

 

[IlDestriero]

I call ophthalmologists eye dentists.


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Il Destriero