Managing use of Doctor title for Psychologist

[Psychfemine22]

Hi Everyone,

I am a mid-career psychologist who recently switched jobs to an AMC. At my previous jobs at a community mental health center and small private hospital, I was referred by my first name or Dr. X, as title went along with the workplace culture--either all the psychologist and psychiatrist were referred to as Dr. X or everyone was referred to by their first name. However, upon switching to the AMC, I noticed some administrative staff, all master-level clinicians, and most psychiatrists refer to psychologists by their first name and psychiatrist via Dr. honorific . I wonder, is this normal practice at AMC’s? Anyone else dealt with this? For me, it’s not the Dr. title that matters the most, but it does bother me that staff/other clinicians acknowledge the doctoral training of medical professionals but not the psychology profession. Am I overreacting here?

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[borne_before]

Call me Dr in front of patients. Call me first name when they aren’t around.

Psychiatrists tend to be more touchy about this stuff and there prolly a track history of them biching ppl out over it. Projection.

 

[smalltownpsych]

In my experience, the places with more midlevel therapists are the ones who are most likely to try and get away with that. The medical people such as RN’s and MD’s are the ones to gently correct first and then eventually the counselors and social workers will reluctantly have to cave. We absolutely should fight for the title as we owe it to each other, our field, our bank accounts, and our patients. For myself personally it doesn’t mean much beyond helping with marketing and it still feels a little awkward sometimes.

 

[AcronymAllergy]

Probably depends on the specific AMC, but it's not been common at any AMC where I trained.

 

[PsyDr]

i don’t play around with this. It’s a game to make you hesitant to show the differences between 2 years of education and 7 years. I’m not willing to be that self sacrificing to make someone else feel better.

“ I know you know my title, and I don’t appreciate the little games of acting like you forgot it. Are you going to knock this off, or do we need to see HR.”

 

[Psychfemine22]

I do think there might be some sense-of-self related dynamic going on, as I noticed the clinicians with masters degrees were the first to “forget” about my title, even after the management staff (both master-level people and doctoral) introduced me with my appropriate honorific. I think the other psychologists who work there just go along with it to avoid offending people, as they tend to be the good-hearted therapist kind. I will probably develop some sort of boundary setting regarding this issue.

 

[smalltownpsych]

I do think there might be some sense-of-self related dynamic going on, as I noticed the clinicians with masters degrees were the first to “forget” about my title, even after the management staff (both master-level people and doctoral) introduced me with my appropriate honorific. I think the other psychologists who work there just go along with it to avoid offending people, as they tend to be the good-hearted therapist kind. I will probably develop some sort of boundary setting regarding this issue.

Too many of us have the dynamic of people pleasing and part of our professional development should be to work on that. We need to learn to advocate for ourselves so that we can teach and model self-advocacy for our patients.

 

[PsyDWannabe]

I do think there might be some sense-of-self related dynamic going on, as I noticed the clinicians with masters degrees were the first to “forget” about my title, even after the management staff (both master-level people and doctoral) introduced me with my appropriate honorific. I think the other psychologists who work there just go along with it to avoid offending people, as they tend to be the good-hearted therapist kind. I will probably develop some sort of boundary setting regarding this issue.

Please insist that they address you by your proper earned title. Now is the easiest time to win that battle. Wait too much longer and you may as well accept that you’ll be addressed by your first name indefinitely.

 

[Therapist4Chnge]

Hi Everyone,

However, upon switching to the AMC, I noticed some administrative staff, all master-level clinicians, and most psychiatrists refer to psychologists by their first name and psychiatrist via Dr. honorific . I wonder, is this normal practice at AMC’s? Anyone else dealt with this?

Easy fix. Next time you and the psychiatrist are with a patient call them their first name, repeatedly. They’ll catch on, and then you tell them you don’t appreciate it when they use your first name in front of patients either.

For the mid-levels, be direct and tell them to use proper titles on the floor. It is a matter of respect and they clearly do not respect you if they continue.

As for other AMCs, I saw it briefly with my female fellows and some male residents, and I called them by their first names and told them to use titles in front of patients.

 

[PikminOC]

Is it so you don't confuse the patient on who the physician in the case is?

 

[WisNeuro]

Is it so you don't confuse the patient on who the physician in the case is?

I doubt it, this is not all that common. In my experience, it's much more a symptom of the workplace culture and interpersonal issues more than anything else.

 

[Therapist4Chnge]

Is it so you don't confuse the patient on who the physician in the case is?

The physician has the DO/MD on their badge, which is pretty easy to see.

 

[PsyDr]

Is it so you don't confuse the patient on who the physician in the case is?

Your title is "physician", not "doctor.". This has been the case since before 1392 as described by Chaucer. After that, the states, recognizing that FMG do not necessarily have a doctorate, had to create state laws for non-doctoral physicians to protect them from false advertising torts, because they are not a "doctor". Then this idea was further codified in the Bologna process, with physicians have lesser academic regalia than research doctorates. In 2011, the AMA tried to create a federal law to prevent non-physician use of the term "doctor" in hospitals in 2011, but failed the legal tests.

 

[PikminOC]

Your title is "physician", not "doctor.". This has been the case since before 1392 as described by Chaucer. After that, the states, recognizing that FMG do not necessarily have a doctorate, had to create state laws to non-doctoral physicians from false advertising torts, because they are not a "doctor". Then this idea was further codified in the Bologna process, with physicians have lesser academic regalia than research doctorates. In 2011, the AMA tried to create a federal law to prevent non-physician use of the term "doctor" in hospitals in 2011, but failed the legal tests.

Did you answer the question? I'm confused

 

[PikminOC]

The physician has the DO/MD on their badge, which is pretty easy to see.

People in the hospital get confused. Heck even outpatients do! Esp with the proliferating DNP

 

[PsyDr]

People in the hospital get confused. Heck even outpatients do! Esp with the proliferating DNP

They wouldn’t if you used the term “physician”. That’s your protected title.

 

[WisNeuro]

People in the hospital get confused. Heck even outpatients do! Esp with the proliferating DNP

This was extremely rare in my experience of over a decade in hospital settings.

 

[PikminOC]

This was extremely rare in my experience of over a decade in hospital settings.

Were you these with midlevels using the dnp? That's what's happening now. And no one reads the name tags

 

[WisNeuro]

Were you these with midlevels using the dnp? That's what's happening now. And no one reads the name tags

Nope, our hopsitals always had credentials and title under the badge, pretty easy. Only people who have ever had a problem with it has been physicians, and it was was always super easy to solve that problem.

 

[Psychfemine22]

The patients mostly address me via my earned title and understand that I am a doctoral-level provider that does not prescribe. Thus, the medical providers, masters’ folks, and staff have no excuse. I wonder if it stems from ignorance regarding the complexities of studying research/psychotherapy/psych testing/psychopathology at the doctoral level. If most of them had gone through the complexities of writing a dissertation at the culmination of 10 years of higher education, they would be less likely to see doctors as only physicians.

 

[WisNeuro]

The patients mostly address me via my earned title and understand that I am a doctoral-level provider that does not prescribe. Thus, the medical providers, masters’ folks, and staff have no excuse. I wonder if it stems from ignorance regarding the complexities of studying research/psychotherapy/psych testing/psychopathology at the doctoral level. If most of them had gone through the complexities of writing a dissertation at the culmination of 10 years of higher education, they would be less likely to see doctors as only physicians.

Very quick fix to this. Start addressing these people simply by their first names in every context (meetings, emails, in front of patients, etc). Puts a stop to this real quick.

 

[pediatric_psydoc]

I am at an AMC, and when a psychologist and mid-level jointly run a patient/family group, both end up going by their first name. I have been the one to go rogue by telling the mid-level clinician that in front of patients/when we are in group, I am “Dr SoandSo” and not “first name.” However, all the other psychologists go by “first name” and it gives the inaccurate appearance to families of equal training between the two providers when really one has a doctorate and the other a masters.

 

[smalltownpsych]

Patients call me first name, almost everyone else calls me Dr. 😁
Physicians and I go by first name with each other and title when talking to anyone else. If someone doesn’t refer to me as a doctor in a professional setting where title should be used, then I will ask them to use the title when introducing me to patients. This is Dr. Smalltown he is a psychologist. Then it’s up to me to correct the patients if they think I’m a psychiatrist. They usually all figure it out pretty quick.

 

[PsyDWannabe]

Patients call me first name, almost everyone else calls me Dr. 😁
Physicians and I go by first name with each other and title when talking to anyone else. If someone doesn’t refer to me as a doctor in a professional setting where title should be used, then I will ask them to use the title when introducing me to patients. This is Dr. Smalltown he is a psychologist. Then it’s up to me to correct the patients if they think I’m a psychiatrist. They usually all figure it out pretty quick.

Yup. It is easy for patients to grasp the idea. I am a psychologist and not a physician. I’ve never had to explain it more than once to any patient, ever.

 

[Therapist4Chnge]

The physician has the DO/MD on their badge, which is pretty easy to see.

I actually forgot the non-doctoral physicians (some FMG). It’d probably be clearest and most accurate to address all as Physicians, so as to not confuse w the doctorally-trained clinicians.

 

[PsyDr]

I actually forgot the non-doctoral physicians (some FMG). It’d probably be clearest and most accurate to address all as Physicians, so as to not confuse w the doctorally-trained clinicians.

It was a BIG thing, for a while. Various states had to pass laws to protect them from false advertising lawsuits. Because they were physicians, but not doctors.

Chaucer noted the difference between doctoral degrees and physicians in 1392, in the widely discussed “doctor of physic”.

Which is why, in academic regalia, MBBs are considered to be “lesser” than those with professionals doctorates (like MDs, PsyDs, JDs, and specifically wisneuro), which are considered of lesser rank than PhDs. Don’t know why they included him in that consideration, but it’s there, trust me.

 

[R. Matey]

Not at all common at the AMCs I'm familiar with. But these are ones that largely employ psychologists rather than midlevel clinicians. Agree with
others, I'd insist in this situation since it sounds like there's some weird passive-aggression going on there (are you in the Midwest, by chance).

That said, I'm a bit sympathetic to fears about patient confusion since I'm frequently asked whether I'm a psychiatrist or a psychologist, but most people know that both a psychologist and psychiatrist are doctors, given the academic origins of our discipline compared with others.

 

[PsyDr]

 

[R. Matey]

There is literally never an inappropriate moment to inject Captain Holt into a conversation.

 

[eeor1006]

This is not common at all where I work (AMC in midwest). But they only employ psychologists for evaluation and therapy. LISWs mostly work in case management and whatever they do in emergency room. If it were me, I'd respectfully insist to be called Dr soandso.

Confusion happens when there are a mid-level therapist and psychologist essentially doing the same thing.

 

[cara susanna]

I've never run into this issue at VAs or the AMCs I've been affiliated with.

 

[AcronymAllergy]

I've never run into this issue at VAs or the AMCs I've been affiliated with.

Yeah, VAs in my experience have typically gone in the other direction (i.e., anyone with a doctorate, whether or not it's related to patient care, is "doctor").

 

[AbnormalPsych]

Your title is "physician", not "doctor.". This has been the case since before 1392 as described by Chaucer. After that, the states, recognizing that FMG do not necessarily have a doctorate, had to create state laws for non-doctoral physicians to protect them from false advertising torts, because they are not a "doctor". Then this idea was further codified in the Bologna process, with physicians have lesser academic regalia than research doctorates. In 2011, the AMA tried to create a federal law to prevent non-physician use of the term "doctor" in hospitals in 2011, but failed the legal tests.

Just learned about this for CA while reading a story about three DNPs suing the state to block 2054 below to use the doctor title. Calling @PsyDr , for thoughts for psychologists:

California Business And Professions Code Section 2054​

(a) Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that he or she is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that he or she is entitled to practice hereunder, or who represents or holds himself or herself out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor.
(b) Notwithstanding subdivision (a), any of the following persons may use the words “doctor” or “physician,” the letters or prefix “Dr.,” or the initials “M.D.”:
(1) A graduate of a medical school approved or recognized by the board while enrolled in a postgraduate training program approved by the board.
(2) A graduate of a medical school who does not have a certificate as a physician and surgeon under this chapter if he or she meets all of the following requirements:
(A) If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B) Does not otherwise hold himself or herself out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C) Does not engage in any of the acts prohibited by Section 2060.
(3) A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
(Amended by Stats. 2017, Ch. 775, Sec. 22. (SB 798) Effective January 1, 2018.)

 

[WisNeuro]

Just learned about this for CA while reading a story about three DNPs suing the state to block 2054 below to use the doctor title. Calling @PsyDr , for thoughts for psychologists:

California Business And Professions Code Section 2054​

(a) Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words “doctor” or “physician,” the letters or prefix “Dr.,” the initials “M.D.,” or any other terms or letters indicating or implying that he or she is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that he or she is entitled to practice hereunder, or who represents or holds himself or herself out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor.
(b) Notwithstanding subdivision (a), any of the following persons may use the words “doctor” or “physician,” the letters or prefix “Dr.,” or the initials “M.D.”:
(1) A graduate of a medical school approved or recognized by the board while enrolled in a postgraduate training program approved by the board.
(2) A graduate of a medical school who does not have a certificate as a physician and surgeon under this chapter if he or she meets all of the following requirements:
(A) If issued a license to practice medicine in any jurisdiction, has not had that license revoked or suspended by that jurisdiction.
(B) Does not otherwise hold himself or herself out as a physician and surgeon entitled to practice medicine in this state except to the extent authorized by this chapter.
(C) Does not engage in any of the acts prohibited by Section 2060.
(3) A person authorized to practice medicine under Section 2111 or 2113 subject to the limitations set forth in those sections.
(Amended by Stats. 2017, Ch. 775, Sec. 22. (SB 798) Effective January 1, 2018.)

I can see lawyers salivating at the many lawsuits that will come from this. What a truly awful state.

Btw, there is already at least one lawsuit going forward at the moment.

 

[PsyDr]

LOL. I hope they uphold this law.

If "doctor" is synonymous with "physician", then every single attorney in the state of California, and every institution granting a "Juris Doctor" including UCLA, is guilty of a misdemeanor, and misrepresenting themselves to the courts. Repeatedly... In writing...In front of many witnesses...To the bar... and SCOTUS....

 

[AcronymAllergy]

Yeah, I can see regulating use of the term "physician," but not so sure about regulating the use of "doctor." That seems...broad.

 

[PsyDr]

Yeah, I can see regulating use of the term "physician," but not so sure about regulating the use of "doctor." That seems...broad.

It does look like the board overstepped its authority and that a lawsuit was necessary to clarify the law. Realistically, the lawsuit is going to result in a legal interpretation to mean "So long as you are not trying to misrepresent yourself as a physician, or confuse someone with your degree or title, you're fine." . Most commercial speech case law says something similar, outside of puffery.

 

[Ollie123]

Will be interested to follow this.

On the original post - in front of patients I think it is important to present the designation at initial introduction. Past that point it becomes a judgment call based on context, patient population, etc. Once again though, I feel obliged to point out this board is literally the only place I've ever heard of anyone routinely using the term "Dr" when among colleagues/staff. Out of quite literally hundreds of faculty I've interacted with across a half dozen institutions, I've met a grand total of about 3-4 people who did this.

 

[WisNeuro]

Will be interested to follow this.

On the original post - in front of patients I think it is important to present the designation at initial introduction. Past that point it becomes a judgment call based on context, patient population, etc. Once again though, I feel obliged to point out this board is literally the only place I've ever heard of anyone routinely using the term "Dr" when among colleagues/staff. Out of quite literally hundreds of faculty I've interacted with across a half dozen institutions, I've met a grand total of about 3-4 people who did this.

I think it's much different on mostly patient facing situations. In grad school and academia, no one use the doctor title. But, in all of my clinical training and jobs in hospitals, it was pretty universal amongst psychology staff.

 

[Ollie123]

I think it's much different on mostly patient facing situations. In grad school and academia, no one use the doctor title. But, in all of my clinical training and jobs in hospitals, it was pretty universal amongst psychology staff.

I was actually referencing the clinical settings in those places (admittedly I don't do clinical work in my current gig, but did in the last several). Dr when patients are present and during initial intros, first name in all other contexts with a stop-being-weird look given to anyone who did use Dr. Freshly graduated post-doc to division chief, it didn't matter.

Admittedly, even the clinics I've worked in were at research-heavy places so even the purely-clinical faculty were far more "academic" than you'd see in a random private hospital setting. The directors were always folks who had successful research programs in addition to their clinical role, so maybe that cultures just ends up permeating.

 

[smalltownpsych]

I was actually referencing the clinical settings in those places (admittedly I don't do clinical work in my current gig, but did in the last several). Dr when patients are present and during initial intros, first name in all other contexts with a stop-being-weird look given to anyone who did use Dr. Freshly graduated post-doc to division chief, it didn't matter.

Admittedly, even the clinics I've worked in were at research-heavy places so even the purely-clinical faculty were far more "academic" than you'd see in a random private hospital setting. The directors were always folks who had successful research programs in addition to their clinical role, so maybe that cultures just ends up permeating.

Agreed. Title is with patients and some professional interactions, not in casual conversations. When I worked in a hospital, it seemed pretty straightforward. When we were in official capacity talking about a case then we would refer to each other using the title, but when we were just hanging out chatting, then not so much.

Dr. Smalltown, should we admit this patient or are they ok to discharge? Well Dr. ER physician, I think that I have a good safety plan in place, supports, and follow-up with me tomorrow in outpatient so let’s get then out of here. By the way Pat, did you try that new Mexican restaurant in town? No, Fred, but I’m definitely going to try it.

 

[WisNeuro]

I was actually referencing the clinical settings in those places (admittedly I don't do clinical work in my current gig, but did in the last several). Dr when patients are present and during initial intros, first name in all other contexts with a stop-being-weird look given to anyone who did use Dr. Freshly graduated post-doc to division chief, it didn't matter.

Admittedly, even the clinics I've worked in were at research-heavy places so even the purely-clinical faculty were far more "academic" than you'd see in a random private hospital setting. The directors were always folks who had successful research programs in addition to their clinical role, so maybe that cultures just ends up permeating.

This has been my experience as well.

 

[AcronymAllergy]

This has been my experience as well.

Mine also. Although if I'm meeting someone for the first time in a professional context, I'll often use "doctor" the first time or so that I refer to them out of courtesy/respect.

 

[Ollie123]

Mine also. Although if I'm meeting someone for the first time in a professional context, I'll often use "doctor" the first time or so that I refer to them out of courtesy/respect.

Oh to be fair, I absolutely do that too. Better to err on the side of caution until you read the room, even if 99% of them are the same in my experience.

And you damn well better believe I use the Dr. title when say...calling our IT department to yell at them for the umpteenth time.

 

[borne_before]

I demand to be called doctor ALL THE TIME - even by gas station attendants.

 

[aim-agm]

I demand to be called doctor ALL THE TIME - even by gas station attendants.

People kept not calling me Doctor. Recognizing that I shouldn't try to control the behavior of others but rather reflect on what I can do differently, I legally changed my first, middle, and last names to "Doctor." For good measure, I also changed my preferred pronouns to "doctor/doctor/doctor"

Mine also. Although if I'm meeting someone for the first time in a professional context, I'll often use "doctor" the first time or so that I refer to them out of courtesy/respect.

If I'm talking about others, particularly in a professional context, I'll also refer to them as "doctor" unless they'd prefer otherwise.

 

[AcronymAllergy]

If I'm talking about others, particularly in a professional context, I'll also refer to them as "doctor" unless they'd prefer otherwise.

Same. The exception being if we all know each other well and talk frequently (including the person being referred to). But if the person I'm referring to is someone I don't personally know well, then yeah, it's usually "Dr. ____." Or sometimes first and last name.