i am a pa of several years. I can speak for my co-workers and classmates. Most pa's are taught about the clear distinction between md and midlevel as well as the importance of maintaining that distinction with patients. There are some mid-levels who do not care to maintain that distinction (whether because of ego or laziness). It is important for mid-levels to recognize the reasons for and ramifications of not maintaining that clear line. Legal, moral, and ethical boundaries must be maintained.
I think it is dishonest and dangerous for mid-levels to use the "doctor" title in the clinical setting. I have no problems with the earning of a doctorate as a midlevel, but using that degree/title in the clinical setting blurs the line between who is ultimately responsible and/or liable for the patient's treatment and care. Some exceptions may apply...
In the patient care setting md=doctor