Not All Doctors Are Physicians

A colleague recently sent me a link to the “American College of Cathopathic Physicians” a new organization whose mission “is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a ‘cathopathic physician’ completely equal in every way to our MD and DO counterparts.”

I was, I admit, so stunned by the statement (and confused by its grammatical errors) that I thought the whole thing might be an elaborate joke. It was only after spending some time exploring the site that I realized that it was for real, and a really bad idea.

Lets start with the absurd circular “reasoning” that the group uses to justify labeling DNPs as “physicians.” According to the site (their quotations are unattributed):

A physician is commonly defined as a “doctor who practices medicine” which is “the art of healing” or “promoting, maintaining, or restoring health through the study, diagnosis, and treatment of disease”. Other organizations, such as the federal government, define a physician as a healthcare professional with “the authority to make independent judgments in the examination, diagnosis, treatment, prevention, and care of the human body”.

It then goes on to advocate for DNPs to have such authority, which in turn it believes would justify calling DNPs physicians. And of course, once you get to call yourself a physician, why wouldn’t you have full independent authority? After all, that’s what it means to be a physician, right? So, basically, if you call yourself a physician, then you are one.

Of course, the site does its best to completely obscure the very real differences in training and experience that distinguish true physicians from DNPs and other health professionals. It is so much easier to just assume the functional equivalency of “different” training paths than to recognize that those differences in training lead to differences in knowledge, understanding and skills. In fact, the group bemoans the “burdens of the current medical educational model” as a barrier to entry, without acknowledging the obvious: becoming a physician is hard because being a physician is hard. The years of nursing experience that DNP candidates bring to their training are held as a false equivalent of medical training. They are, in fact, no more a substitute for medical training than years spent as a laboratory scientist, hospital administrator, radiology technologist or pharmacist.

To make matters worse, the curricula for DNP programs often have minimal, if any advanced clinical content. A quick scan of DNP programs across the country at institutions like Duke, Vanderbilt and Hopkins shows that the degree can be earned without any advanced training in the understanding, evaluation, or treatment of human illness.

Finally, the message repeated throughout the site is that DNPs are needed to alleviate the “doctor shortage” that seems to continuously loom just over the horizon. I remain skeptical that the situation is as dire as predicted, but even it if were, the correct remedy is to leverage technology and the diverse skills of a variety of health professionals, including advanced practice nurses, into a more effective team, not to label nurses as physicians.

What do you think?




10 thoughts on “Not All Doctors Are Physicians

  1. There are hosts of physician extenders dromPA’s to assistants in office. In some specialties, like cardiac surgery, the PA’s seem to have learned through the on site learning how to care within a limited scope. In office situations or now Emergency Rooms I have seen extenders acting way beyond skill or knowledge.
    A friend with a doctorate in nursing urology is far better at handling the bladder diseases of woman than most or all family docs. I studied decades ago with a surgeon who had a PA in a subspecialty. The PA was a better assistant than most any resident, a competence in skills but not a physician.
    It’s a confusing arena of people jousting for control of market. There are charlatans everywhere and always have been.How do educators work to teach “providers” how to think like physicians, with ongoing curiosity and ongoing learning along with compassion and empathy?

    1. As an RN (although one WITHOUT an advanced degree) I have to say I tend to agree with the physicians here. I wholly support APN practice within the scope of their training but, an APN does not equal a physician. Each bring unique perspectives to health care. A physician’s mandate is to “diagnose and CURE”, a nurse’s is to “promote health, prevent illness and injury” and live as well as they can despite illness. While I like what Scott just said about having experience with DNP and PAs he has known being EXTREMELY competent in their areas of expertise, I have had that experience too. And there are advantages in some arenas to chose a NP or DNP for one’s specialty care, especially when the medical mandate to CURE is not attainable. It takes more than the 15 min allotted by insurance for an Physician appt to manage patients’ issues when they are chronically ill and need lots of support. There is room in this arena for more health care providers. But I do agree they do not get to call themselves physicians, any more than the PhD-prepared PT I saw this week calling himself anything more than that.
      On the other hand I do not agree with Scott that “with ongoing curiosity and ongoing learning along with compassion and empathy” are the sole purview of physicians. As a nurse, my BSN education instilled LIFELONG learning as a major tenant of my education, and I partner with my physician colleagues to ask and attempt to answer clinical research questions on a daily basis.

    2. I agree that non-physician providers can provide high quality care within a defined scope of practice. Earlier in my career, I worked closely with an outstanding group of NPs who cared for patients on our inpatient cardiac telemetry floor. Two things made that work as well as it did: first, the patient population was well defined, with a limited number of admitting diagnoses, which allowed the NPs to get very good at taking care of a few kinds of patients; second, each patient had a cardiologist as his or her physician of record, so that issues outside the defined scope of the NP could be addressed easily.
      The danger in the “cathopathic physician” model is that neither of these conditions is met.

      1. I see where you are coming from Dr. Nash, BUT part of the issue is that some states and the VA are allowing APNs to practice as autonomous providers without a physician colleague as part of their licensure, in which case they are the sole providers. Then what?

    3. Here is actually no specialty training for a DNP. They cannot specialize in Urology. What they can do if jump from specialty to specialty on a whim. They may have only a days training in Urology after working in an Internal Medicine office or Endocrinology office previously.

  2. Ira, I agree! It is indeed interesting, though perhaps beside the point, to wonder aloud whether the circular reasoning you describe bespeaks an intention to obscure distinctions or the inability to make them. There is no question that team-based care can extend the reach of well-trained physicians by surrounding us with nurse practitioners, nurses, social workers, health coaches and others, permitting us to deploy our knowledge and skills efficiently, working (in the current parlance) at our “top of license.” But nothing good will come from continuing down the path of obscuring the differences between physicians and non-physician healthcare professionals. The most consequential loss will not be to ourselves, of course, but to our patients and the society we serve.

  3. Re: SB’s question above — I am not in favor of fully autonomous practice for APNs. They may work well in situations where the issues confronted are tightly circumscribed (i.e., urgent care) but even there I believe physician back up is essential.

  4. DNP’s should not be referred to as physicians. DNP’s are doctorate prepared nurse practitioners, providers of patient care. The question remains why it is so offensive that nurses who hold doctorate degrees are referred to as doctor? A clinical psychologist is referred to as doctor, a dentist is referred to as doctor, a doctorate prepared speech pathologist is referred to as doctor. College professors with PhD degrees are referred to as doctor. Scientists are referred to as doctor. None of these professions are medical doctors and yet no one goes crazy about titles unless it is a doctorate prepared nurse. Why is that? Every licensed profession has a scope of practice to practice within. Why be concerned about DNP’s practicing outside of their scope?

    There are many nurse practitioners with decades of experience who have treated thousands of patients you should think twice about questioning their clinical knowledge and expertise versus a 26 year old MD. At the end of the day, there are differences in licensing across the professions. There are 2 year associate prepared nurses, bachelor prepared nurses, masters prepared nurses and doctorate prepared nurses. Are they all the same? Absolutely not. The most important thing is for all licensed professionals to practice within their own scope of practice per the law. Period.

    1. None of those other doctors are called doctors in a clinical setting. They are not medical doctors, period (with the exception of the dentist). And no, I will not think twice about questioning the clinical competence of that NP who’s education was not standardized, and did not go through the same rigorous training and testing as that 26 year old MD.

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