A nurse practitioner with a doctorate introduces herself as a doctor. If she doesn’t clarify that she’s not a physician, she could potentially face licensing penalties under a year-old law that limits who can use the doctor title.
The new Georgia law applies to many healthcare professionals commonly referred to as doctors, including those with doctorates, and was intended to improve transparency for patients. But clinicians impacted may not be aware of the new legislation and leaders of the largest state healthcare professions say they do not believe the law is necessary as they already comply with it.
“Everyone using medical specialty titles is impacted,” said Carmen Kavali, MD, a Sandy Springs plastic surgeon and president of the advocacy group that pushed for the legislation known as the Health Care Practitioners Truth and Transparency Act.
The law prohibits nonphysician health care clinicians who aren’t a medical doctor (MD) or osteopathic medicine doctor (DO) from deceptively advertising, misleading or misrepresenting their specialty titles.
Physicians who support the law say its purpose is to ensure patients can distinguish between medically trained doctors and nonphysicians. The law applies to dentists, chiropractors, optometrists, podiatrists, pharmacists, and therapists, among others who we generally consider doctors.
Kavali explained that the law doesn’t prevent dentists or chiropractors, for instance, from using the doctor title in a clinical setting. “If the professional has a clinical doctorate degree and chooses to use the title of doctor in a clinical setting, they simply have to also clarify their licensure for the patient. ‘I’m Doctor Smith. I’m a Doctor of Nursing Practice (DNP), and I am not a physician,’” Kavali said.
“It is meant to prevent someone who is not a physician, residency-trained in, say, dermatology, from calling themselves a dermatologist or a specialist or expert in dermatology.”
Other than physicians, the largest groups of healthcare professionals in Georgia include nearly 12,000 advanced practice nurses, mostly nurse practitioners (NPs), and more than 4,700 physician assistants (PAs).
Georgia is one of a dozen states, most in the South, with restricted practice for Advanced Practice Providers (APPs) such as PAs and NPs, preventing them from working independently or prescribing medication without physician oversight.
Leaders of associations representing Georgia PAs and NPs say they don’t know why the law was needed because they don’t call themselves doctors. But Michelle Nelson, an NP with a doctorate who is active in legislative affairs, said the new law puts APPs at risk if they use doctor in a clinical setting. Clinicians who violate the new law risk disciplinary action from their licensing boards, potentially even losing their license.
Amy Reeves, legislative government affairs co-chair for the Georgia Association of PAs, says she never misrepresents herself. She has a master’s of PA studies degree and is enrolled in a doctorate program.
“In an educational setting, using titles are appropriate, but in patient care settings, PAs would never want to misrepresent ourselves as MDs or DOs and we refer to ourselves as a PA,” said Reeves, a PA at Wellstar Pediatrics at Brookstone in Kennesaw. “Our patients realize that we are PAs and appreciate the care we provide.”
Nancy Krieger, treated by various clinicians during recent healthcare visits, hasn’t noticed an issue. “Every doctor, PA or NP I’ve seen has been up-front and honest. I don’t think the law is necessary,” the Marietta resident said.
“I have not had the experience of a PA or NP ever introducing themselves as a doctor. I was always aware of who they were; they made it very transparent.”
Dentists also rank among the largest healthcare groups in Georgia with about 5,000 dentists in the state, according to the Georgia Data Analytics Center. “It is our position that this bill upholds the current ability of dentists as Doctors of Dental Medicine (DMD) and Doctors of Dental Surgery (DDS) to use the title of ‘doctor,’” said Theresa Garcia-Robertson, Georgia Dental Association vice president of government and regulatory affairs.
“This legislation has been thoroughly reviewed by a dentist and multiple medical doctors within the general assembly. We have no reason to believe that it would put those who have put years into their educational career at accredited medical and dental schools at risk.”
In terms of the law’s impact on dentists, Kavali further explained that most patients know they are seeing a dentist when they visit a dental office. “The dentist is not being deceptive by using the title of doctor in her own office ... If the patient is in a hospital room or clinic, it’s not as clear who is treating them, which is why this law is important.”
The Georgia Pharmacy Association (GPhA) also weighed in on the subject. “Pharmacists already ask people to call them by their first name, in most cases,” said GPhA CEO Dawn Randolph. “Even in hospital settings we have heard of no issues. Professors teaching pharmacy are commonly referred to as doctors as in all academic settings.”
Nelson, who directs a graduate nursing program in South Georgia, said nurses learn not to misrepresent themselves or willfully try to mislead patients. “They don’t use it to trick people into believing they are medical doctors.”
APPs who earn a doctor of nurse practice (DNP) or other doctorate are clear when informing patients they have a higher level of education and knowledge and operate at the highest level of their licensing and expertise, said Nelson, who serves as senior advisor of the government relations council of the United Advanced Practice Registered Nurses of Georgia.
Georgia followed Indiana and California in passing a ban on non-physicians using the doctor title. Other states are considering similar measures.
Last year, a group of California NPs sued their state after a DNP was fined nearly $20,000 for illegally calling herself a doctor on social media and with patients. The NPs in the suit said the law violates their right to free speech, according to media reports.
Kavali said the Georgia law that aims to improve transparency for patients is not widely publicized. “There are still many misleading advertisements and listings, so the law has not yet had its full intended effect.” Kavali is president of the Georgia Alliance for Patient Protection, an advocacy group that helped write the bill and worked with the Medical Association of Georgia to pass it.
“I expect truthful advertising from all healthcare professionals and facilities that doesn’t mislead patients. I expect patients to be able to rely on the accuracy of information presented to them by their healthcare professional or facility.”
In terms of enforcement, Kavali said it may take a few years before anyone violating the law to face repercussions as it’s up to the licensing boards. “Someone advertising untruthfully would be reported to their licensing board, who would then hopefully take corrective action. We rely on colleagues to spread the word about the law.”
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