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Plaintiffs claim state is criminalizing speaking the truth about their earned advanced degrees

Doctorate of Nursing Practice (DNP) is the highest degree that can be acquired by a nurse practitioner (NP). But can NPs who achieve this degrees call themselves doctors? What about others who hold doctorates, such as PhDs in clinical laboratories?

According to the State of California—which has enacted a law restricting the use of the word “doctor” or the prefix “Dr.” in titles, online, or in business communications solely to physicians and surgeons—the answer is no.

Predictably, implementation of the law brought a lawsuit. In June, three California nurse practitioners with DNP degrees sued the California attorney general and leaders of the Medical Board of California and California Board of Registered Nursing.

They are seeking to block enforcement of the law, according to The Washington Post.

“The word ‘doctor’ doesn’t belong to physicians,” Jacqueline Palmer, DNP, one of the three NPs suing over California’s law restricting non-physician medical providers from using that word, told The Washington Post. Palmer argues that NPs should be able to use the word “doctor” or the prefix “Dr.” when describing themselves much like PhDs and other non-physicians do who hold doctorates. (Photo copyright: Jacqueline Palmer, DNP.)

Plaintiffs Claim Criminalization of the Truth

The statute in question is the California Business and Professions Code Section 2054 which is part of California’s Medical Practice Act originally written in 1931.

Section 2054 of the statute states, “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.”

In their complaint, the three lawsuit plaintiffs state, “Defendants are California state officials charged with enforcing a law that criminalizes the truthful use of the title ‘Dr.’ by any healthcare professional who is not a licensed physician or surgeon. That means veterinarians, dentists, pharmacists, physical therapists, and nurse practitioners are subject to severe penalties if they truthfully refer to themselves as ‘doctor.’ This is true even where the doctor specifies the specific profession in which he or she has obtained his or her doctorate degree. The statute that mandates this regime goes far beyond patient protection and violates the First Amendment rights of doctors to truthfully describe themselves and their credentials.”

The three plaintiffs in the case are:

California is not the only state that restricts the use of the word “doctor” or “Dr.” but it is the strictest, according to Donna Matias, JD, Pacific Legal Foundation, the attorney representing the three plaintiffs.

“If you read the law literally, it appears to prohibit even PhDs and university professors from using the title,” she told the Post.

Previous Case Led to Stiff Penalties for Nurse Practitioner

In November of 2022, California Nurse Practitioner Sarah Erny, DNP, was fined a total of $22,500 by both the State of California and the State Medical Association for describing herself as a doctor on several professional online platforms without also including that she was a nurse, not a physician.

“While in most instances Ms. Erny indicated that she was a nurse practitioner, she failed to advise the public that she was not a medical doctor and failed to identify her supervising physician. Adding to the lack of clarity caused by referring to herself as ‘Dr. Sarah,’ online search results would list ‘Dr. Sarah Erny,’ without any mention of Ms. Erny’s nurse status,” wrote County of San Luis Obispo District Attorney Dan Dow, JD, in a statement.

Dow went on to say, “All forms of professional medical services advertising, including websites and social media accounts, must be free of deceptive or misleading information and must clearly identify the professional license held by the advertiser. Providing patients upfront with the proper title of our healthcare professionals aids consumers in making a more informed decision about their healthcare.”

Along with the financial penalties, Erny was ordered to “refrain from referring to herself as ‘doctor’ in her role of providing medical treatment to the public. [The judgement] also requires Ms. Erny to identify and make reasonable efforts to correct information on internet sites referring to her as ‘doctor’ or ‘Dr.’” the statement noted.

Speaking Truthfully about Advanced Degrees

Palmer spent 14 years in school pursuing her degrees. She feels her patients are smart enough to know the difference between her and a physician. “It’s not an ego trip; it’s not a power trip,” Palmer told the Post, “It’s just validation that I worked hard to get where I am today.”

The Pacific Legal Foundation argues in favor of the nurses by virtue of their advanced and in-depth training: “[After] years earning their advanced degrees and qualifications … they should be able to speak truthfully about them in their workplaces, on their business cards, the internet, and social media, so long as they clarify that they are nurse practitioners.”

Until the dust settles, NPs in California are taking precautions. Palmer said she has asked her patients to stop calling her “doctor” out of fear of being fined like Erny, a move she also claimed her patients protested against. “They all have said that they know that I worked hard for it,” she told the Post.

Clinical laboratory PhDs and others with advanced degrees may want to investigate their state’s requirements as to how they can legally refer to themselves.

—Ashley Croce

Related Information:

Should Nurses with Doctorates Be Called Doctor? Lawsuit Targets California Rule

Nurse Practitioners Sue State Over Right to Use ‘Doctor’ Title

Nurse Practitioners Sue California over Restricted Use of ‘Doctor’

Complaint for Declaratory and Injunctive Relief: United States District Court Central District of California

California Medical Practice Act

DNPs Can Face Heavy Fines If They Call Themselves Doctors. Some Are Fighting Back Against the Laws

Nurses with a Doctorate in Nursing Practice (DNP) Should Not Call Themselves “Doctor” in a Clinical Setting

California Business and Professions Code Section 2054

Nurse Practitioner (DNP) Fined $19K for Calling Self “Doctor Sarah”

District Attorney Dan Dow Announces Settlement with Arroyo Grande Nurse for Unlawfully Advertising Herself as “Doctor”