Board Asks: Are There Too Many ‘Doctors’ in Medical Profession in NJ?

Andrew Kitchenman | February 18, 2014 | Health Care
Physician assistants would be barred from using title in clinical settings in New Jersey

State Board of Medical Examiners member Kevin Walsh, center, spoke in support of a proposal to prohibit physician assistants with doctoral degrees from using the title "doctor" in clinical settings.
Just who is entitled to be called “doctor” in hospitals, medical offices and other clinical settings is being considered by the State Board of Medical Examiners.

Under a proposal before the board, physician assistants with doctoral degrees would be barred from using the title in clinical settings.

Board member Kevin Walsh, a physician assistant, said the rule would help ease confusion among patients.

“I think this is an issue, especially now that there are so many different providers, I think people should be clear as to who the providers are,” Walsh said at the February 12 board meeting.

Walsh said the issue has been raised in the past in connection with pharmacists who earned doctor of pharmacy degrees.

The board’s physician assistant advisory committee said confusion results when physician assistants who hold doctoral degrees are referred to as “doctors” and patients believe they are medical doctors or doctors of osteopathic medicine.

Physician assistants would also be prohibited from using the title on stationery and prescriptions, but not in nonclinical settings.

Walsh predicted that the state board would ultimately be hearing disciplinary cases in which physician assistants are accused of misrepresentation “or there will be malpractice cases in which you were seen by a PA and thought you were seen by the doctor because he identified himself as the doctor.”

Board member Karen Criss, a certified nurse-midwife, said nurses with doctoral degrees are increasingly being addressed as doctors in clinical settings.

While the State Board of Medical Examiners licenses both medical doctors and physician assistants, it doesn’t license nurses, who are overseen by the Board of Nursing. If the board adopts the proposal, Walsh said, it should ask state officials to raise the issue with the nursing board.

Carol Biscardi, who holds a doctor of philosophy in health science, said she supports the proposal. She served as a physician assistant prior to receiving her doctoral degree and currently directs Monmouth University’s physician assistant program.

“I think it’s a confusing issue for patients,” Biscardi said. “Patients have an idea of who this physician is and, you know, PAs do a lot of the same tasks as a physician and it’s hard for patients to distinguish what all that is.”

Physician assistants support doctors by conducting physical examinations, diagnosing and treating illnesses, ordering and interpreting tests, and providing counsel to patients on preventive care, as well as assisting in surgery.

While the proposal received a positive response from physician assistants who were contacted last week, that support may not extend into nursing.

Raymond Scarpa, an advanced practice nurse with a doctor of nursing practice degree, said he’s never had patients become confused about his role.

“I have physicians call me ‘doctor’ in front of my patients – for me, it’s never been an issue,” Scarpa said. He added that “doctor” is an academic title and that it’s appropriate for members of each profession who hold the title to clarify what their professions are. He said it’s up to each person to determine how to handle the issue, not for the state to regulate it.

“Everybody in healthcare now is leaning toward a doctorate preparation academically,” said Scarpa, who works at University Hospital in Newark.

Scarpa described the way he handles titles: “If I got introduced to a patient as Dr. Scarpa or I walk into a room and I introduce myself as Dr. Scarpa I always say, ‘Hi, I’m Dr. Scarpa, I’m the nurse practitioner for the ear, nose and throat practice.’ ”

While few physician assistants have doctoral degrees, New Jersey State Society of Physician Assistants President Ryan White said this could change in the future. He noted that Lynchburg College announced in January that it would be the first institution to launch a doctor of physician assistant medicine degree.

“It is very important for PAs, as well as any medical professional, to properly identify themselves and not misrepresent themselves,” White said. “That’s the crux of the issue… I think it’s a patient-care issue first and foremost. Patients need to know who’s treating them.”

White added that he didn’t think that the proposal would bar physician assistants from discussing their qualifications with patients – including whether they have a doctorate – but only from using the title “doctor.”

The exact wording of the proposal wasn’t immediately available.

White said physician assistants should be proud of their training and skill level.

“I don’t think they should feel they should have any need to call themselves ‘doctor,’” he said.

The proposal also won support from the chief executive of the state’s largest physicians’ group.

Medical Society of New Jersey CEO Lawrence Downs sees limiting the use of the title “doctor” to physicians as a benefit to consumers. As healthcare moves increasingly toward team-based care, he said, “It will be important from a consumer’s perspective to be able to differentiate who they’re seeing… it’s simple – in a clinical setting, it’s just not appropriate” for non-physicians to be referred to as “doctors.”

The State Board of Medical Examiners’ executive committee will consider the proposal and may recommend that the full board adopt it at a future meeting.

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