Guidelines for education and clinical hours as well as testing on the pathway to licensure are clearly defined for physicians, nurse practitioners and physician associates.
More nebulous is the credential "Dr." — specifically, who has earned the right to use the title in practice as well as how patients perceive the various medical titles of their caregivers.
Physicians who have graduated from medical school and earned an MD or DO degree and have passed the United States Medical Licensing Examination or Comprehensive Osteopathic Medical Licensing Examination are eligible to apply for and receive these medical licenses.
They are permitted to use the "Dr." title and represent themselves as such to patients, and on this point, all sides agree.
However, for the American Medical Association, this is a line in the sand.
Jack Resneck Jr. MD, AMA president, told Becker's this is an issue of "clarity and transparency" for patients.
"There are immense differences in the education, training and qualifications among healthcare professionals. In healthcare settings, patients find it increasingly difficult to identify who is or is not a physician," Dr. Resneck said. "Truth in advertising laws, including those supported by the AMA, provide common sense, clarity and transparency for patients, ensuring patients have the basic information necessary to make informed decisions about their healthcare, such as the license of the healthcare professional providing their care."
From the nurse practitioner's point of view:
April Kapu, DNP, president of the American Association of Nurse Practitioners, agrees that "patients have the right to know who is providing their care," and be informed about the academic preparation of their medical caregivers.
The AANP supports the use of the title doctor for "doctorally prepared nurses," Dr. Kapu told Becker's, noting the organization opposes any legislation that would prohibit healthcare professionals from using their fully earned credentials and representing themselves in line with their licensure to patients.
Further, Dr. Kapu added that laws or regulations calling for "anti-competitive and punitive measures that unnecessarily prohibit nurses and other health professionals from accurately communicating their education, licensure and certifications to patients and the public" should be rejected.
Training for nurse practitioners is based on the nursing model of education. Following appropriate training and licensure, NPs focus on patients as they test, diagnose and treat their conditions.
From the physician associate's point of view:
Physician associates use the medical education-based model for training, as physicians do. PAs focus on testing, diagnosing and treating patients' conditions.
In 2021, the American Academy of Physician Associates voted to adopt "physician associate" as the official title for the physician assistant profession. Individual states must formally adopt the name change and, while many are considering legislation to do so, "physician assistant" remains the legal title for now.
The American Medical Association and American Osteopathic Association remain opposed to changing physician assistant to physician associate, maintaining the title change will create confusion for patients.
While the American Osteopathic Association recognizes PAs and advanced practice registered nurses' struggle to achieve professional parity, Thomas Ely, DO, president of the AOA, said "such efforts should "not be at the expense of the truth in advertising and clarity of roles in our healthcare system," said in a statement released days after the AAPA voted to formally adopt the "physician associate" title.
"Professional credentials, titles and how we convey such information to patients is of great import and not a matter of marketing," he said. "This title change could easily create confusion for patients and put their safety at risk."
The American Hospital Association declined to comment on this story.
According to Kantar Research, 71 percent of patients surveyed believe the title "physician associate" is the job description of a PA. More than 61 percent of physicians surveyed agreed.
Jennifer Orozco, DMSc, PA-C, president of the American Academy of Physician Associates, said there is no reason to think patients will be confused about titles.
"PAs are committed to being fully transparent with our patients," Dr. Orozco told Becker's. "The most important thing for PAs to do is to make sure they are transparent and clear with patients that they are a PA and that they are following state laws. I am Dr. Jennifer Orozco, but when I see a patient, I make it very clear that I am a PA."
PAs who have achieved doctorate degrees, she added, should feel empowered to use the title that communicates their highest level of education in appropriate settings.
Dr. Orozco said she wants PAs to always be completely transparent about their medical titles with patients. However, the issue lies in the job title "physician assistant."
"PAs do not 'assist' physicians. They are a distinct profession. PAs are licensed clinicians who practice medicine in every specialty and setting. We are trusted, rigorously educated and trained healthcare professionals," she said. "PAs are dedicated to expanding access to care and transforming health and wellness through patient-centered, team-based medical practice."
The AAPA maintains the "physician associate" title will better highlight PAs' contributions to healthcare and offer patients assurance about their abilities to provide high-quality care.