It’s increasingly common for patients to encounter nonphysician practitioners as members of their health care teams. Meanwhile, ever more nonphysician practitioners have received advanced training resulting in a doctorate degree, such as the doctor of nursing practice.
To help patients keep pace with these changes, physicians should make new strides to clarify their roles and credentials vis-a-vis other members of the health care team and also promote collaboration among all health professionals, according to an AMA Council on Ethical and Judicial Affairs report that was adopted at the 2022 AMA Interim Meeting.
The core issue is that “the skill sets and experience of nonphysician practitioners are not the same as those of physicians.” Thus, when nonphysician practitioners identify themselves as “doctors”—consistent with the doctoral-level degrees they earned—“it may create confusion and be misleading to patients and other practitioners,” says the report.
In fact, surveys (PDF) performed as part of the AMA Truth in Advertising Campaign have found that while patients strongly support physician-led health care teams, many are confused about the level of education and training of health professionals—and the confusion isn’t limited to nonphysician practitioners who hold doctorates. For example, roughly one-fifth of respondents think psychiatrists are not physicians, while a similar number think nurse practitioners are physicians.
The AMA Code of Medical Ethics touches on this issue in an opinion on collaborative care, which provides guidance on the roles of physicians in team-based settings where a mix of health professionals provide care.
In SCAM, we have the problem that practitioners often call themselves doctors or physicians without having a medical degree. This confuses patients who might consult and trust these practitioners assuming they have studied medicine. We recently discussed the case of a naturopath who called himself a doctor and failed to diagnose a rectal tumor of his patient. Much more dramatic was the case of a UK-based chiropractor who called herself a doctor, thus attracting a patient suffering from complex health issues contraindicating spinal manipulations. She nonetheless manipulated his neck and promptly killed him.
I know that patients are being misled every day by SCAM practitioners (ab)using the ‘Dr.’ title. Therefore, the AMA reminder is an important, timely, and necessary lesson for SCAM. I feel that the professional organizations of SCAM providers should issue similar reminders to their members and make sure they behave appropriately.