She'it Talkers

All Things Considered, February 22, 2009 · No one wants to badmouth Florence Nightingale, but a new degree for nurses is causing bad blood between doctors and their longtime colleagues. The program confers the title of doctor on nurses, but some in the medical profession say only physicians should call themselves "doctor."

Dr. Steven Knope is a family practitioner in Tucson, Ariz. "If you're on an airline," he jokes, "and a poet with a Ph.D. is there and somebody has a heart attack, and they say 'Is there a doctor in the house?' — should the poet stand up?" Knope laughs. "Of course not."

Physicians such as Knope say the title of doctor implies a certain amount of training, hours in medical school that nurses just don't have. Dr. Ted Epperly, president of the American Association of Family Practitioners, says that while doctors place a high value on nurses, sharing the same title could confuse — and even harm — patients.

"I can just imagine a patient of mine walking into my exam room and saying, 'Now Dr. Smith, are you a doctor doctor, or are you a doctor nurse?'"

"I am a doctorally prepared nurse," says doctor nurse Ray Scarpa. A doctor, he says, "is a doctorall -prepared physician."

Scarpa works in the department of surgery at University Hospital in New Jersey. "I am not here to practice medicine, I am here to practice nursing," he says. "And I practice it at an advanced level, and I have earned the right to be called doctor."

For nursing students who begin right after college, it can take about six years to get the degree. While there is some overlap in knowledge, Scarpa says, doctors diagnose and treat while nurses have a wider focus including family, support and community.

Doctors Feel Threatened

The doctoral program for nurses is offered at more than 200 schools and began at the Columbia University School of Nursing. Dean Mary Mundinger says the tension is more about turf than patient confusion.

"It's about status," Mundinger says. "It's about ego, it's about presence. It's about standing in their community."

Here's where physicians and the new doctor nurses agree: Both groups say physicians feel threatened. They see the new breed of nurses as an invasion of their turf.

Fourth-year medical student Janet Pullockaran at University Hospital's emergency room understands the threat. "With all these new people — physician assistants, nurse practitioners coming into the field — maybe our training won't lead to a secure position in the future," she says.

A Role Doctors Can't Fill

But there's a shortage of primary caregivers, and it's possible the new nurses will help fill the void.

Louis Boeckel has throat cancer. He faces people in white coats day in and day out. He just had a tracheotomy and can't talk, so he writes notes on a pad for his wife, Carol, to read. When asked if he's worried about mixing up his physician with his nurse, Ray Scarpa, Boeckel writes, "Best doctor."

Boeckel's wife says they are concerned about who's providing their care, but to them, the title of doctor for their nurse just means he's that much more qualified.

"We view him as a doctor, because he does come and take care of all [Louis'] immediate needs as any doctor would do," she says.

The first exam to certify the doctor nurses was given in November. It's a modified version of a test given to physicians. The next test is scheduled for October, but some physicians are trying to prevent the National Board of Medical Examiners and the American Board of Comprehensive Care from administering it.