I'm a doctor, the badge says so!

...at least according to this Instagram video posted by @doseofsupport, perhaps better known as Vanessa Kasper, APRN, CNP, DNP, who works "in the oppressive American healthcare system" doing geriatrics over at Fairview Health Services in Minnesota.

Now, to be fair to the pedants of academia out there, yes, NP Vanessa technically does have a DNP from the University of Minnesota, but that's besides the point. Needless to say, a glorified midlevel nurse practitioner with 1,000 clinical hours doing god-knows-what is a far cry from an actual doctor, i.e. a physician who has completed 4 years of medical school, 3+ years of residency, possibly another 1-3 years in fellowship, culminating in thousands upon thousands upon thousands of hours more of structured academic and clinical training that's actually, you know, rigorous.

And of course there's that whole other issue of working in healthcare and calling yourself a doctor when you're not actually a physician. It's ironic that NP Vanessa lists a certification in unconscious bias training, when in a medical setting the term "doctor" is reflexively associated with "physician". Certainly, the colloquialism "going to the doctor" is not understood to mean "attend an appointment with a doctorally-prepared nurse practitioner".

In the same vein, the average patient walking into a hospital or clinic cannot be expected to understand in good faith that a person wearing a white coat and a name badge that says "DOCTOR" is, in fact, not a physician at all. Studies have shown that patients can barely distinguish between different levels of physicians. So how can they be realistically expected to tell the difference between a physician and a non-physician midlevel provider when they're both wearing name badges that read "Doctor", especially if the latter is deliberately doing so to blur the distinction? They can't. And therein lies the problem.

Minnesota is actually one of a handful of states with so-called title protection laws for physicians. Minnesota Statute §147.082 states the following:

(a) A person not licensed under this chapter is prohibited from using the title "doctor of medicine," "medical doctor," "doctor of osteopathic medicine," "osteopathic physician," "physician," "surgeon," "M.D.," or "D.O." in the conduct of any occupation or profession pertaining to the diagnosis of human disease or conditions.

(b) Nothing in this section shall be construed to prohibit a health care professional from using a title incorporating any of the words specified in paragraph (a), or from using a title or designation that is not specifically protected in paragraph (a), if the title or designation used is permitted under the health care professional's practice act.

Furthermore, the Minnesota Board of Nursing's guidance on this very topic also notes that "If an APRN holds doctoral level education, the identified laws above do not prohibit the APRN from using the title "doctor"; however, it is suggested, if using the designation of doctor, that the nurse also identify one's self as a nurse."

Based on the way NP Vanessa is presenting her badge in the video, one might surmise that, at best, her conduct falls into a legal and ethical gray area. How exactly does she introduce herself in clinical settings? Based on her statements "nurses are doctors", her blatant disregard for the axiom that "nurse practitioners aren't real doctors", and the fact that her "Doctor" badge almost completely obscures what appears to be a "Nurse Practitioner" badge in the back, we honestly wouldn't be surprised if she conveniently "forgot" to mention the fact that she's actually a nurse practitioner when introducing herself to patients. We also have to wonder what Fairview's internal policies on ID badges and employee conduct are; we certainly can't imagine that they would condone this sort of deliberate misrepresentation.

Moreover, it's especially unfortunate and misleading for NP Vanessa to conflate physicians' desire to protect the term "doctor" with the "fight for patriarchy". She's absolutely right - you don't need to be a man with an MD or DO to be called doctor. You can be a woman too! Did NP Vanessa forget to look up the proportion of women in medicine these days? Indeed, such a statement is a parvovirus-worthy slap in the face to the 50.5% (yes, a majority) of female medical students. It's even harder to take her fight against the patriarchy seriously when almost 90% of nurse practitioners are women. (More like matriarchy, amirite?) Perhaps NP Vanessa has gotten confused over the difference between patriarchy and hierarchy. While the former remains a problem in virtually all sectors of employment, the latter exists in healthcare for a good reason. There's nothing wrong with transparently referring to physicians as doctors, nurses as nurses, and nurse practitioners as nurse practitioners unless one has a serious ego problem. The hierarchy of medicine exists to ensure that those with the most comprehensive and rigorous medical training - i.e. physicians - are placed in charge of patient care and medical decision-making. It doesn't take a genius to realize that diseases don't become easier to understand and treat, and the practice of medicine doesn't magically become simpler to accommodate the intellectual limitations of a midlevel nurse practitioner.

Personally and anecdotally, we've seen a handful of health systems and hospitals pursue implementation of more transparent and patient-friendly ID badges that clearly state the wearer's, role, e.g. "Physician", "Resident", "Nurse Practitioner", "PA", etc. Ideally, such labeling should be the standard everywhere to prevent patient confusion and ensure that midlevels like NP Vanessa have absolutely no wiggle room with which to stretch the definition of "doctor".