Who Is Entitled to the Title of “Doctor”?

CMAJ News Who is entitled to the title of “doctor”?

wo letters, one period, so much fuss. Then again, this short T combination of letters and punctuation is rather coveted. It proj- ects expertise and draws respect. It indicates status, accomplishment, years of study. It earns patients’ trust. It makes parents proud. So perhaps it should be no surprise that more health care professionals want to see the honorific “Dr.” before their names. But who should be allowed to call themselves a doctor? That remains a matter of debate, especially in health care. Some non-physicians say they have achieved doctoral-level degrees and deserve the title. Others wonder if this is Carmen MartA-nez BanAs/iStock merely careerism that will confuse, not Would allowing more health care professionals, such as audiologists, to use the title help, patients in clinical settings. “doctor” benefit patients or only careers? “I’m very comfortable with doctors of audiology, doctors of nutrition, doc- and all professionals are aware of their ates the title ‘doctor’ with those who pro- tors of pharmacy. I often see someone abilities and boundaries, why wouldn’t vide medical treatment and advice,” the say, ‘I’m Dr. so-and-so, and I’m a phar- physicians respect the wishes of col- letter states. “Identifying non-physician macist.’ That’s not that unusual,” said leagues who want to be called doctors? doctorates by the title ‘doctor’ may lead Dr. Wanda Filer, president of the Amer- “I think we need to avoid, as profes- to misconceptions from the public that ican Academy of Family Physicians. sionals, demeaning each other. We need such individuals, when working in a “The big issue is to make sure the to think collectively about what is best health care setting, are able to offer medi- patient knows who they are talking to.” for patients,” said Filer. “Quite frankly, cal treatment and advice.” This issue recently resurfaced in as I read about the case and the creden- According to Kathryn Clarke, senior Canada, after an Ontario audiologist tials of that audiologist, in my mind, communications coordinator for the col- named Brenda Berge launched a free- she’s a doctor of audiology, flat out. lege, restricted titles are an essential pub- dom of expression challenge before the From the training she has had, I’d be lic-protection component in regulating Ontario Divisional Court for the right to very happy to have her see my patients.” health professions. They help patients be called a doctor. Though Ontario law One of Filers’ predecessors didn’t identify various health care professions, allows various health care professionals appear to hold the same opinion. In a distinguish the qualified from the unqual- without medical degrees to use the 2011 article in the New York Times, ified and differentiate practitioners who “Dr.” honorific — dentists, naturopaths Dr. Roland Goertz, who was then the are regulated from those who aren’t. and chiropractors among them — the board chair of the American Academy “A significant factor to be considered privilege is not extended to audiologists. of Family Physicians, said that physi- before a health-care professional is per- Berge, who has a doctoral-level cians were worried about losing con- mitted to use the designation doctor is, degree, had previously been using the trol over the title of “doctor” because at minimum, consistent and rigorous title, until the College of Audiologists it could lead to loss of control over the educational, training and accreditation and Speech Language Pathologists of medical profession itself. “There is requirements to ensure consistency Ontario found her guilty of miscon- real concern that the use of ‘doctor’ amongst health professionals permitted duct. The college suspended Berge for will not be clear to patients,” he told to use this restricted title while providing three months. She also had to take a the newspaper. health care to patients,” Clarke said in course in professional ethics and pay In 2009, the College of Physicians and an email. “In this way patients will the college nearly $100 000 in costs. Surgeons of Ontario provided input to the know that the health care professional According to Filer, however, bring- Minister of Health and Long-Term Care with whom they are dealing is regulated ing more expertise into patient care about the use of the title “doctor.” One of by a college, and is therefore duly quali- from other medical disciplines is a the main concerns was that the lack of fied and subject to disciplinary processes good thing. And if those experts have consistent requirements for professionals for incompetent, impaired or unethical the credentials and want to call them- permitted to be called “doctor” would be practice.” — Roger Collier, CMAJ selves doctors, so be it. As long as confusing to the public. “Within a health there is no intent to mislead patients, care setting, the public typically associ- CMAJ 2016. DOI:10.1503/cmaj.109-5303