Introduction
As more Nurse Practitioners (NPs) earn doctoral-level degrees, many understandably want to acknowledge their hard-earned credentials by using the title “Dr.” in clinical and professional settings. However, state laws, medical-board rules, and recent enforcement trends show that using “Dr.” without also clarifying one’s licensure can create significant regulatory and legal risk.
These restrictions aren’t about diminishing the value of advanced practice providers or reinforcing hierarchy in medicine. Rather, they exist to prevent patient confusion about who is a physician and who is not. Several states, including California and Ohio, have statutes that directly regulate or restrict how non-physicians may use titles such as “Doctor” or “Dr.” when interacting with patients. Courts have recently upheld these restrictions, citing evidence that patients frequently misunderstand the meaning of advanced practice titles.
With increased scrutiny, litigation, and board complaints nationwide, it is more important than ever for NPs to understand how to use professional titles safely and compliantly.
State Restrictions
In California, the titles “Doctor” and “Physician” are expressly reserved physicians under state law CA Bus & Prof Code § 2054 (2024), which defines physicians as graduates of an approved medical or osteopathic medical school licensed to practice medicine in the state. Misrepresenting or holding oneself out as a physician, including by using the title “Doctor” or “Physician” as an NP could be considered a misdemeanor.
Ohio state law similarly restricts using the titles “Dr.” and “Doctor,” noting that doing so as a non-physician may be considered the unauthorized practice of medicine under OH Rev Code § 4731.34 (2024). OH Rev Code § 4731.41 (2024) expands on this, noting that “No person shall practice medicine and surgery, or any of its branches, without the appropriate license or certificate from the state medical board to engage in the practice. No person shall advertise or claim to the public to be a practitioner of medicine and surgery, or any of its branches, without a license or certificate from the board.” With this being said, NPs may technically engage in the practice of medicine in Ohio under OH Rev Code § 4723.151(B) (2024), but the Ohio Association of Advanced Practice Nurses still advises that there is significant risk attached with identifying as a “Dr.” to patients as an NP. The association encourages NPs to explicitly qualify themselves as NPs with patients to avoid confusion.
These are just two examples of states that restrict an NP from identifying as a Doctor, representing a broader national trend towards tighter regulation of professional titles.
Litigation
Recently, a District Court in California has pondered this very issue. The case, Palmer et al. v. Bonta et al, involved three nurse practitioners in California who claimed that the California state law that reserves the title “Doctor” and “Dr.” to California-licensed MDs and DOs was unconstitutional. The Court dismissed the case for a very practical reason: to avoid patient confusion. In its ruling, the Court cited an American Medical Association Survey that found thirty nine (39%) percent of patients surveyed believe that “Doctor of Nursing Practice” is a physician. Further, eighty eight (88%) percent of patients surveyed said that only licensed medical doctors or doctors of osteopathic medicine should be able to use the title of “Physician.” It is worth noting that the survey was conducted by the American Medical Association, which has been outspoken in its support for tighter restrictions around using the title “Doctor” and “Physician,” citing concerns about “scope creep” and advocating for physician-led patient care.
Enforcement Actions
Around the country, enforcement action has increased and providers are seeing an uptick in board complaints regarding using the proper title. In 2022, for example, an APRN in California was sued for identifying and referring to herself as a “Dr.” Importantly, her advertising materials and social media presence did not specify that she was an APRN and she failed to use the APRN designation after her name. A judgement was ultimately entered against the APRN in amount of $19,750 in civil penalties.
This is just one example of an enforcement action against a provider for identifying as a Doctor, as a non-physician. At Lengea Law, we have seen this uptick in state-level regulation and scrutiny for this issue and predict tighter regulations for NPs in the near future.
What NPs Can Do
To err on the safe side, Lengea Law advises that NPs refrain from identifying themselves as doctors to patients. States that have yet to show broad sweeping enforcement action against this may be more likely to after the California District Court’s ruling discussed above. However, providers who would like to continue to identify as “Dr.” to patients should implement the following safeguards:
1.) Always Pair “Dr.” With Your Professional Designation
If you use “Dr.” at all, immediately follow it with your licensure (e.g., “Dr. John Smith, DNP, APRN-CNP”). Never use “Dr.” alone in clinical settings, marketing materials, websites, or social media.
2.) Train Front-Desk and Clinical Staff
Receptionists, officer managers, and medical assistants should know: how to introduce you properly; how to respond when a patient asks, “Are you a doctor?;” and what titles are permissible under your state’s laws.
Nurse Practitioners Use the Title “Dr.”
3.) Understand Your State’s Laws and Enforcement Actions
Regulations and enforcement actions vary significantly by state. Consult with a Lengea attorney to talk about your state’s rules and regulations and assess your individual risk.