Encouraging Patient Awareness and Healthcare Practitioner Title Transparency on National Doctor’s Day
By Antonio Hernandez Conte, MD, MBA
Every year we celebrate National Doctor’s Day on March 30. During this day I always stop to reflect on the importance of physicians’ contributions to patient care, our groundbreaking research, and physicians’ role in advancing both the art and science of medicine.
I am a practicing cardiac anesthesiologist, and the advancements in technologic monitoring, anesthetic medications, surgical techniques, safety paradigms and pain management due to research and innovation led by physicians has truly transformed how we care for our patients. Patients with cardiac diseases who were previously thought to be too be sick to survive surgery can now be safely anesthetized by an anesthesiologist, undergo complex cardiac surgery, and walk out of the hospital (sometimes even the next day) ready to lead a new life. As anesthesiologists, we manage patients before, during, and after surgery; this now occurs through a multi-modal physician-led approach that has increased safety, efficacy, and efficiency of care for all patients.
Truly, a multi-disciplinary patient care team—including physicians, nurses, surgical assistants, technologists, and administrative support—is essential. Now more than ever on National Doctor’s Day, it is important to recognize that there is a clear distinction in the training and qualifications of physicians compared to nurse practitioners, physician assistants or other healthcare practitioners, and you may easily be confused when you encounter us dressed in scrubs in the clinic or operating room.
Within the specialty of anesthesiology, anesthesiologists (who are physicians with medical degrees) undergo the highest level of training, which includes four years of medical school and a minimum of four years of internship/residency/fellowship, and complete between 12,000 to16,000 hours of patient-centered clinical training before practicing independently.
Although undergoing anesthesia is now safer than ever before, there still remains the potential for complications and side effects that may occur during procedures. Anesthesiologists have the advanced training and expertise to help minimize these risks by vigilantly monitoring for any problems, immediately responding to complications, exercising medical judgment, and making split-second decisions that save lives. Certified registered nurse anesthetists (CRNA) are also an important part of the healthcare system and provide high quality care in many settings and situations, but their training is not the same as physicians, and therefore their skills and capabilities are not the same.
As we see state legislatures expanding scope-of-practice for physician extenders and nurse practitioners to address challenges related to access to care, we also now see increasing confusion amongst patients about the different types of healthcare practitioners who are taking care of them. Survey research completed by Seven Letter Insight in California in November 2023 shows a significant level of confusion by patients about which degrees and credentials represent a physician, as well as which type of clinician they are seeing. The “alphabet soup” of letters related to educational degrees (such as MD, DO, DNAP, PA, DNP, ARNP, FNP-C, etc.) does not easily identify the exact expertise of a particular healthcare practitioner. Even more challenging is the fact that “Dr.” may be used by people with advanced doctorate degrees who are not actually physicians.
I believe that in a healthcare setting, the term “Doctor” or “Dr.” should only be used by a physician who has completed medical school with an MD or DO degree. Additionally, physician-equivalent terms—indicated by an “ologist” suffix like dermatologist, anesthesiologist, cardiologist, etc.—should also only be used by physicians with the credentials that title suggests. It is essential that the information patients are given about their healthcare providers is clear and accurate.
Words and titles matter
Like any group of professionals, healthcare professionals often communicate about their services on social media or public platforms. Healthcare practitioners should refrain from misleading terms that may falsely characterize their training or confuse the public. In a hospital or medical clinic setting, truthful title communication is essential as patients must make complex medical decisions and literally entrust their lives to their healthcare practitioners. When non-physicians use misleading language about their qualifications, it threatens patients’ ability to make informed decisions. The issue is even more critical when we interact with patients for whom English is not their first language: the nuanced distinctions of the various types of healthcare practitioners may literally be lost in translation.
Think about it: When we go to the salon, the professional must visibly display their license issued by the Department of Consumer Affairs Board of Barbering & Cosmetology, indicating licensure such as Barber, Esthetician or Cosmetologist. Not all hair care professionals are the same, and most certainly not all healthcare practitioners are the same.
Despite their confusion credentials, nearly 100% of likely voters who responded in a recent poll believe it is important to know about the training and qualifications of the clinician they are seeing. Additionally, an overwhelming majority believe that California should adopt a law requiring “informed consent,” which would offer greater transparency about the qualifications, title and licensure of the medical or nursing professional with whom patients engage. Furthermore, Californians believe that patient safety is at risk if we don’t strengthen current regulations to increase title transparency.
As anesthesiologists, our top priority is patient safety, while also maximizing patient outcomes and ensuring that the patient’s surgical journey is optimized so they can thrive. Providing high quality care by a team of many different healthcare practitioners is essential to meet that goal. But along the way, clear communication with patients is critical, and everyone needs to provide accurate information regarding the different roles and qualifications of the team. Patients deserve honesty, clarity and transparency when making decisions, and all healthcare practitioners have a responsibility to provide truthful, clear information.
Dr. Antonio Hernandez Conte, MD, MBA, is the President of the California Society of Anesthesiologists and practices as a full-time cardiac anesthesiologist in Los Angeles.