After 14 years in the classroom earning several degrees, Jacqueline Palmer wants to call herself a doctor.
The Lancaster, Calif., nurse practitioner earned a doctorate of nursing practice, the highest degree available in her field, from Chamberlain University. Until last year, Palmer introduced herself as a doctor to her patients, signed her name with “Dr.” and had the prefix embroidered in purple before her name on her clinician’s jacket.
Then Palmer learned that might have been enough to sink her career. In November, prosecutors announced that Sarah Erny, another California nurse practitioner with a doctorate, would pay almost $20,000 in a civil settlement for allegedly describing herself as a doctor on professional websites and social media.
“I was shocked,” Palmer told The Washington Post.
Under California law, only physicians and surgeons can use the word “doctor” or the prefix “Dr.” In announcing Erny’s penalty, prosecutors said enforcing the restriction is necessary to protect the public from being misled.
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Palmer described her nursing degree and clarified that she was not a physician whenever she introduced herself as a doctor, and her patients understood, she said. But the steep punishment Erny faced rattled her — and she felt she shouldn’t face legal jeopardy for describing a qualification she had earned.
So last month, Palmer and two other nurses with doctorates of nursing practice sued the California attorney general and leaders of the Medical Board of California and California Board of Registered Nursing, arguing that they have a right to call themselves doctors. The lawsuit seeks to permanently prevent the state from enforcing the law.
“It’s not an ego trip; it’s not a power trip,” Palmer said. “It’s just validation that I worked hard to get where I am today.”
An attorney representing the state officials did not immediately respond to a request for comment.
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Nurse practitioners — registered nurses who have completed a master’s degree and additional training — are distinct from physicians, who go through medical school and have a wider scope of practice. Both may diagnose conditions and act as primary care providers, though in some states, including California, nurse practitioners must be supervised by a physician.
Several states regulate the use of the “doctor” title, but California’s law is the strictest in the country, said Donna Matias, the attorney representing Palmer and her co-plaintiffs. It restricts any person from using the word “doctor” or the prefix “Dr.” in signs or advertisem*nts without having a valid certificate as a physician or surgeon.
“If you read the law literally, it appears to prohibit even PhDs and university professors from using the title,” Matias said.
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In practice, enforcement of the restriction to such a severe extent is rare, Matias said. But she said the crackdown on Erny, which stemmed from an anonymous complaint, set a chilling precedent.
Prosecutors alleged that Erny, who holds a doctorate of nursing practice, operated a health-care business with a supervising physician and referred to herself as “Dr. Sarah Erny” on social media.
Erny, who did not immediately respond to a request for comment, was fined $2,500 by the state’s medical board, on top of the legal settlement, according to Palmer’s lawsuit. In an online fundraiser, Erny denied presenting herself as a physician and said she closed her clinic after state authorities began investigating her.
Palmer said she does not want to face a similar investigation. She was so nervous after hearing news of Erny’s punishment that she said she urged her patients to stop calling her “doctor,” over their protests.
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“They all have said that they know that I worked hard for it,” Palmer said. “… They know that I’m a nurse practitioner; there was no misconception.”
Palmer and Matias said that other types of health-care professionals who hold doctorates, like chiropractors or dentists, commonly describe themselves as doctors — and should be able to. For her, the title reflects the time and effort she invested to pursue her degree and the greater expertise she has gained from it.
“The word ‘doctor’ doesn’t belong to physicians,” she said. “We need to educate everybody. … Patients are very intelligent. They can understand the difference.”
