Contributor: Misty McNabb, MSN, APRN, PMHNP-BC, PhD Student

The power imbalance between physicians and nurses has existed for over a century and is reinforced not only through policy but also through language, perceived professional identity, and institutional structures. One of the most persistent debates centers on the use of the title “Doctor”, a term that physicians have historically claimed as exclusive, despite the growing number of doctoral-prepared nurses.

As a psychiatric nurse practitioner (PMHNP) and current PhD student, I’ve been called midlevel, assistant, and subordinate. When I earn my PhD, I no longer want to be called any of these things. Labels like this don’t reflect my education, training, or scope of practice, but something else entirely. Power. The issue isn’t just semantics. It’s systemic. Physicians are consistently referred to as “doctors,” while NPs, even when we hold DNP or PhD degrees, are often denied the use of this title. In some states, it’s illegal to use the title “Doctor” in clinical practice unless you’re a physician. In others, patients are misled to believe that MDs hold exclusive rights to the term. But “doctor” is not a medical title. It’s an academic one.

We need to reframe the debate. This is not about pretending NPs, or doctorly prepared nurses, are physicians because we’re not. This is about reclaiming the legitimacy of our own discipline. Nursing is not a junior version of medicine. It is a distinct field with its own philosophy, knowledge base, training pathways, and doctoral education.

Training Time: Who’s Actually More Prepared?

Critics often cite the 12,000 to 16,000 hours of training that medical doctors (MDs) receive through school and residency as evidence of superiority. However, this ignores the layered, cumulative training path many NPs take. According to the 2022 National Sample Survey of Registered Nurses, over 70% of RNs held a health-related job before becoming nurses, with nearly half having worked as CNAs or LPNs (Nursing Education and Training: Data from the 2022 NSSRN, 2024). Many NPs accrue 8,000–15,000 hours of direct care before ever entering graduate school, often more than a newly minted physician. Further, nurse practitioner education includes 600–1,000 clinical hours (Ljungbeck et al., 2021) and increasing numbers of NPs are graduating with Doctor of Nursing Practice (DNP) degrees. We often surpass the hands-on patient contact of a new MD. Yet we’re treated as if we are less prepared. If a newly minted physician with zero years of experience can be called “Doctor,” why can’t a DNP-prepared NP with 10 years of RN background and specialty certification? The truth is, the “Doctor” title isn’t about preparation, it’s about perception. The educational differences are not about less rigor; they’re about a different paradigm.

Misaligned Comparisons Nursing vs. Medical Model: Two Disciplines, One Goal

Nursing is not a subfield of medicine; it is a distinct discipline grounded in a philosophy of human response, healing, and holistic care. As Nursology.net demonstrates, our discipline has a broad and well-developed theoretical and philosophic foundation. Nurse practitioners are regularly compared to physicians using medical standards of evaluation. But as Carter & Assa (2023) notes, these comparisons distort reality. NPs and MDs are trained through different paradigms. Medicine focuses on pathophysiology and diagnosis. Nursing emphasizes human response, pattern recognition, holistic care, and healing. Comparing nurse practitioners to physicians is like comparing two teams playing different sports in the same city. One isn’t better than the other, they’re playing by different rules, with different goals, serving different fans.

Education Reform: Universal DNP?

To further close the gap, and perhaps eliminate this debate altogether, it’s time to consider standardizing NP education at the doctoral level. Recent studies show DNP-prepared NPs are associated with higher-quality outcomes and improved safety measures. A DNP enhances leadership, evidence translation, and professional credibility. It’s more than a degree. It’s a declaration of our value.

Policy Matters

Scope of practice restrictions, title protection laws, and institutional hierarchies shape public perception. When policy limits our ability to use our earned titles, it’s not about protecting patients. It’s about preserving power. Calls to limit NP title use often come from organized medicine, not from patients. In fact, multiple studies show patients report equal or higher satisfaction with NP care. The title confusion argument is a red herring. Patients understand the difference when clinicians clearly explain their role.

As Nursology.net reminds us, in Nursology, Nursing, Nursologist, and Nurse: An Invitation to Dialogue about Disciplinary Terms (n.d.), nursing is not a subset of medicine but a distinct discipline with its own knowledge base and language. We don’t need to copy physicians. We need to stop being erased by them.

Rather than mirror the physician pathway, nursing should elevate its own. One policy solution is to:

• Transition all NP programs to the DNP as the entry-to-practice standard
• Require 15,000 hours of specialty RN experience before NP enrollment into the same specialty
• Replace “supervision” with structured mentorship for early NP graduates for a designated time frame

This model respects the strengths of nursing while addressing concerns about clinical readiness. It also aligns with research advocating for more intentional educational pipelines that build on RN experience (Buck, 2021). If a newly minted physician with four years of medical school and no patient-facing work history can be called ‘Doctor,’ why can’t an NP with a doctorate in nursing, a decade of RN experience, and more than 15,000 hours of clinical time earn the same respect?

Final Thoughts

The question of who “gets” to be called “Doctor” speaks to deeper truths about power, discipline, and legitimacy. The time has come to assert the titles we have earned through the education we’ve completed. Nurse practitioners are not failed physicians. We have our own values, paradigms, and contributions.  If someone with four years of medical school and no medical background can be called “Doctor,” then so can someone with a doctorate in nursing, 10 years of experience, and a deeper understanding of human suffering than any textbook could teach. We are not mid-level. We are not assistants. We are not extenders. We are nurse practitioners. Some of us are doctors.  Calling a DNP-prepared NP “Doctor” is not misleading. It is accurate. And it’s time policy caught up.

Perhaps the better solution is this: Let’s start calling physicians what they are, physicians, and call all doctoral-prepared professionals by their earned title: Doctor. No doctorate is inherently superior; each reflects deep expertise in its own field. Respect must follow qualification, not tradition.

References

Buck, M. (2021). An Update on the Consensus Model for APRN Regulation: More Than a Decade of Progress. Journal of Nursing Regulation, 12(2), 23–33. https://doi.org/10.1016/S2155-8256(21)00053-3

Carter, M. A., & Haji Assa, A. S. (2023). The problem of comparing nurse practitioner practice with medical practice. Nursing Inquiry, 30(3), e12551. https://doi.org/10.1111/nin.12551

Ljungbeck, B., Sjögren Forss, K., Finnbogadóttir, H., & Carlson, E. (2021). Content in nurse practitioner education—A scoping review. Nurse Education Today, 98, 104650. https://doi.org/10.1016/j.nedt.2020.104650

Nursing Education and Training: Data from the 2022 NSSRN. (2024).

Nursology, Nursing, Nursologist, and Nurse: An Invitation to Dialogue about Disciplinary Terms. (n.d.). https://nursology.net/about/definitions/nursology-nursing-nursologist-and-nurse-an-invitation-to-dialogue-about-disciplinary-terms/

About Misty McNabb

Misty is a psychiatric mental health nurse practitioner and PhD student in nursing at Texas Woman’s University. With over a decade of experience in mental health and a personal history shaped by trauma and resilience, she brings a soul-level lens to her clinical work and scholarly inquiry. Her doctoral research currently explores complex trauma, language, and sleep as energetic expressions of the human condition. Deeply influenced by Rogerian nursing science, Misty is committed to reimagining assessment and diagnosis through pattern recognition, aesthetic knowing, and pandimensional awareness. She currently serves on the board of Grace After Fire, a nonprofit supporting women veterans. She is also a board member for the Psychiatric Advanced Practice Nurses of North Texas, is adjunct faculty for Texas Women’s University, and sees patients in private practice.