On June 6, 2023, three nurse practitioners with doctorates sued the California attorney general, and leaders of the Medical Board of California and California Board of Registered Nursing over the restrictive use of the term "doctor."1 The statute they are challenging provides the following:
Any person who uses in any sign, business card, or letterhead, or, in an advertisement, the words "doctor" or "physician," the letters or prefix "Dr.," the initials "M.D.," or any other terms or letters indicating or implying that he or she is a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, or that he or she is entitled to practice hereunder, or who represents or holds himself or herself out as a physician and surgeon, physician, surgeon, or practitioner under the terms of this or any other law, without having at the time of so doing a valid, unrevoked, and unsuspended certificate as a physician and surgeon under this chapter, is guilty of a misdemeanor.2
In their complaint challenging this law, the nurse practitioners allege that the law is unconstitutional, violating their freedom of speech to truthfully describe their educational and professional credentials. The plaintiff nurse practitioners seek a declaration that the statute violates the First and Fourteenth Amendments and a preliminary injunction to prevent the enforcement of the statute.
Sarah Erny, one of the nurse practitioners in the lawsuit, claims she was fined and subjected to administrative actions to revoke her nursing license due to her use of the term "doctor" to describe herself even though she also identified herself as a nurse practitioner. She claims in the complaint that, in January 2023, the Medical Board of California issued a citation that ordered her to pay a $2,500 fine and to "immediately cease and desist the use of the initials 'Dr.'"
Health care professionals and health care organizations should be cognizant of how the term is being in their workplace to avoid unwanted disciplinary actions or fines unless and until the law about using the term "doctor" has been altered. Permitting nurses to reference themselves as doctors may impact a patient's expectations regarding the level of care they are receiving. This could become an issue should a malpractice lawsuit arise. Additionally, misleading use of the term doctor by a professional or organization could be considered a violation of the law relating to false advertisement, which makes it a misdemeanor to disseminate untrue or misleading statements3 or could be considered aiding and abetting the unauthorized practice of medicine.4 In addition, without clear guardrails, terms of a medical staff's bylaws that are applicable to physicians, may unintentionally be applied to an expansive group of non-physicians as well.
Footnotes
1. Jacqueline Palmer et al. v. Rob Bonta et al.
2. Cal. Bus. & Prof. Code § 2054(a).
3. Cal. Bus. & Prof. Code § 17500.
4. Cal. Bus. & Prof. Code § 2052.
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