REPORT OF INTERSPECIALTY SOCIETY COMMITTEE
CM-IS Report 1-A-06
Subject: Appropriate Title Nomenclature in Medical Settings
Presented by: Michelle A. Berger, MD, Chair
Referred to: Reference Committee on Socioeconomics
A delegate to the committee reported that while our American Medical Association has well defined the training and certification of 65 allied health professionals in its 33 rd edition of Health Professions Career and Education Directory, 2005-2006, there is no similar source of information on such limited licensure health care providers as chiropractors, optometrists, nurse anesthetists, advanced practice nurses, podiatrists, or psychologists. At the November 2005 House of Delegates, our American Medical Association passed Resolution 814 to "study the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of the limited licensure health care providers, including but not limited to, chiropractors, optometrists, nurse anesthetists, advanced practice nurses, podiatrists, and psychologists, and report back at the 2006 Annual Meeting.
The Centers for Medicare and Medicaid Services (CMS) limit the definition of "anesthesiologist" and all other specialties to a doctor of medicine or osteopathy; and defines the term "resident" as "an allopathic or osteopathic physician, dentist, or podiatrist who participates in an approved graduate medical education (GME) program, including programs in osteopathy, dentistry, and podiatry"; and CMS considers the term "resident" to be synonymous with the terms "intern" and "fellow." Many limited licensure health care providers including pharmacists, physical therapists, and psychologists may have earned doctorate level degrees. The American Academy of Nurse Practitioners (AANP) and the American Association of Colleges of Nursing (AACN) are implementing strategies and activities leading to the development of Doctor of Nursing Practice (DNP) educational programs for advanced practice nurses. In school classrooms, university, and other educational settings the term "doctor" may be appropriately applied as a title of respect earned by those who have attained a Ph.D., Pharm.D., or other doctorate level of education.
The Texas Occupations Code (TOC) defines a physician as a person licensed by the Texas Medical Board (TMB) to practice medicine in this state, the terms "physician" and "surgeon" being synonymous. The TOC and the TMB limit the title doctor of medicine (MD) to a person licensed by the TMB who holds a doctor of medicine degree, and limit the title doctor of osteopathy (DO) to a person licensed by the TMB who holds a doctor of osteopathy degree. The TOC limits any other use of the title "doctor" to persons licensed by the Texas Board of Dental Examiners, Texas Board of Chiropractic Examiners, Texas Optometry Board, or Texas State Board of Podiatric Medical Examiners. The title "doctor" when used by the afore-mentioned must be clarified by the appropriate initials or defining words after the title "doctor" to identify the college or honorary degree that gives rise to the title.
In hospitals, ambulatory care centers, and other medical facilities the terms "doctor," "surgeon," "resident," "intern," "fellow," "psychiatrist," "obstetrician," "pediatrician," and "anesthesiologist" are commonly used to refer to physicians.
In the facilities listed above and other medical facilities the terms "nurse," "nursing student," "nurse midwife," "pediatric nurse practitioner," "nurse anesthetist," and "certified registered nurse anesthetist" are commonly used to refer to registered nurses and registered nurses with advanced training. It is important for patients, regulators, administrators, and legislators to understand clearly the educational background, training, and professional licensure of all health care providers in medical settings such as a hospital, physician's office, or an ambulatory care facility. The practice of referring to advanced practice nursing students as "residents," "interns," or "fellows" may mislead patients; and the use of the term "doctor," "surgeon," "anesthesiologist," "pediatrician," "obstetrician," or "psychiatrist" to refer to a pharmacist, advanced practice nurse, physical therapist, psychologist or audiologist is confusing and misleading to patients, medical facility administrators, state regulatory authorities, and state legislators.
Recommendation 1: That the Texas Medical Association (TMA), within the construct of its patient safety initiatives, advocate for a requirement that appropriate and specific nomenclature, consistent with the definitions in the Texas Occupations Code (TOC) and The Centers for Medicare and Medicaid Services (CMS) regulations, be required to clearly identify the training, educational background, and licensure under the TOC of any and all health care professionals who provide care in any Texas hospital, ambulatory care facility, or medical office. This requirement for appropriate and specific nomenclature should include name badges as well as all verbal, telephone, and electronic communications media.
Recommendation 2: That the TMA, within the construct of its patient safety initiatives, advocate for terminology clearly differentiating physicians in a board approved residency training program from nursing students in an advanced practice nurse training program. This requirement for appropriate and specific nomenclature should include name badges as well as all verbal, telephone, and electronic communications media.
Recommendation 3: That the TMA delegation to our AMA carry forward this resolution to the AMA to advocate for inclusion of these appropriate and specific nomenclature requirements in the CMS rules for hospital and ambulatory care center Conditions of Participation.
TMA House of Delegates: TexMed 2006