A survey of the general public found that 39% of people think a DNP is a physician. Two of the three nurse practitioners admitted in deposition they chose to call themselves doctor for financial gain. This isn't a turf battle — it's a patient safety battle.
This week in California, a federal judge ruled against three nurse practitioners who had sued for the right to call themselves "Doctor" in the medical setting without any clarification.
This wasn't a turf battle between physicians and nurse practitioners. It was a patient safety battle. And it's a really important ruling — both for what it says about transparency in medicine, and for what it reveals about how confused the public is about who is actually caring for them.
California has a law on the books that prohibits anyone in a medical or clinical setting from calling themselves "doctor" unless they are a physician (MD or DO). The law is straightforward: in a clinical context, "doctor" implies a level of medical training the public assumes is there.
This isn't to say nurse practitioners and other clinicians aren't valuable — they absolutely are, and many have doctoral-level degrees (DNPs and others). The law is specifically about clinical advertising and communication with patients, where the title "doctor" carries a very specific meaning.
The three NPs were calling themselves "Dr. So-and-So" on:
…with no clarification that they were nurse practitioners, not physicians. One of them was advertising in this way for a med spa — exactly the kind of clinical environment where a patient is making a real medical decision (about injectables, lasers, prescription products) based on what they believe the practitioner's training is.
The state of California fined them. They sued the state in federal court, arguing they had a First Amendment right to use the title.
The judge sided with the state and said: no, they do not have the right to call themselves doctors without clarification, because it is genuinely confusing to patients.
A few details from the ruling that I think are worth highlighting:
A survey cited in the judgment found that 39% of the general public believes a DNP (Doctor of Nursing Practice) is a physician. Almost 4 in 10 people. That's the entire problem in one statistic.
When you call yourself "doctor" in a clinical setting, a third of the people you're talking to believe they're seeing a physician — when in fact they're seeing someone with a different (and significantly different in length) training pathway.
This was the part that, frankly, gave away the game. In their depositions, two of the three nurse practitioners openly stated that they chose to call themselves "doctor" for financial gain — because they believed it would:
Once you say that out loud, it stops being a free-speech issue and starts being a deceptive-advertising issue. The judge was unsurprisingly unmoved.
I want to make this really clear, because the framing matters: this isn't physicians vs. nurse practitioners.
Nurse practitioners are an essential part of the healthcare system. They:
The issue isn't that NPs exist or that NPs work alongside physicians. The issue is truth in advertising. Patients deserve to know who is caring for them and what their qualifications are. Period.
A nurse practitioner can identify themselves clearly as a nurse practitioner — and patients can choose to see them with full information. That's how it should work. What patients don't deserve is to think they're seeing a physician when they're not because someone wanted the marketing benefits of a title they didn't earn through that specific training pathway.
In academia, "doctor" is a broad term — anyone with a doctorate-level degree (PhD, EdD, JD, DNP, MD, DO, DPT, DDS) technically holds the title.
In clinical medicine, the public has a much narrower expectation. When a patient walks into a clinic, sees someone in a white coat introduced as "Dr. Smith," and is being given a medical recommendation, they are reasonably expecting:
This is the expectation embedded in the word in that context. Using it without clarification when that expectation isn't met is, plainly, misleading.
The argument that "it doesn't matter, I provide great care" isn't a great argument when patients are making important decisions about:
Patients deserve to know where the recommendation came from and what the qualifications are of the person making it. Without that information, informed consent is essentially broken.
This is the same logic behind verifying board certification — it's not gatekeeping for the sake of gatekeeping. It's transparency in service of safety.
The 39% statistic should be a wake-up call. Science literacy in the United States is genuinely low, and most patients have no idea:
That's not the patients' fault. It's a systemic education gap. And it's on us as a profession to help people understand rather than to exploit the confusion for marketing purposes.
When clinicians choose to capitalize on that gap by using titles their patients don't fully understand, they are not advocating for themselves — they're actively making the problem worse.
I'll just say it directly: I love truth-in-advertising laws in healthcare. Patients deserve:
When all three of those are present, patients can make informed decisions. When any one is muddied, decision-making suffers.
Three California nurse practitioners argued for the right to advertise themselves as "doctor" without clarification. A federal judge said no — because it's confusing for patients (39% of whom already think a DNP is a physician), and because the practitioners themselves admitted they were doing it for financial gain.
This isn't a turf war. It's a transparency issue. Patients deserve to know who's caring for them. Nurse practitioners can be excellent clinicians and identify themselves accurately at the same time. Both things are true. The ruling protects patients' ability to make informed decisions about their own care — and that should be a non-controversial thing to be in favor of.