PAs and NPs for Primary Care

WayOutWestMom
Fri, 14 Nov 2025 17:42:49 +0000

tamagotchi:

My NP would never refer to herself as “Doctor” but when I go to check in at her practice, it’s not uncommon for the front desk staff to refer to her as “Doctor NPName.” And when I go to a specialty appointment at another clinic they invariably say something like, “Would you like us to send your test results to your PCP…” (glancing at file) “…Doctor NPName?”

This is EXACTLY what the recent CA federal court case was about and this is now prohibited behavior.

Judge Jesus G. Bernal wrote in the opinion that using the title “Dr” by nonphysicians in clinical contexts is *“inherently misleading”*and amounts to regulated commercial speech. Because of that, it does not fall under free speech protections.

The court sided with the state, which argued that allowing nonphysicians to use “Dr” could confuse patients about who is providing their care. Bernal cited an American Medical Association (AMA) survey showing:

Judge Jesus G. Bernal wrote in the opinion that using the title “Dr” by nonphysicians in clinical contexts is *“inherently misleading”*and amounts to regulated commercial speech. Because of that, it does not fall under free speech protections.

The court sided with the state, which argued that allowing nonphysicians to use “Dr” could confuse patients about who is providing their care. Bernal cited an American Medical Association (AMA) survey showing:

39% of patients mistakenly believed that DNPs are physicians.

He concluded that even when nurses disclose their credentials, the risk of confusion remains high in healthcare settings.

It appears that your healthcare provider organization needs to do some retraining for their personnel.

And perhaps set up a better system for distinguishing between physicians and mid level providers in patient records.

FWIW, CA is a state the partially restricts mid-level provider (NP and PA) practice rights. Mid level providers cannot provide all the same primary care services as physicians. The restriction is in flux, however, and CA is in the midst of phasing in FPR for NPs over the next few years.