From Scope Creep, to Calling Yourself Doctor, to Puerto Rican Licensing
PAs have not always seen eye to eye with the American Medical Association (AMA). Their “Fighting Scope Creep” campaign of several years suggests that the medical care PAs and NPs provide is subpar, not evidence-based, and jeopardizes patient safety. In 2020, the AAPA wrote an open letter to the AMA explaining that this “misleading narrative” denigrates the PA profession and “attempts to instill more fear and uncertainty in the public at a time of already heightened anxiety” (referring to COVID).
A Commentary
From Scope Creep, to Calling Yourself Doctor, to Puerto Rican Licensing
There is another topic, however, where PA opinion is divided: the use of “doctor” as a title in the clinical setting. Using first the example of California and then Puerto Rico, you may be surprised to discover what side you come out on.
Last summer, three NPs sued the state of California to be able to use the title doctor, which they earned academically when introducing themselves to patients. The California Medical Practice Act strictly prohibits healthcare professionals other than licensed MDs or DOs from using the title “doctor” in any setting including clinics, business cards, or social media, and any person who does so is guilty of a misdemeanor.
AMA President Ehrenfeld, MD, MPH said, “Patients want and deserve clarity and transparency in who is providing their care as there are immense differences in the education, training, and qualifications among healthcare professionals… Patients find it increasingly difficult to identify who is or isn’t a physician. The potential for confusion is especially heightened when non-physician healthcare professionals use terms that are customarily understood to refer to a physician.”
Now, what if you went to medical school outside the US? The AMA’s current
stance is to “require all international medical graduates (IMGs) to complete a US-based residency, even if they have previously practiced medicine in another country.” There are already several states such as Tennessee and Mississippi where governors signed laws bypassing this, but IMGs still had to pass at least one USMLE Step exam. Now Florida, whose ‘Live Healthy’ bill passed in March adds to this by creating the new profession of ‘Graduate Assistant Physician’ or GAP. Will there be room for PAs now?
What about IMGs who, in addition to not completing a residency, also did not pass their USMLE exams? Simply appropriate the title PA and apply for licensure in Puerto Rico. Law 71 specifically includes the definition of a PA as someone who “has a medical degree or certificate attesting to satisfactorily completed academic studies of the medical career” or of completed PA school and passed PANCE. Those completing the academic study as a doctor do not have to take the PANCE to call themselves PA to their Puerto Rican patients. Once you have obtained this PA license, you may head to any clinic or hospital where no one is looking when you introduce yourself as a doctor again since you did complete medical school.
Take Away
Ultimately, as PAs and as healthcare professionals, we have a duty to uphold ethical standards as well as maintain the integrity of our own profession. Appropriate use of titles maintains patient trust. A doctorate, whether academic, professional, or from completing medical school is a tremendous accomplishment. It must be represented honestly in professional circumstances, but not in a clinic or to patients. To come full circle, one last thing: With the projected physician shortage in both the US and currently in Puerto Rico, how do you want to know who is directing your medical care and what would you call them?
References
Bailey, S. Madara, J. AAPA Response to AMA’s Stop Scope Creep Campaign. November 2, 2020.https://www.aapa.org/news-central/2020/11/aapas-response-to-amas-stopscopecreep-campaign/
California Code, Business and Professions Code, BPC § 2054. Current as of January 01, 2023. https://codes.findlaw.com/ca/business-and-professions-code/bpc-sect-2054/#:~:text=(a)%20Any%20person%20who%20uses,surgeon%2C%20or%20practitioner%20under%20the
Hollowell, A. Tennessee law lets international medical grads skip US residency. Beckers Hospital Review. June 27, 2023. https://www.beckershospitalreview.com/hospital-physician-relationships/tennessee-law-lets-international-medical-grads-skip-us-residency.html
Mississippi Code §73-25-23. Limited Institutional Licensure Requirements. Mississippi State Board of Medical Licensure. July 2007. https://www.msbml.ms.gov/sites/default/files/Documents/Regulation_Filings/lilappforms.pdf
Betta, K. LIVE HEALTHY: Senate unanimously passes comprehensive legislation to grow Florida’s healthcare workforce. March 21, 2024. https://www.flsenate.gov/Media/PressRelease/Show/4547
Ley No 71 of 2017. Law to Regulate the Profession of PA of Puerto Rico. https://www.lexjuris.com/lexlex/Leyes2017/lexl2017071.htm