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Sue Shirato is a nurse. And a doctor.

But probably not the kind of doctor you think, which makes her introduction to patients at Thomas Jefferson University’s Heart Institute more complicated.

“I’m Dr. Shirato, but feel free to call me Sue,” she tells patients. “I am Dr. Duffy’s advanced-practice nurse.”

Shirato, a nurse practitioner, just got her doctor of nursing practice degree at Thomas Jefferson University. Most nurse practitioners still have master’s degrees, but nursing schools want the doctorate to be the entry-level degree for advanced-practice nurses by 2015. Enrollment in those programs nationally jumped from 70 in 2002 to more than 5,000 last year.

Most newly graduating physical therapists now have doctorates, too. Pharmacists and psychologists already made that move. Audiologists, physician assistants and occupational therapists also can get doctorates.

As nonphysicians with doctorates proliferate, the potential for confusion has grown, and physicians aren’t happy about it. A 2008 survey by the American Medical Association found that 38 percent of patients thought that nurses with doctorates were medical doctors.

The association has produced model “truth in advertising” legislation that requires health professionals, including physicians, to wear badges that clearly spell out their credentials. Similar laws have passed in Arizona, Florida, Illinois and Oklahoma and are under consideration in California and Pennsylvania.

James Goodyear, a general surgeon and president of the Pennsylvania Medical Society, said health-care workers who are not physicians should immediately tell patients what they do.

“I am a physician. They are not,” he said. “They trained for hundreds of hours. We trained for thousands of hours.”
People with doctorates in other fields said they generally don’t want to call themselves doctors around patients, but they reserve the right to do so.

“There are some physicians who look at their title — doctor — as a protected title when it really isn’t,” said Kathleen Potempa, president of the American Association of Colleges of Nursing. “There are lots of people who have the entitlement to ‘doctor’ now.”

Not everyone is a fan of the trend, which some critics call “degree creep.” Some vocal naysayers, including Afaf Meleis, dean of the University of Pennsylvania’s nursing school, worry that it’s a bad time to demand more training of the nurses best-equipped to provide primary care. Health reform soon will flood the market with newly insured patients, and some think there won’t be enough primary-care doctors to tend to them.

Nurses who completed Jefferson’s doctor of nursing practice program said they wanted to focus on patient care.

“If I’m taking care of you, you don’t want me to have a Ph.D.,” said Dolores Grosso, who got her doctorate a year ago and who works with blood and bone-marrow transplant patients at Jefferson.

She said her coursework improved her problem-solving skills and taught her about statistics.

She doesn’t plan to call herself “doctor” around patients. “I’m happy with who I am,” she said. “I don’t feel the need to walk around and have people think I’m either a Ph.D. or a doctor.”