The Doctor Is In: DNP Leadership, Professional Clarity, and Evidence That Guides Care

By: Monika Do, DNP, AGNP-C, PMHNP-C, NE-BC, FACC

My professional work has centered on developing the clinical guidelines that physicians, nurse practitioners, and other clinicians use in practice. As Vice Chair on a National Appropriate Use Panel, I worked alongside physicians and other leaders to critically analyze trial data, weigh benefits and risks, and publish recommendations. These guidelines are not academic abstractions, they define appropriateness, inform payer policies, and set standards of care across the United States. It is from this vantage point, as someone who has co-led the writing of the very documents that physicians follow, that I address an increasingly debated question: Should nurse practitioners who hold a Doctor of Nursing Practice (DNP) degree be permitted to use the title “Doctor”?

The Legal Landscape

In September 2025, a federal court in California upheld the state’s law that prohibits non-physicians from using “Doctor” in clinical settings, even if they hold doctoral degrees. The California Medical Association and the AMA praised the ruling as a measure for clarity. Other states have taken a disclosure model: allowing doctoral-prepared clinicians to use “Doctor” as long as licensure is stated (for example, “Dr. Taylor, Nurse Practitioner”). This is consistent with the AANP position, which supports accurate use of titles provided professional role is clear. The result is a patchwork. What is constant is the responsibility of clinicians to introduce themselves with both precision and integrity.

The Ethical Lens

The ANA Code of Ethics emphasizes honesty and transparency. For DNP-prepared nurse practitioners, using the title “Doctor” alongside the designation “Nurse Practitioner” honors both academic achievement and clinical role. This practice does not diminish physicians. Instead, it highlights the fact that doctoral education is found across health care; PharmD, PsyD, DPT, DNP each with distinct contributions. Patients are best served when all members of the team are recognized for their expertise. The ethical standard is not fear of confusion; it is fidelity to accuracy. By introducing ourselves with both degree and licensure, we strengthen patient trust.

Educational Pathways: Distinct Routes to Advanced Practice

Both physicians and nurse practitioners follow demanding educational routes, tailored to different scopes of practice.

• Physicians (MD/DO): Typically complete a four-year undergraduate degree, four years of medical school, and three to seven years of residency and fellowship. Residency training is full-time, averaging 60–80 hours per week under ACGME regulations, providing extensive supervised patient care and subspecialty depth.

• Nurse Practitioners (NPs): Complete a four-year degree followed by graduate education (MSN or DNP). National certification requires 500+ supervised direct patient care hours, with most programs exceeding this.

• Doctor of Nursing Practice (DNP): The DNP is the terminal practice degree in nursing. CCNE accreditation requires at least 1,000 post-baccalaureate practice hours, including leadership, quality improvement, and evidence translation. Unlike the PhD, which generates new research, the DNP leads implementation, systems change, and measurable practice improvement.

• Postgraduate NP Fellowships/Residencies: Over 300 accredited NP postgraduate programs now exist nationwide, providing one year or more of structured, specialty-specific training in fields such as cardiology, critical care, psychiatry, and women’s health. These fellowships reinforce the technical breadth of NP practice and underscore its sophistication.

• Physician Associates/Assistants (PAs): Complete a bachelor’s degree followed by a master’s program with rigorous coursework and clinical rotations. Clinical hour requirements vary by program and are fewer than those for physician training. An increasing number of universities now offer post-professional doctorates, such as the Doctor of Medical Science (DMSc) or Doctor of PA Studies (DPAS), designed to prepare PAs for leadership, education, policy, or advanced clinical roles.

These are distinct but complementary pathways. Physicians bring subspecialty depth and complex diagnostics. NPs bring broad technical expertise, access, systems leadership, and patient-centered approaches. Together, they expand the reach and quality of care.

Professional Positions

• AANP: Supports use of “Doctor” by DNP-prepared NPs when licensure is identified.

• AMA/CMA: Advocate reserving “Doctor” for physicians in clinical settings.

• AACN: Defines the DNP as nursing’s practice doctorate and emphasizes that the title “Doctor” is not exclusive to medicine.

• ANA: Grounds the issue in ethics and transparency. These statements highlight policy divergence but a shared emphasis on patient clarity.

Contributions of DNPs in Guidelines and National Documents

The ACC/AHA describe three major document types: Clinical Practice Guidelines (CPGs), Appropriate Use Criteria (AUC), and Expert Consensus Decision Pathways (ECDPs). CPGs synthesize high-level evidence and grade recommendations. AUC documents use a structured Delphi process to rate clinical scenarios as “appropriate,” “may be appropriate,” or “rarely appropriate.” ECDPs provide practical guidance where evidence is limited, combining available data with expert clinical judgment. As Vice Chair on a National Appropriate Use Panel, I engaged in all aspects of this process; reviewing data, debating risk–benefit thresholds, interpreting evidence strength, and shaping recommendations. My physician colleagues brought subspecialty expertise; I contributed both as a clinical peer and as a DNP leader. My role was not limited to implementation, but to co-authoring and co-leading the clinical evidence work itself. This kind of contribution is not unique to cardiology. The American Academy of Family Physicians (AAFP) emphasizes that guidelines must be feasible and achievable, and that competence, not title, determines who should deliver care. The American College of Obstetricians and Gynecologists (ACOG) uses structured Clinical Consensus and Guideline processes that integrate multidisciplinary input, relying on both evidence and expert opinion when research is incomplete. These models underscore that credibility comes from rigor, transparency, and multidisciplinary expertise, not professional turf. Together, these national processes affirm the value of including DNP-prepared NPs as full clinical contributors and, in some cases, leaders.

Collegiality, Not Competition

The debate over “Doctor” is too often framed as professional competition. It is more accurate to view it as recognition of complementary expertise. Physicians and nurse practitioners both bring doctoral-level training, with different emphases. Recognizing the DNP does not diminish the MD/DO it affirms the collaborative reality of modern health care. Using “Doctor” with licensure is accurate, honors achievement, and clarifies scope. It demonstrates respect for physician colleagues by distinguishing roles clearly, while also respecting the academic and clinical contributions of NPs.

The Bigger Picture

“Doctor” in academia refers to a degree, not a profession. PharmDs, PsyDs, DPTs, DNPs, and MDs/DOs are all doctors in the academic sense. What matters to patients is role clarity, scope of practice, and team collaboration. Health care works best when patients benefit from the full breadth of expertise: physicians with subspecialty training, nurse practitioners with broad technical and translational expertise, and other doctoral-prepared professionals.

A Call to Action

As a DNP and practice leader, I know value is measured not in titles but in outcomes. When we publish guidance, success is seen in reduced adverse events, improved equity, and consistency across practice. That is the DNP ethos: making evidence usable in real-world care.

For DNP-prepared NPs:

1. Use credentials with clarity. Always pair “Doctor” (where permitted) with the title “Nurse Practitioner.”

2. Display both degree and licensure. Patient-facing materials should reflect both.

3. Stay current on state laws. Compliance matters, but so does communication.

4. Emphasize outcomes. Highlight quality improvement, access, and implementation.

5. Consider advanced training. Postgraduate fellowships expand technical expertise and underscore the breadth of NP practice.

The title debate will continue in legislatures and courts. But the real test will always be the same: Are we transparent, collaborative, and relentlessly focused on evidence and patient outcomes? Recognizing the title “Doctor” for DNPs, alongside licensure, affirms both the integrity of nursing and the collegial spirit of medicine.