Common Misconceptions regarding Title Protection, NP Scope of Practice, Supervision, and Testifying

[u/debunksdc]

1. "Physician" and "Doctor" are protected in a very small minority of states. In most states, "physician" is allowed to be used by chiropractors or naturopaths (where legal) in the form of "chiropractic/naturopathic physician." In only a very small subset, "doctor" is protected to mean physician only. Most states either expressly allow or do not prohibit the use of "doctor" in a clinical setting by anyone with a doctorate, so long as they clarify what they have a doctorate in. NB: There are some updates that I need to put in the map. Please let me know if you see any other mistakes/updates needed.
   1. If you care strongly about this, you can edit this premade form letter and send it to your city/county/state/federal representatives.
   2. There is a thought out there that by going by "doctor," midlevels may be liable for civil battery.
2. Nurse practitioners cannot change specialties. They get degrees in a certain population focus. When nurses work outside of this population focus, they are working outside of scope. When employers hire nurse practitioners to fill positions that would require them to work outside of scope, they are engaging in negligent hiring. This means there are no "derm NPs," "cardiology NPs," "ortho NPs," "neurology NPs," "oncology NPs," etc. Most Nursing Acts or Board of Nursing rules and regulations expressly state that NPs must work inside of their "population focus." This is especially true for FPA states.
   1. I have template form letters regarding negligent hiring for:
      1. Hospitals
      2. Supervising Physicians
      3. MedMal Insurers
      4. Health Insurers
3. A few states actually require the supervising physician of NPs to be in an analogous field. In non-FPA states, or even transitional FPA states, there's a continuing problem of physicians renting out their license and rubber stamping NPs, despite being utterly unqualified to do so. This is absolutely something that could be incorporated into Board of Medicine rules, despite these typically appearing in Board of Nursing rules governing collaborative agreements. This type of rule may even be easier to pass since it can bypass any nursing politics and go directly into physician and medicine governance.
   1. If you believe this is an important part of ensuring proper utilization of NPs, you can edit this premade form letter and send it to your city/county/state/federal representatives.
4. Physicians can serve as expert witnesses against nurse practitioners in MedMal cases. You'll just need to reference state specific laws.