Terra Sigillata

Doctor, doctor, give me the news*

I’ve been having this 3:30 am (EST) insomnia for about the last two months, so I often pull the laptop up and survey the blogosphere in the still of the night. A simple look at the Last 24 Hours at ScienceBlogs and elsewhere in the blogosphere tells me that some knuckleheads in the mainstream press have taken issue with Dr Jill Biden, doctor of education, using the honorific, “Dr.”

Keep in mind that the article in question comes from the L.A. Times – the very same paper that graces my e-mail account weekly humping their fishwrapper’s science and environment coverage. I did just look up some of these articles and while some folks are referred to as Senator or General, professionals who earned PhDs carry no honorific.

My dear colleagues below have done a collectively admirable job on addressing the historical use of “doctor” for PhDs, even before physicians used the term “medical doctor.” (However, I do believe that while physicians in Great Britain use “Dr,” it is more honorable to use “Mr” if one is a surgeon.)

But because my pharmaceutical and herbal medicine work causes me to straddle different worlds, here are my two contributions to raise more ire regarding who should or shouldn’t be using the honorific, “Dr”:

N.D. – Doctor of Naturopathy

Pharm.D. – Doctor of Pharmacy

Doctor of Naturopathy
There are five colleges of naturopathy in North America, if you count the correspondence school, and they generally offer a pretty reasonable first two years of what might be considered medical school. Naturopaths then learn a lot of nutrition, a good bit of herbal medicine, but throw in homeopathy for good measure. For some reason, though, naturopaths act in the most anti-medical ways possible, such as in opposing vaccination. Just over a dozen US states license naturopaths but take a look at the “Natural Health” section of your local newspaper. Note that the ND requires no thesis or dissertation. But residencies and other experiential learning are usually required. Invariably, naturopaths refer to themselves as “Dr.”

Doctor of Pharmacy
I know I’ll draw trouble from questioning the use of “Dr” by my Pharm.D. colleagues. The Doctor of Pharmacy degree became the entry-level degree for pharmacists in the last 1980s and early 1990s with the idea that pharmacy services added significant value, especially clinically, to medical care and the avoidance of medical errors. Previously, the B.S. in pharmacy was the entry degree, requiring two years of an undergraduate basic science foundation followed by two years of progressively applied pharmacotherapeutics that included unpaid experiential rotations in four or five diverse pharmacy settings.

Now, the PharmD is a 2 + 4 program such that even your newly-minted community retail pharmacist must have a PharmD. It also allowed pharmacy schools to charge a doctoral level tuition for those four years instead of the undergrad tuition for the three years of the old five-year B.S. Community PharmDs rarely request the honorific “Dr” but academic and clinical PharmDs do as a matter of routine practice. Note that the PharmD requires no thesis or dissertation. But residencies and other experiential learning are usually required. Most of my slightly elder PhD colleagues who were at the table when the PharmD was being debated as the required entry-level degree felt that the title of M.S. in Pharmacy would have been more appropriate.

A Career Aside
A few months ago, a reader studying undergraduate biochemistry asked me what I might do if I did my training again. I never got around to a formal response (sorry!) but after watching my students over the last 15 years, I might have been just as happy with a PharmD that had a clinical pharmacology emphasis.

The pharmacy degree allows you great geographical freedom, unlike an academic position, tied only to places with hospitals or retail pharmacies, the latter of which can provide four offerings of employment at a single road intersection. The starting pay is about that of an average PhD associate-to-full professor ($80,000 – $100,000 USD) and if you can stand insurance paperwork and some of the reality vs. academic stuff described by The Angry Pharmacist and The Angrier Pharmacist, it makes for a pretty darn good life.

My former students: they live in the mountains, at the beach, the magnificient desert Southwest, in quiet rural woods, and bustling metropolis. Many use the career less for professional satisfaction and more as a vehicle for their other activities, like marathons and triathlons, professional stained glass crafting, mountain climbing, music, etc. Moreover, pharmacy is incredibly friendly for the parent who wishes to spend more time with the family as part-time wages are not much lower than full-time rates – about $40-50 USD per hour.

One of my favorite moments as a professor was standing outside an Aspen, Colorado pharmacy on a brilliant, hot but characteristically dry summer day waiting for my former student to get off to go enjoy a fermented beverage. An older gentleman came by and my student brought him outside and introduced me to him as, “the guy who made this life possible for me,” his hand sweeping across the sky and mountains of the Roaring Fork Valley. I may be a professor, but my student gets to live in Aspen – moreover, he’s married to another one of my students even more charming and beautiful than he.

And, by the way, he got in before the PharmD became mandatory.

One Final Aside – to newly-minted PharmDs, courtesy of the wisdom of The Angry Pharmacist:

Respect your elders – Waltzing in with your fancy PharmD and showing up all of the BS’s with 30+ years of experience is a good way to piss people off. Be humble towards people who have been practicing pharmacy for longer than you have been alive. You may know more book-learned material than they do, but they know what does and doesn’t fly with the patients and doctors. You can’t teach experience, remember that.

But now back to my original thesis before I try to go back to sleep:

Question: Should individuals earning the N.D. or Pharm.D. be permitted to use the title of “Dr.?”

Links to commentary on the Dr Jill Biden coverage:
GrrlScientist – Living the Scientific Life
Mike Dunford – The Questionable Authority
DrugMonkey
Chad Orzel – Uncertain Principles
Dr Dr Janet D Stemwedel/Free-Ride – Adventures in Ethics and Science

*with apologies to the late Robert Palmer.

Comments

  1. #1 Tracey
    February 3, 2009

    N.D. = No way. That’s probably just bias on my part, but I really don’t think its the same at all, and since they tend to work against medicine they shouldn’t get the honorific (not that I don’t think there’s a lot of value to be found in herbal medicine, it just needs to be tested – naturopaths offer concoctions based on a set of traditions that may or may not have anything to do with reality or scientific evidence).

    PharmD. = Depends. I would not address the guy who works at Walgreens as Doctor. However my best friend’s husband went through six years of his PharmD and then two more of clinical residency. He now works as a clinical pharmacist, does research, keeps totally insane hours, and carries a beeper at all times. I think he deserves the title.

    As for others with academic degrees I think it’s fine to go by Dr. in an academic setting and within your field, but I’m not sure how I feel about it in the world at large… my dad has a PhD but Emily Post told me not to list him as “Doctor” on my wedding invites, so I’m not sure Jill Biden should be referred to as Doctor by the press/White House either…

  2. #2 speedwell
    February 3, 2009

    Meh, going by “Doctor” unless you are an MD, OD, DDS, or even a DVM is insufferable. The people I know with the above degrees happen mostly to be leaders in their field who do research and contribute largely to the professional literature, as well as being talented and exemplary healers. If a pharmacist diagnosed and prescribed, did research, and made solid contributions to the professional literature, then I would have no problem calling them Doctor as well. But then they’d be “dispensing doctors,” which of course many pharmacists are not. I’m assuming you mean the ones who aren’t.

    For them, maybe a different sort of honorific is in order. The engineers I work for, no matter how well-educated and well-credentialed, are proud to bear “Eng.” or the equivalent in countries where it is customary. Lawyers and judges have their “Hon.” and “Esq.” Academic luminaries have “Professor.” I think it would be perfectly appropriate to have something like that for pharmacists who are more than clerks and technicians but less than full hands-on patient consultants. What the title should be, I’ll leave to other commenters. :)

    Naturopaths? Bleah. A decade ago, Mom (who was heavily into alt-med) financed a couple years at Clayton College (the correspondence school) for me, and since I was in a boring-ass job and needed a diversion, I accepted. Between the unrelenting dangerous foolishness of the curriculum and the hostility of the advisors after I made it plain I was only interested in what demonstrably “worked,” I did not care to finish. If I had finished, I would have been awarded an N.D., Ph.D., but the only title I would have deserved would have had to start with Q.

  3. #3 anjou
    February 3, 2009

    Doctoral level psychologists typically use the title Doctor- I think its ok. Mostly, I just use it on my office answer machine, patients use my either my first name or the title- I’m ok with either, go with patient preference. 5 years of grad school, 3 yrs clinical training… Taught Med students and residents for a bunch of years, been tethered to the beeper etc… Outside of work tho, I rarely use the title.

  4. #4 Joe
    February 4, 2009

    I doubt that NDs http://www.naturowatch.org have the basic science education that they claim; more likely they just go through the motions. However, even if they do learn some science, homeopathy is not the only flaw in their education. They also employ acupuncture, their own style of chiro (another group that should not be called Dr.), bogus “detoxification” schemes, unproven herbs, and much more.

    One reason I doubt their science education is that an educated person cannot believe in all that. One ND, a (former?) senior editor of their official “journal” advocates treating asthma by having a person soak in a tub with a little hydrogen peroxide to increase the blood level of oxygen! Apparently nobody told her that peroxide is different from elemental oxygen, nor does she know the technical term for someone trying to absorb oxygen from water (drowning).

    A hospital/clinic/medical office would be a confusing place if everyone with a doctoral-level degree were termed “doctor.” In those contexts, it should be reserved for MD, DO, DDS or DVM (and whatever serves for optometrists and podiatrists). It is useful to distinguish the people who can diagnose and treat.

    Outside of that, why bother? In the distant past (before color TV) Ph.D.s were rare. How common they are today depends on where one lives; but there are many more than was the norm, and the quality control is poor in many fields.

    So, ND = no doctor (same for DC) in any context.

  5. #5 Dr. Val
    February 4, 2009

    When “doctor” is positioned in such a way as to lead the audience to believe that the person is a medical doctor – that bothers me. I don’t begrudge the term to those who earned it (my mom’s a Ph.D.) – but when someone with a Ph.D. in Spanish Literature is selling medical products without making the “doctor” issue clear, that’s not cool.

    Typical Val conversation with lay strangers:

    Me: “Hello, I’m Dr. Jones…”

    Person: “Oh, hi Dr. Jones. What kind of doctor are you?”

    Me: “A medical doctor.”

    Person: “Oh, so you’re like, a pediatrician?”

    Me: “No, my specialty is rehabilitation medicine.”

    Person: “Oh, my uncle has a drug problem. He’s been in and out of rehab for years. I’m so glad that there are people like you willing to help addicts.”

    Me: “Uh… Well, actually my specialty is focused on physical rehabilitation – like patients with spinal cord injuries, amputations, strokes, car accidents, etc…”

    Person: “Oh, so you’re a physical therapist?”

    Me: “No, I’m a physician. But I work closely with physical therapists.”

    Person: “So you’re a REAL doctor?”

    Me: “Yes, I went to Columbia Medical School…”

    Person: “Well, you don’t LOOK like a doctor.”

    Me: “Uh… thanks?”

    ###

  6. #6 Healer
    February 4, 2009

    I’m a homeopath. I did 6 years of training & a dissertation. Let me tell you, I know far more about helping sick people than ‘real doctors’. I’d rather not be called ‘doctor’, ‘real doctors’ kill thousands of innocent people.
    Call me ‘Healer’. For that is what I do.

  7. #7 anjou
    February 4, 2009

    “A hospital/clinic/medical office would be a confusing place if everyone with a doctoral-level degree were termed “doctor.” In those contexts, it should be reserved for MD, DO, DDS or DVM (and whatever serves for optometrists and podiatrists). It is useful to distinguish the people who can diagnose and treat.”

    I would add psychologists to the list– when I worked in a hospital, when the psychiatrists were stumped on a diagnosis, they would call me in for a consult, not another MD. Psychologists can diagnosis and treat, just not prescribe.

  8. #8 Joe
    February 5, 2009

    @anjou, sorry, I missed one.

    @Howler, … ’nuff said.

  9. #9 Not-a-Dr. Yeager
    February 5, 2009

    “Call me ‘Healer’. For that is what I do.”

    Well done! I suppose that’s why marketing isn’t my strong suit. I would have just said you were a Water Sales Specialist, or a Placebologist.

  10. #10 film izle
    May 29, 2009

    I’m a homeopath. I did 6 years of training & a dissertation. Let me tell you, I know far more about helping sick people than ‘real doctors’. I’d rather not be called ‘doctor’, ‘real doctors’ kill thousands of innocent people.
    Call me ‘Healer’. For that is what I do.

  11. #11 Dr.A.Warren,M.D.
    April 16, 2010

    I think Pharm.D. holders should use the “Dr.” title.
    First of all,their degree is a 4 year investment and it’s not easier than the M.D. or Dental degrees in any way.They deserve it.
    As long as they display their degree in their name to avoid confusion among other people i.e:Dr.J.Marcel,Pharm.D.,i think it’s pretty good for them.
    For N.D. holders,same thing,since the N.D. is a Doctorate level anyways.

    What’s important in this is that the holder using this title should do the things that he is allowed to do(A Naturopath pretending to be a Physician just because they have the “Dr.” is not good…if know what i mean.)

    To the blind people out there,a “Doctor” does not always have to treat and diagnose someone,since this title means “To Teach” and not “To heal”…There’s a lot of stereotypes about it already,a Ph.D. holder in arts can use the “Dr.” title so i don’t see what’s wrong with it.I personally wouldn’t get into a Doctorate level degree if i get told “You can use that title if you’re not a physician!” …

    That was my 2 cents.

    Dr.A.Warren,M.D.

    Cardiology Resident.

  12. #12 Dr.A.Warren,M.D.
    April 16, 2010

    I think Pharm.D. holders should use the “Dr.” title.
    First of all,their degree is a 4 year investment and it’s not easier than the M.D. or Dental degrees in any way.They deserve it.
    As long as they display their degree in their name to avoid confusion among other people i.e:Dr.J.Marcel,Pharm.D.,i think it’s pretty good for them.
    For N.D. holders,same thing,since the N.D. is a Doctorate level anyways.

    What’s important in this is that the holder using this title should do the things that he is allowed to do(A Naturopath pretending to be a Physician just because they have the “Dr.” is not good…if you know what i mean.)

    To the blind people out there,a “Doctor” does not always have to diagnose and treat someone,since this title means “To Teach” and not “To heal”…There’s a lot of stereotypes about it already,a Ph.D. holder in arts can use the “Dr.” title so i don’t see what’s wrong with it.I personally wouldn’t get into a Doctorate level degree if i get told “You can’t use that title if you’re not a physician!” …

    That was my 2 cents.

    Dr.A.Warren,M.D.

    Cardiology Resident.

    PS:Sorry for typing errors,this is my clean version!

  13. #13 Joe
    April 17, 2010

    “Dr.A.Warren,M.D.” is a bit of a clumsy construction because of the redundancy.

    N.D. (and D.C.) are not legitimate graduate degrees. They are not offered by academic institutions and they do not cover factual subjects.