Nurses Can’t Be Called ‘Doctor’ in CA, Even With a Doctorate Degree —Judge Rules

A federal judge has ruled that nurses with doctorates in California cannot call themselves “doctor” in clinical settings — even if they hold a Doctor of Nursing Practice (DNP) degree.

In a decision issued September 19, the U.S. District Court for the Central District of California upheld a state law that limits how professional titles can be used in healthcare. The court ruled that referring to oneself as “Dr” without being a licensed physician is misleading and not protected under the First Amendment.

What the Court Said

Judge Jesus G. Bernal wrote in the opinion that using the title “Dr” by nonphysicians in clinical contexts is “inherently misleading” and amounts to regulated commercial speech. Because of that, it does not fall under free speech protections.

The court sided with the state, which argued that allowing nonphysicians to use “Dr” could confuse patients about who is providing their care. Bernal cited an American Medical Association (AMA) survey showing:

• 39% of patients mistakenly believed that DNPs are physicians.

He concluded that even when nurses disclose their credentials, the risk of confusion remains high in healthcare settings.

Background on the Lawsuit

Three California-based nurse practitioners with DNPs filed the lawsuit in June 2023. They challenged California Business and Professions Code Section 2052, which makes it a misdemeanor for nonphysicians to use “Dr” in clinical settings or advertisements.

According to court documents:

• Two of the nurse plaintiffs previously used the title “Dr,” including on their embroidered clinician jackets, clinical documents, nameplates, and social media.

• One nurse said she would introduce herself to patients as “Dr,” but always clarified that she was a nurse practitioner.

• The third plaintiff planned to use the title when opening an esthetics clinic but delayed the launch and its website after learning about the law.

The nurses argued that the law violates their constitutional rights and goes too far in restricting truthful speech.

But the court didn’t agree.

“The Court finds that it is reasonable to infer that some consumers will assume that plaintiffs are licensed physicians or surgeons if they use ‘Dr’ or ‘doctor’ in healthcare settings and in advertising materials promoting medical services, even if plaintiffs also identify themselves as DNPs,” Bernal wrote.

Physician Organizations Support the Ruling

The California Medical Association (CMA) and American Medical Association (AMA) supported the state’s position in the case and filed a joint amicus brief.

“This decision protects patients by providing clarity and transparency about the level of training and education of the person providing their care,” said CMA President Shannon Udovic-Constant, MD.

She added that informed decision-making by patients is foundational to the healthcare system.

Legal Team for Nurses Responds

Donna Matias, an attorney with the Pacific Legal Foundation who represented the nurses, said the plaintiffs were disappointed and argued that the ruling strengthens the state’s ability to restrict how professionals describe their credentials. 

“The First Amendment does not allow the government to silence truthful speech simply because some listeners may be confused — especially when disclosure can address any concerns short of a total ban,” Matias said in a statement to Medscape Medical News.

Some Nurses See Unequal Treatment

Lorie A. Brown, RN, JD, an Indianapolis-based attorney who represents nurses and healthcare providers, said she was surprised by the ruling. She noted that other professionals with doctorates, such as educators or psychologists, are allowed to use the title “Dr” without similar restrictions.

“So, I guess Dr Jill Biden can still use her title, but yet nurses who have the same level of degree can’t use the title, I think that’s unfair. All of your hard work and education, you can’t even use the title that you earn, at least in California,” Brown said.

She added that California is often a leader in legislation, which means the decision could influence laws or legal challenges in other states.

What’s Next?

The plaintiffs may choose to appeal the ruling. For now, California DNPs must avoid using the title “Dr” in patient care settings or in any promotional materials that imply medical services.

The California Nurses Association declined to comment on the decision. The American Nurses Association did not respond to requests for comment.

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