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There's another debate going on amid the test tubes of American medicine. It involves a quite common word there - doctor. See, a training program is allowing people to get doctorates in nursing. And the title, Doctor of Nursing, isn't sitting well with some doctors, physicians.

Sally Herships has the story.

SALLY HERSHIPS: No one wants to badmouth Florence Nightingale, but a new degree for nurses is causing bad words between doctors and their longtime colleagues. The program bestows the title of doctor on nurses.

Dr. Steven Knope is a family practitioner in Tucson. He says in a medical setting, only physicians should call themselves doctor.

Dr. STEVEN KNOPE (Internal Medicine Physician): Well, if you're in an airline and a poet with a PhD is there and somebody has a heart attack, and they say, is there a doctor in the house, should the poet stand up?

(Soundbite of laughter)

Dr. KNOPE: Of course not.

HERSHIPS: Physicians like Dr. Knope say the title of doctor implies a certain amount of training, hours in med school nurses just don't have.

Dr. Ted Epperly is president of the American Association of Family Practitioners. He says while doctors place a high value on nurses, if they share their title, patients could be confused, even harmed.

Dr. TED EPPERLY (President, American Association of Family Practitioners): I can just imagine a patient of mine walking into my exam room and saying, now, Dr. Smith, are you a doctor doctor or are you a doctor nurse?

HERSHIPS: Ray Scarpa is a doctor nurse. He works in the Department of Surgery at University Hospital in New Jersey.

Mr. RAY SCARPA (Doctor Nurse, University Hospital): I am a doctorally-prepared nurse. He is a doctorally-prepared physician. I am not here to practice medicine, I am here to practice nursing. And I practice it at an advanced level, and I have earned the right to be called doctor.

HERSHIPS: For nursing students who begin right after college, it can take about six years to get the degree. But while there is some overlap, Scarpa says doctors diagnose and treat while nurses have a wider focus including family, support and community.

The program was started at Columbia University School of Nursing. I asked the dean there, Mary Mundinger, how patients can tell their caregivers apart if they have the same title.

Ms. MARY MUNDINGER (Dean, School of Nursing, Columbia University): For starters, you would say, I'm Dr. Mundinger, and I'm your nurse.

HERSHIPS: But Mundinger says the tension is more about turf than patient confusion.

Ms. MUNDINGER: It's about status. It's about ego. It's about presence. It's about standing in their communities.

HERSHIPS: And here's where MDs and the new doctor nurses finally agree. Both groups say physicians feel threatened. They see the new breed of nurses as an invasion of their turf.

I stopped to talk with Janet Pullockaran in the emergency room at University Hospital. She's a fourth-year medical student there.

Ms. JANET PULLOCKARAN (Medical Student, University Hospital, New Jersey): With all these new people, physician assistants, nurse practitioners coming into the field, maybe our training won't lead to a secure position in the future.

HERSHIPS: But there's a shortage of primary caregivers, and it's possible the new nurses will help fill the void.

Louis Boeckel has throat cancer. He faces people in white coats day in and day out. He just had a tracheotomy and can't talk, so he writes notes on a pad for his wife, Carol, to read. I asked him if he's worried about mixing up his physician with his nurse, Ray Scarpa. What did he write?

Ms. CAROL BOECKEL (Wife of Cancer Patient): He wrote, best doctor.

HERSHIPS: Carol Boeckel says they are concerned about who's providing their care, but to them, the title of doctor for their nurse just means he's that much more qualified.

Ms. BOECKEL: And we do view him as a doctor because he does come and take care of all of his immediate needs as any doctor would do.

HERSHIPS: The first exam to certify the doctor nurses was given in November. It's a modified version of a test given to physicians. The next test is scheduled for October, but MDs are trying to prevent the National Board of Medical Examiners and the American Board of Comprehensive Care from administering it. For NPR News, I'm Sally Herships.

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