Brence Sell: In medical settings, titles matter
Back view of male doctor showing fake oath gesture isolated on white background with copyspace advertising area

Back view of male doctor showing fake oath gesture
Many degree recipients now insist they should be called “doctors.”

What’s in a name? Or, more specifically, in a medical title? … and does it matter?

Recently, the subject of titles has become an important topic of conversation in the world of medicine even making news headlines.

Does it matter what someone in a medical setting calls themselves?

Yes, it does.

Interestingly this is not a topic of discussion in the military where a clear chain of command — who is in charge, who has the proper authority and who has the best training and experience to make vital decisions — is well understood to be a matter of efficiency and, most importantly, safety. As a veteran, I know this only too well and know firsthand that in our armed services, titles do matter greatly.

As a practicing physician anesthesiologist, I deal with life-and-death decisions every day I am on the job. I also know that in a medical setting, knowing who is in charge and who has the proper training, experience and education to make split-second decisions is vital to the safety of our patients.

There is a dangerous trend in medicine where non-physicians call themselves “doctors” in medical settings like surgical suites, hospitals and outpatient clinics. To be clear, these practitioners are well-educated professionals who are an important part of the medical care team, but their self-styled title of “doctor” refers to an academic degree even though they are not practicing or licensed physicians.

And this confusion can be dangerous — especially in emergency circumstances where lifesaving decisions must be made in the blink of an eye.

When problems arise in a clinical setting — and I have been in this situation dozens of times — being confused about who is qualified to make critical medical decisions can literally be a matter of life and death. Having an advanced degree where you studied about medicine or about nursing or even (in my field) about anesthesia is certainly a worthy accomplishment. It does not make that person qualified to make lifesaving medical decisions. Conversely, anesthesiologists — the actual specialty physicians — must not only complete extra years of intense medical education and hands-on training, but we must also complete an accredited residency program as part of an arduous path to produce highly trained specialists. And frankly, for the safety of our patients, that is how it should be.

To further compound this situation, some degree programs are now offering “doctorates” in less-than-rigorous academic environments where a student can take online courses and receive a “doctor of nursing” degree. These degrees do not require rigorous clinical training, nor do they offer years of vital hands-on engagement and education.

Many of these degree recipients now insist they should be called “doctor.”

Calling oneself a “doctor” at a cocktail party or around the dinner table causes nobody any harm. But referring to oneself as a “doctor,” and thereby implying you are a physician with the requisite education and clinical training, is not only misleading but dangerous, especially where something as critical as the provision of anesthesia medicine is concerned.

Fortunately, and in recognition of this growing problem, there are two bills (SB 230/HB 583) intended to fix this and ensure accuracy in titles and abbreviations in medical and clinical settings.

I hope this good idea becomes the law in Florida. I would encourage those degree seekers to continue furthering their education (always a good idea). They should not use their degrees to deceive patients and other practitioners. Clarity will make hospitals, clinics, and all medical settings safer for everyone involved.


Brence Sell, M.D. is a U.S. Army veteran and serves as the president of the Florida Society of Anesthesiologists. Dr. Sell is also a Fellow of the American Society of Anesthesiologists and is Board Certified in Anesthesiology by the American Board of Anesthesiology.

Guest Author


  • cassandra

    March 28, 2023 at 11:55 pm

    Petty little man…oooops, I meant god…lolol…

    You’re still the whiny little tattletale you were in school, right Phyzzie? If you get confused, pick up a crayon and write “Physician” on your shirt. That way everyone can laugh at you to your face. Right now they are ALL laughing at you behind your back, Phyzzle..Ha-Ha-Ha !!!

    • Chizoba

      March 30, 2023 at 3:49 pm

      If you have something tangible to say, can you go ahead and say it without calling people names.

  • alex williams

    March 30, 2023 at 10:20 am

    I guess the solution is to continually dumb things down Cassandra …

  • linda reynolds

    March 30, 2023 at 10:30 am

    I’m curious, cassandra. Are you comfortable reducing the education and training requirements for the medical professionals who take care of you, say for example, the next time you have surgery? Because that’s what your childish comment indicates

  • Sharon McClean

    March 30, 2023 at 10:55 am

    I think what Dr. Sell has to say makes sense. I say that as someone who received a PhD and worked at the NIH before going to medical school. I never used Doctor as a title where it could be confused as to my training in a medical setting until I was an MD

    • cassandra

      March 31, 2023 at 12:34 pm

      You say: “…never used Doctor as a title where it could be confused as to my training in a medical setting…” And Sell doesn’t provide any evidence that anyone else is doing so either. Yet I’m sure he’s familiar with the expression: Citation, or it didn’t happen.

      Sell’s hysterical and manipulative rant is designed to evoke fear. That’s it. APRNs are not presenting themselves as physicians to patients or anyone else on their healthcare team. It would be unethical. They would lose their license. There would be lawsuits.

      Sell’s condescension and contempt for other healthcare practitioners—-particularly CRNAs— is an insult to readers. It also makes one wonder whether Sell suffers the same fear about calling the Chaplain or the Social Worker “doctor” or the Psychologist “doctor”. Or will that somehow not confuse Sell?

      Sell—-like many MDs yearning for ‘the good old days’—-seems to be grasping at anything to stop the competition he’s facing from CRNAs. Undermining trust in CRNAs is bad for patients and healthcare systems. I suspect that Sell also really resents having to address APRNs as “Dr” in the cafeteria line—or risk revealing his pettiness.

      These bills take away a patient’s right to know their provider’s credentials, thereby limiting the patient’s ability to make informed choices about their own care. Patients are entitled to know whether their ‘nurse’ is a two-year college Nursing Student or an APRN with a doctorate and years of experience. Using accurate titles and initials on IDs or clothing reduces incentives for hospitals to staff with personnel educated at the lowest possible level.

      Personally, I want to know what level of education my ARNP (any provider) has attained. Why do Sell and the legislature want to limit my ability to make informed healthcare decisions?

      Importantly, Sell is aware that the vast majority of Nurses are women. So it’s reasonable to ask whether there’s a bit of misogyny behind this.

      tl;dr This legislation harms patients by taking away their right to make informed healthcare decisions, and encourages risky hospital behavior by incentivising staffing decisions based on costs, not qualifications. It is another example of legislators—and their donors—‘picking winners’.

      • cassandra

        March 31, 2023 at 1:50 pm

        I accidentally deleted my paragraph on CRNA versus anesthesiologist. To summarize:

        Healthcare consumers have the right to know!

  • Concerned Citizen

    March 30, 2023 at 9:54 pm

    I find supervision in anesthesia fascinating. 1) It is the ONLY physician specialty where the supervising physician isn’t reimbursed above & beyond for their care – the standard reimbursement simply gets split in half if the physician documents that they meet the criteria (and their own ASA study says they don’t 30-40% of the time even at 1:2). Can’t believe every other physician specialty hasn’t objected to the fact that physician anesthesiologists get paid for this.
    2) The pure audacity to stand in front of the public and legislators and say they are the difference between life & death in the OR is quite impressive considering a significant number of the 42,000 practicing physician anesthesiologists have never independently administered an anesthetic since residency.
    The fact that anyone would consider a brand new physician anesthesiologist superior in decision-making capability to a Nurse Anesthetist with even 3-4 years
    of actual experience is mind boggling. What’s even worse, Dr Sell and his FSA colleagues expect you to believe that the brand new physician anesthesiologist is superior in every way to any CRNA, despite Reddit and other message boards being full of messages from medical students stating they rarely interacted with patients during medical school, and certainly not in the context of an anesthetic. Meaning- the anesthesia training between CRNAs and physician anesthesiologists is virtually identical and the only difference is what each did between undergrad and residency. It’s a shame all the data shows the patient outcomes are identical, otherwise this political mess could be dismissed very quickly one way or the other. I wonder why the physician anesthesiologists haven’t published the overwhelming data that they’re superior, despite their ubiquitous conjecture?

    Facilities are being duped daily, and patients are ultimately bearing that cost. Thankfully, stakeholders and the public are starting to understand the ruse.

Comments are closed.


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