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Nurse practitioner fined $19K for advertising herself as ‘doctor’

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District attorney cites California ethics code for businesses in civil case.

A nurse practitioner who advertised herself as a physician must pay $19,750 in civil penalties for violating California’s business ethics code.

San Luis Obispo County District Attorney Dan Dow announced the settlement with Sarah Erny, RN, NP, who used a doctorate degree in nursing practice to advertise herself as “Doctor Sarah Erny.” From October 2018 to March 2022, Erny’s professional website and social media accounts identified her as “Dr. Sarah Erny.”

“We want all health care professionals to clearly display their education and licensure so that patients know who is providing their care,” Dow said in his announcement. “All forms of professional medical services advertising, including websites and social media accounts, must be free of deceptive or misleading information and must clearly identify the professional license held by the advertiser. Providing patients upfront with the proper title of our health care professionals aids consumers in making a more informed decision about their health care.”

In most instances Erny indicated that she was a nurse practitioner, but she failed to advise the public that she was not a medical doctor and failed to identify her supervising physician. By referring to herself as “Dr. Sarah,” online search results listed “Dr. Sarah Erny,” without any mention of her nurse status, Dow’s announcement said.

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Along with the fine, Erny must refrain from referring to herself as “doctor” and must make reasonable efforts to correct the online references to her as “doctor” or “Dr.”

Sunshine state law

California’s Business and Professions Code specifies which health care professionals may call themselves “doctor” or “physician.” The state allows specially trained registered nurses to use appropriate titles such as “certified nurse practitioner” and “advanced practice registered nurse.”

“The courts have held that the purpose for limiting the use of titles within the health care field is to protect the public by ensuring every health care provider properly represents themselves in their true capacity by an appropriate title,” Dow’s announcement said. “Simply put, there is a great need for health care providers to state their level of training and licensing clearly and honestly in all of their advertising and marketing materials. “

Growing confusion

Dow acknowledged growing confusion among patients and consumers about who is or is not a medical doctor. He cited the American Medical Association’s (AMA) Truth in Advertising Campaign, which had surveys indicating 39% of respondents incorrectly identified a doctor of nursing practice as a medical doctor, and 10% wrongly believed a nurse practitioner was a physician.

“This is to say there is a great need for health care providers to state their level of training and licensing clearly and honestly in all of their advertising and marketing materials,” Dow’s announcement said.

Simmering claims

For years, physicians, NPs, PAs, lawmakers, and patients have argued for and against expanding scopes of practice in medicine and nursing, and the terminology to describe practices and the clinicians. Dow’s announcement of the California case settlement came just days after the AMA announced physicians’ groups and state medical societies were united against the federal “Improving Care and Access to Nurses Act,” known as the “I CAN Act,” which would expand scope of practice for various nonphysician practitioners.

Medical Economics has published three articles in a four-part series examining scope of practice expansions and the effects on primary care. “Are primary care physicians being replaced?” “Quality vs. quantity,” and “The training debate” all are available online.


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