I see this all the time. An NP, PA, or chiropractor with a doctorate calls themselves "Dr." on their website, Instagram, or lab coat, and when I flag it, they get a little offended. I get it, they earned the degree. But in a clinical setting, using "Dr." the wrong way can break state law, and in some states it is a misdemeanor.
The short version
Having a doctorate is not the problem. The problem is whether a patient would think you are a physician. In a medical setting, most patients hear "Dr." and assume MD or DO, and an AMA survey found 39% of patients believe a nurse with a Doctor of Nursing Practice is a physician (AAO).
That is really the whole rule: your license has to be clear every time a patient sees or hears your name.
What happened in California
California's rule is Business and Professions Code section 2054. It makes it a misdemeanor for anyone without a California physician license to use, "in any sign, business card, or letterhead, or, in an advertisement, the words 'doctor' or 'physician,' the letters or prefix 'Dr.,' the initials 'M.D.' or 'D.O.'" It also bars using those titles "in a health care setting that would lead a reasonable patient to determine that person is a licensed" MD or DO (B&P 2054).
That statute is what caught a nurse practitioner who called herself "doctor" with patients and on social media. The Board of Registered Nursing filed an accusation, the county District Attorney pursued her under California's false advertising laws, and she paid nearly $20,000. Her collaborating physician agreed to pay $25,000 (Becker's ASC).
Three NPs then sued, and in September 2025 a federal judge upheld the law, calling the title "inherently misleading" commercial speech in clinical settings (AMA). They have appealed to the Ninth Circuit, but the ruling stands for now. The part that surprises people is that one plaintiff introduced herself as "Dr. Palmer, I'm a nurse practitioner," and patients still assumed she was a physician (Tushnet). So in California, NPs and PAs should not use "Dr." with patients at all, even with a clarifier.
State rules at a glance
- California: NPs and PAs cannot use "Dr." with patients or in marketing. Chiropractors can, as long as "D.C." or "chiropractor" follows their name (B&P 2054; B&P 1000-15).
- Georgia: The statute says an APRN with a doctorate who uses "doctor" in a clinical setting "shall clearly state that he or she is not a medical doctor or physician." Every clinician also has to wear an ID showing their license, and ads must list license type (O.C.G.A. 43-1-33).
- Texas: The Healing Art Identification Act lists who may use "doctor" with their designation, including chiropractors ("doctor, D.C."), dentists, optometrists, and podiatrists. Anyone else using the title "shall designate the authority under which the title is used or the college or honorary degree that gives rise to the use of the title" (Occ. Code ch. 104). NPs also must use "APRN" plus their role and population title (22 TAC 221.2).
- Florida: It is grounds for discipline to fail to identify, by name tag or orally, "the type of license under which the practitioner is practicing," and "any advertisement for health care services naming the practitioner must identify the type of license the practitioner holds" (s. 456.072(1)(t)).
- Tennessee: Your office sign, photo ID badge, and any website you control must show your license type, and a violation is unprofessional conduct (T.C.A. 63-1-109).
- Indiana: Ads must show your license type, and titles like "medical doctor" and "dermatologist" are for physicians only (SB 239).
More states add these rules every session. Florida and Texas both had title bills that did not pass in the last cycle (FL SB 36; TX HB 3415), so check your board's rules too.
Nuances people miss
- It is about patient-facing use. These laws target clinical settings and advertising. Using "Dr." on a research paper or in a faculty role is a different situation, and California's statute itself carves out uses that aren't tied to practicing medicine and aren't misleading.
- Telehealth follows the patient. If you see patients in multiple states, the rules of the state where the patient is located apply. Your website and bio have to work in the strictest one.
- "Physician" and specialty words count too. California's law covers "physician," not just "Dr.," and Indiana restricts specialty titles. Calling yourself a "hormone physician" or "aesthetic dermatologist" can be a problem even without "Dr."
- It is not just the board. In California, a county District Attorney brought the case under consumer protection law, separate from the nursing board.
- Patients can't usually sue under these laws, but that doesn't make them toothless. Georgia and Tennessee both say a violation creates no private cause of action, but boards can discipline your license.
- Saying it once is not enough. Georgia requires you to clarify every time you use the title in a clinical setting, and California showed that even a clarifier can fall short.
- PA titles have their own rules. "Physician associate" is the legal title only in Oregon (Oregon Medical Board), and AAPA warns that using it in other states could draw discipline (AAPA).
How to protect yourself
- Put your license right after your name, like "Jane Doe, DNP, FNP-C, Nurse Practitioner."
- If your state allows "Dr.," always say your license with it: "I'm Dr. Doe, a nurse practitioner."
- If you practice in more than one state, follow the strictest one.
- Check everywhere your name shows up: website, Instagram, Google profile, badge, lab coat, email signature, patient portal, and reminder texts.
- Keep "Dr." out of your practice name unless a physician is in it.
- Have your staff say "our nurse practitioner," not "the doctor."
Your collaborating physician is on the hook too
In the California case, the physician had never reviewed the NP's charts and didn't know she had opened her own practice, and she still paid $25,000. If you are the physician, how your NP or PA presents themselves is part of your oversight, so it is worth adding a line to your collaborative agreement that requires accurate titles.
How I help
Title and license identification is part of every compliance review I do. That includes your website, social, bios, badges, portal settings, and collaborative agreements, mapped to each state you practice in. If you'd like me to look at yours, reach out at caminostrategygroup.com.
This post is general information about state laws and is not legal advice. Title rules change often and vary by state and board, so confirm your situation with a healthcare attorney before you make changes.
Sources
- Becker's ASC: Physician fined $25K for supervising NP who called herself doctor
- Dr. Killeen: California NP doctor title ruling
- AMA: Federal court agrees NPs can't call themselves "doctor"
- Tushnet: Palmer v. Bonta summary
- American Academy of Ophthalmology: Truth in advertising
- California B&P Code 2054
- Georgia O.C.G.A. 43-1-33
- Texas Occupations Code ch. 104
- 22 Tex. Admin. Code 221.2
- Florida s. 456.072(1)(t)
- Tennessee Code 63-1-109
- Indiana SB 239 (2022)
- Oregon Medical Board: PA title change