A doctor level, non-MD academic friend from a conventional medical school who has expertise in complementary and alternative medicine inadvertently stepped into a militarized zone the other day. On a conference call with a multidisciplinary group of practitioners, he wished to make a distinction. He first offered a generalization about the roles of “chiropractors, naturopaths and acupuncturists.” Then he distinguished these from what he called “physicians.”
All of us knew that this studied academic was referring to licensed medical doctors, a.k.a. the kings (and queens) of the hill in U.S. medicine. At the same time, many of us were acutely aware by his comment that, while common and even professional usage of the term “physician” may connote MDs, legal realities are shifting. In fact, trends suggest that one endpoint of the movement toward integrative medicine is that “physician” will increasingly umbrella a rainbow of disciplines.
US Department of Labor bestows “physician” on DCs and NDs
The subject is front-and-center recently for a couple of reasons. First, the United States Department of Labor recently published O Net Online which replaces the Department’s Dictionary of Occupational Titles. (1) The language under the section 29.1011 titled “Chiropractors” notes that sample titles of these practitioners include “Chiropractic Physician” and “Physician.” (2)
Profession #29-1199.04 is listed as “Naturopathic Physicians.” Among job titles for this profession are “Naturopathic Physician,” and “Physician.” (3) The American Association of Naturopathic Physicians (AANP) boasted of its success in working with the Department of Labor to create this positioning in an October 14, 2009 note to its members. (4)
In Florida, the LAcs are APs – “Acupuncture Physicians”
A search for “Acupuncturists” on O Net Online finds a page which states merely that research is underway and that they haven’t established anything definitive yet. An honest accounting of use nationally will find that in the state of Florida, licensed acupuncturists have gained authority from the legislature (if not through accredited, doctoral-level educational means – more on this below) to legally work under the professional title “Acupuncture Physician” (as in Jenny Smith, AP). The Florida State Oriental Medicine Association actively promotes and defends the use. (5)
In short, depending on what state you are in, or what federal document you may be reading, or into whose office a patient is walking, the term “physician” term may be referring to not just MDs but also to NDs, DCs and even LAcs, I mean APs.
Some trends toward expanded use of “physician”
The use of the term "physician" by these so-called CAM professionals is trending upward. Naturopathic physicians have been claiming the title since a new generation began re-shaping the field starting in the mid-1970s. They’ve gone back into most of the handful of states where NDs were still licensed and since replaced “drugless healer” acts with modern practice acts in which physician is part of the title and at least some prescription drug rights, typically, in the scope. (The O net Online notes that naturopathic physicians “may also use prescription or legend drugs.”) Hawaii was the profession’s most recent update, in 2009. In the profession’s slow expansion to new states – now at 15 – the right to use the physician title is across the board except California where the California Medical Association exacted a concession that these affiliates of the AANP could only call themselves “doctors.”