“Why do you call yourself a doctor on your website?” “You won’t give me my oxycodone…you’re not even a real doctor? I want to speak to a real doctor!” “Telephone Call: Dr. Fudin, This is Mr. A. Torney. I need an expert witness to testify in a case where a patient overdosed on fentanyl. I have the hospital and office records, toxicology and pathology reports. As a toxicologist, can you opine on whether or not the prescribed fentanyl dose was a toxic overdose in this patient based on his previous opioid usage and tolerance to opioids?”
Dr. Fudin: “Yes, I can, but I’m not a toxicologist”.
A. Torney: “I was told by 3 other doctors that you were the one to call, but I thought you were a toxicologist”.
Dr. Fudin: “No. I’m a PharmD”.
A. Torney: “What’s a PharmD, what do they do, and how does that compare to an MD? Can you be of help on this case?”
Welcome to my world and this real dialogue! So, who’s the real doctor here; is it the MD, the PharmD, or some other “D”? The answer is; it depends on your definition of “real doctor”. I learned several years ago that the NY Times has a policy, if you’re not an MD, you don’t get the title “Dr.” before your name in print. That seems to be a pretty short-sighted policy considering the caliber of such a widely read international newspaper. What about attorneys, aren’t they JD’s (juris doctors)? What about PhD’s, aren’t they real doctors? What about dentists, veterinarians, optometrists, DO’s (doctors of osteopathy); aren’t they real doctors? The answer is, yes, they all are real doctors and earned that title by successfully completing their education and earning their respective degrees.
Focusing more on MD vs. PharmD, one must first understand that these are “clinical” degrees, unlike most PhD’s. The MD is a clinical degree that stands for “medical doctor”. The PharmD is a clinical degree that stands for “pharmacy doctor”, more commonly called “doctor of pharmacy”. Although both programs are quite intense, they are not PhD programs. The PhD candidate generally completes a BS (or BA) degree, followed by an MS (or MA) degree, and finally a PhD. It always involves a thesis and research in the specified area of study. To me, the only “real doctor”, if forced to delineate, is the PhD because of the rigorous academics and requirement for a research and thesis within their scholarly field of study. All of the clinical doctors therefore by default might be considered the “fake doctors”. The MD and PharmD degrees may involve required research depending on the college, but that is not always mandatory. But, many doctoral clinicians choose to participate in scholarly activities such as research and also publish in peer reviewed journals or texts post-graduation as their careers unfold. Indeed, some may even write a blog or two while flying around the country to educate other “fake doctors”. (hint, hint)
There are many parallels between MD and PharmD programs. Both have options for completion within 6 years without an undergraduate degree. Both are based on a four year professional degree, three years of which concentrate on didactic work (with some practical experience sprinkled in), and a fourth year of clinical experience. Many, if not most that complete these degrees, first obtain a bachelors level degree, sometimes masters level degree, and less frequently, a PhD.
Okay then; what’s the difference between an MD and PharmD? Much of the prerequisite classes are superimposable for acceptance into either program. For entry into the MD program, you must score well on the MCATS; for the PharmD program, you must score well on the PCATS. Certain course concentrations are more advanced in the medical programs and others are more advanced in the PharmD programs. In essence, an MD’s course training focuses on diagnostics, while the PharmD’s training focuses on medicinal therapeutics and related pharmaceutical sciences. For sure, the MD degree includes some pharmacology and medication training, but it is nowhere near the complexity required in the PharmD curriculum. For sure, the PharmD degree includes some diagnostics and medical training, but it is nowhere near the complexity required by the MD curriculum. Both professions may sit for their respective board exams following graduation, both require internship hours, both have bona fide board certifications in various specialties, and both have options for post-graduate residency and fellowship training.
Does the PharmD degree make a pharmacist, a “clinical pharmacist”? That’s a good question. How about this one; does the MD degree make a medical doctor a “clinical doctor”? The answer to both of these questions are no! There are plenty of MDs who choose never to practice medicine and perhaps seek a career in something different, maybe public health. [See MPA degrees online] The same is true for PharmDs. A clinician becomes a well versed clinician with study, and direct patient care experience, not a degree alone. Medicine and pharmacy are science-based arts often requiring “gray” decisions from a black and white science background. Many readers might be surprised to know that the white coat behind your community pharmacy counter is worn by a well-educated, highly learned clinician.
The “medical world” is past a “pecking order” that was once acceptable within the healthcare community. Medical science and technology have irrefutably become too complex to expect any single practitioner to carry the entire weight of knowing every diagnostic test (imaging, laboratory, EMGs, etc.) and thousands of drugs, including their respective intricacies in terms of medicinal chemistry, biopharmaceutics, pharmacology, pharmacokinetics, and therapeutics. Aspiring to exceptional patient care, the best model for complex patients includes a multidisciplinary approach, especially when it comes to pain management. This often includes an MD, NP [See NP degrees online] and/or PA, a PharmD, and a PhD (clinical psychologist), and perhaps many other specialists, some of whom include physical therapists (which by the way is now a doctoral level program), occupational therapists, physiatrists, anesthesiologists, neurologists, and others.
Is the doctor in?
A. Torney: “What’s a PharmD, what do they do, and how does that compare to an MD? Can you be of help on this case?”
IT’S YOUR LUCKY DAY!
“I have an understanding of all the pain and non-pain medications prescribed, which ones alter the serum levels of the other(s); I see patients in a pain clinic daily; I order laboratory tests for my patients daily; I have extensive experience evaluating patients for appropriate medication therapy and I can prescribe; my training was extensive in the biological, chemical, and analytical sciences including biomedical statistics; and I have extensive experience in opioid laboratory monitoring”.
I AM A DOCTOR OF PHARMACY.
“You won’t give me my oxycodone…you’re not even a real doctor? I want to speak to a real doctor!”
IT’S YOUR UNLUCKY DAY!
“YOUR MEDICAL DOCTOR ASKED ME (“YOUR FAKE DOCTOR”) to evaluate you because your pathology didn’t match your level of pain. When I tested your urine, I found cocaine and marijuana, and your blood levels for oxycodone were inconsistent with your prescribed oxycodone dose. I don’t know where your medication went, but I do know you didn’t take it.”
I AM A DOCTOR OF PHARMACY.
“Why do you call yourself a doctor on your website if you’re not a “real doctor”?
Because I earned it!
I AM A DOCTOR OF PHARMACY.
For future reference, if asked the question again, you will be sent to this blog and told…
Yes. I AM A “REAL DOCTOR”.
I AM A DOCTOR OF PHARMACY.
I am Dr. Jeffrey Fudin, Founder and Managing Editor of PainDr.com
Jeffrey Fudin, RPh, BS, PharmD, DAAPM, FCCP, FASHP* (ABC, 123)
Remember, the clinician makes the letters; the letters don’t make the clinician!
*Added March 2015
Very well said Dr. M; I don’t have the years of schooling that you do and defer to you and your higher education; you missed out on a lot other walks of life while going through such a regiment, hat’\s off and thank you for clarifying my point. I doubt this guy still has a job anyways he was probably taking something out of his care of dispensing to act and post in such an unprofessional manner. It does happen.
In a hospital that I work from time to time, the physicians there request that the pharmacists with a PharmD to answer the phone and/or identify the following format: ” This is Dr Smith from pharmacy”. This way they know right away that they are speaking to a clinical pharmacist, not a tech or dispensary pharmacist. When a message is left in their voice mail, like wise. The problem that they were having was questioning the validity of messages in their voice mail, for example: ” This is Suzy from pharmacy”. Who is Suzy? A tech? Clinical pharmacist?
The only people that keep us from using our title are other pharmacists.
Personally, I do not think there is any room for calling ourselves doctors in the patient care area. When people ask for a doctor at a hospital, clinic they are requesting a medical doctor.
I have no issue with pharmacist who want to be called doctor in the academic arena but there is no place for it at the bedside.
I strongly disagree with this individual. You can call yourself a doctor and explain that you are a pharmacy doctor and go get a medical doctor if needed. This is a weak excuse, and it is VERY unprofessional to go by your first name in any clinical environment. I daily prescribe as a PharmD in primary care, and I call myself Dr. every day. In fact, I work on a hall full of other non-medical doctors such as: optometrists, audiologists, and clinical psychologists.
It is not even a consideration that audiologists, optometrists, clinical psychologists, or physical therapists would go by their first name. They all go by ‘doctor’, because they are ALL doctors. Other professionals recognize that you don’t do this. It would be the same to say that someone that is a black belt in Karate is not a black belt because that don’t have a black belt in Tae Kwon Do. This would be foolish logic because they both have the highest training and skill that can be obtained in their discipline and both are deserving of the title.
The lack of using the term ‘Dr.’ has happened in pharmacy because BS Pharms have been grandfathered in and don’t want to step up in their education. It is very difficult to identify those with less education if everyone is called pharmacist and by their first name. Also, PharmDs have listened to criticism from other professions with lame excuses to prevent proper professional title placement such as that in this initial post.