Federal Court Upholds California Ban on Nurse Practitioners Using “Doctor” Title in Clinical Settings

Abstract: A September 2025 federal ruling in Palmer et al. v. Bonta et al. upheld California Business and Professions Code § 2054, affirming that only licensed physicians (MDs and DOs) may use the title “Doctor” or the prefix “Dr.” in clinical or advertising contexts. The decision preserves physician-exclusive title usage, reinforces the legal distinction between medical and nursing practice, and may influence similar “truth-in-advertising” laws in other states.

A federal judge has ruled that in California, only licensed physicians (MDs and DOs) may use the title “Doctor” or the prefix “Dr.” in clinical or advertising contexts. The case, Palmer et al. v. Bonta et al. (U.S. District Court, Central District of California, Sept 19 2025), denied the plaintiffs’ request for relief and upheld Business and Professions Code § 2054 as a legitimate, narrowly tailored protection against patient confusion.

The Ruling

Judge Jesus G. Bernal agreed that using “Dr.” or “Doctor” by nurse practitioners “is inherently misleading” commercial speech because patients reasonably associate those titles with licensed physicians and surgeons .

The court found that California’s restriction “directly advances California’s substantial interest in protecting consumers from misleading advertising by medical professionals.” Bernal relied on evidence that “patients have assumed” that nurse practitioner plaintiffs were medical doctors and that the AMA’s survey showing 39 percent of patients confuse DNPs for physicians was “consistent with [plaintiffs] understanding.”

The Plaintiffs’ Case

Plaintiffs Jacqueline Palmer, Heather Lewis, and Rodolfo Hanson, each a Doctor of Nursing Practice, argued that they truthfully disclosed their credentials and that banning them from using “Dr.” violated their First Amendment rights. The court disagreed, finding their use of “Dr.” in healthcare settings to be “inherently likely to deceive” even when accompanied by truthful credential clarification.

Judge Bernal referenced an earlier ruling that “in common parlance the term ‘doctor’ is customarily used to refer to physicians and surgeons,” and pointed to California’s long-standing regulation of the title. He additionally cited Recht v. Morrisey (2022), stating that “objectively truthful speech can still be misleading” when context causes patients to misinterpret professional status.

Statements from the Record

• Jacqueline Palmer, DNP, FNP-C, acknowledged that “patients have assumed that [she] was a medical doctor” and that “DNPs using the title ‘doctor’ in a healthcare context without clarifying that they are nurse practitioners would be ‘deception’.”
• Heather Lewis, DNP, admitted that in medical settings “‘doctor’ can refer to a licensed physician and surgeon.”
• Rodolfo Hanson, DNP, stated that he wanted to use the title “Dr.” to open an esthetics clinic because “patients would probably gravitate” to the clinic with “Dr. Hanson” on the sign.

The court concluded these examples demonstrated that the speech was commercial, economically motivated, and misleading within the meaning of Central Hudson Gas & Electric Corp. v. Public Service Commission (1980).

Comparative Education and Training Pathways

Reactions

The AMA and California Medical Association supported the decision, calling it a victory for patient clarity. The Pacific Legal Foundation, representing the nurses, argued the law “silences truthful speech.”

One nurse commenting on Nurse.org countered that the ruling was “a very obvious, direct abuse of power, a monopoly on care, and trespassing on a group’s First Amendment rights,” claiming it “has nothing to do with patient care but everything to do with who has more power and money.”

Broader Impact

California joins other states, including Indiana and Tennessee, with truth-in-advertising laws reserving the “Doctor” title for physicians in patient-care contexts. While DNP programs confer doctoral-level education, the ruling noted that DNP training “includes no coursework in anatomy, physiology, pathology, or pharmacology,” reinforcing that the degree does not expand a nurse practitioner’s legal or clinical scope.

References

Correction: Minnesota limits some titles, but not the use of the term “Doctor,” for those without MD or DO degrees. The Broader Impact section has been updated to remove Minnesota from the list of states that limit the use of the term “Doctor.”