This is my column in EM News from last April.

titles, doctor

Remember the old Tootsie Pop commercial with the owl? “Mr. Owl, how many licks does it take to get to the center of a Tootsie Pop?” Apparently three. Well, three and then you crunch it with your teeth, or beak.

Along the same lines, I have to ask, “How many letters does it take to be a physician or nurse practitioner or PA?” I wonder because I’m always seeing people with more and more letters after their names.

We live in a world of degrees and certifications. More to the point, we practice a profession that is obsessed with those. I remember how excited I was to graduate from college. I earned a BS in zoology, of all things. (I know some very cool animal facts, and I can throw out complex Latin taxonomy designations to sound smart at parties.)

But what I really wanted was that MD. Medical Doctor. I wanted it enough to give up a lot of my life. Then, of course, I wanted to finish residency. I didn’t understand at first that it would come with its own set of suffixes. I guess I knew I would be a diplomate of the American Board of Emergency Medicine, but that’s more of a CV thing. One seldom puts it on a name badge. One does sometimes put FACEP, FACOEP, or FAAEM on badges. Certainly on applications.

There are those physicians who do fellowships after residency. I don’t work in academia, so I don’t know how often those certifications wind up embroidered on lab coats or emblazoned on nameplates. Some physicians have MA or MS degrees or MBAs. And the more enlightened, more academic sometimes go on to embrace a PhD. I guess if I had one, I might put it out for all the world to see. As it stands, I’m happy with MD unless I’m applying for something or trying to make a point of my expertise. Besides which, my patients only know what MD or DO means. The rest is generally irrelevant to them.


When I was a young, less enlightened student, I thought LPN, RN, and BSN were the nursing degrees that mattered the most. In fact, BSNs then were rather unusual. (Yes, I’m that old.) Eventually, I learned that there were also MSN and NP degrees, CNM (nurse midwife), and CRNA and DNP degrees. As if those weren’t enough to keep the makers of name badges in business, dozens of certifications exist: CEN, CCRN, TNCC, and SANE, among others.

There are now, of course, doctoral degrees for PAs and various additional certifications for them as well. When I was in college, I considered being a PA. It was a four-year undergraduate degree. Again, I’m that old.

I think advancing one’s education is great, but I wonder sometimes if we equate our clinical skill and our personal professional worth with the letters that follow our names. To the extent that they represent the completion of a prescribed course of study, there’s some truth there. Letters, programs, and degrees, however, can’t rescue us from the hard reality of the sick and injured humans before us.

I thought about this recently at 3 a.m. I was working single-coverage in a rural ED. We were up to our glutei in alligators. I had a patient who opened up his thigh with a concrete cutter. It took me hours to close it. You’ve been there: give local anesthesia, clean it out, put in a few stitches, see a patient with chest pain, rinse and repeat.

Between talking to the patient and running the department, I realized how much I enjoyed doing it. I’m not an academic, and I’m not an administrator. I’ve never done a fellowship. I don’t aspire to much beyond being good at taking care of my patients. (And being a wildly popular best-selling author, of course.)

There really aren’t letters to designate that feeling. As I looked into that wound, as I identified structures and approximated fascia, as the bleeding stopped and the skin came together, I was satisfied. I discharged him and moved on to the next patient in a long series of humans, many of whom had the flu, pneumonia, abdominal pain, and other afflictions. That night, as on so many others, the title “doctor” was enough. Not because the title mattered, but because in attaining the title, I learned what to do, and when, and how. And how to make it work even in the midst of being wildly outnumbered and fatigued.

I suppose if I were going to put something other than MD on my name tag or scrubs, it would be this: ITCOSPADANADIW. I take care of sick people all day and all night and do it well.

That’s all I ever wanted. In the end, it’s enough.

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Dr. Leappractices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available, and Working Knights, Cats Don’t Hike, and The Practice Test, all available at, and of a blog, Follow him on Twitter@edwinleap, and read his past columns at

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