A federal court has upheld a California law that prohibits nurses with doctorates—including those with Doctor of Nursing Practice (DNP) degrees—from using the title “Dr” in healthcare settings, ruling that doing so could mislead patients.
In a decision issued September 19, 2025, U.S. District Judge Jesus G. Bernal concluded that referring to oneself as “Doctor” in a clinical context without holding a medical license constitutes “inherently misleading” commercial speech, which is not protected by the First Amendment.
The case was brought by three DNPs who argued that the law violated their right to truthfully describe their credentials. Two of the nurses had previously used the title on lab coats, documents, and social media, while the third had planned to use it when opening an aesthetics clinic. They emphasized that they always clarified they were nurse practitioners, not physicians.
“Instead of reining in the state’s power to censor professionals who accurately describe their credentials, the decision emboldens it,” said Donna Matias, attorney for the plaintiffs from the Pacific Legal Foundation.
California’s Business and Professions Code Section 2052 makes it a misdemeanor for anyone to use the title “Doctor” in a medical context without being a licensed physician.
The California Medical Association and the American Medical Association, which supported the law through an amicus brief, praised the decision for protecting patients and ensuring clarity about the qualifications of healthcare providers.
“Allowing patients to make informed decisions is foundational to our health care system,” said CMA President Shannon Udovic-Constant, MD.
Judge Bernal cited evidence, including an AMA survey showing 39% of patients mistakenly believed DNPs are physicians, as justification for the law. He acknowledged that while the nurses disclosed their qualifications, the use of “Dr” could still create confusion—particularly in advertising and clinical contexts where patients may assume a higher level of medical training.
Not everyone agreed with the ruling. Lorie A. Brown, RN, JD, a legal advocate for nurses, criticized the decision as unfair.
“If a nurse earns a doctoral degree, it’s reasonable that they should be able to refer to themselves as ‘Dr,’” she said, noting that others with doctorates—like educators or psychologists—face no such restrictions.
The decision may set a precedent for similar cases in other states and influence future regulations around professional titles in healthcare, especially as California is often a bellwether for legislative trends.
