An emergence of "Dr. nurses" has created controversy in the medical world.

As more nurses pursue advanced degrees and earn the title of "doctor," some physicians worry patients might not know the difference between a nurse with a doctorate and a medical doctor.

American Academy of Family Physicians President Glen Stream said the issue is about transparency and not a turf battle over titles.

"If I’m Dr. Smith, and I introduce myself to a patient, they assume that I am a doctor of medicine," he said. "The concern is that the training is not the same [for nursing doctors]."

Patricia Clinton, the University of Iowa assistant dean for master and doctor of nursing practice programs, said adding doctoral education isn’t about the title.

"Nurse practitioners aren’t meant to replace physicians," she said. "We’re part of a team, and nurse practitioners play an important role in this team. This isn’t something that just came out of nowhere."

With more liberties, nurse practitioners are able to treat certain medical conditions without physician supervision.

One reason more nurses are becoming doctors is programs such as the UI’s.

In 2007, the UI began its nursing doctoral program with 25 postmaster’s degree students. In 2010, the program changed so students with bachelor’s degrees could also get on the doctoral track.

At present, there are 118 students in the bachelor’s-to-doctoral program and 56 in the postmaster’s-to-doctoral program. Since 2007, 37 students have graduated from the program with doctorates.

"This shouldn’t be a war between nursing and medicine," Clinton said, noting that, for years, nurse practitioners have sufficiently provided for patients, especially in rural and inner-city settings.

Still, some physicians say lay patients won’t understand the difference.

"I just think that because it’s not in the general public conscience, it’s going to be difficult in a one-on-one to explain the difference between credentials," Stream said.

After 25 years of nursing, Brenda Winkle, decided it was time to go from being a nurse to a provider.

"I wanted to move out of the inpatient hospital setting to be able to work in an outpatient setting …" she said.

Winkle, who is in her first year of the doctoral program, said she understands the confusion that could create.

"Having said that, I think that the community at-large is aware that there are people trained at doctorate levels that don’t necessary mean they’ve been to medical school," Winkle said.

A theologian with a Ph.D. might be referred to as a "doctor," but no one expects her or him to have a medical degree, she noted.

"I think this is a brand-new concept and degree, and it’s just making the public aware of this emerging provider, and it shouldn’t be a problem," Winkle said.

Both Winkle and Clinton cited research showing nurse practitioners and physicians provide similar care.

"Nurse practitioners don’t do an appendectomy, but guess what — neither do family-practice physicians. That’s what a surgeon does," Clinton said, noting that the medical field is already stretched thin and in need of more professionals.

By national average, full-time nurse practitioners made $90,770 last year, while nurse practitioners in Iowa made $87,043, according to the 2010 Nurse Practitioner Salary report.

Doctors of Nursing Practice — an organization that promotes nursing education — founding member Joyce Williams, who is a nurse practitioner, says it’s not as though there are thousands and thousands of nurses coming out with this degree.

"The title of doctor is an earned title," she said. "It’s something that refers to the respect of the person. I guess physicians feel that they are entitled to be the only ones, but really, they’re not."