rehabinkmag Commentary, Issue 16

Mastering the Art of Post-Nominal Titles: Navigating the Use of Professional Titles and Credentials in the Health Sciences

Commentary

By Emma Wardhaugh, Benson Law, & Shannon L Sibbald

Background

In academic and professional spheres, it is important to establish your professional identity using the proper titles and post-nominal letters (letters that come after your name to denote credentials or degrees (1)). Some are referred to as ‘protected titles’, which can only be used by individuals who have undergone specific training and answer to a regulatory body, such as MD for medical doctors and PT for physiotherapists. Other letters represent an educational degree such as PhD and MSc. These designations establish credibility and demarcate professional limitations by defining scopes of practice (2). In Canada, provincial laws outline the use of titles, and scope of practices (e.g., The Regulated Health Professions Act, 1991(2)). Most health care professions have designated regulatory colleges that follow these laws and oversee licensing. Colleges ensure healthcare providers are practicing safely, ethically, and competently to protect the public and the profession (3). Students in health professions should understand these governing laws since patients and the public may make care decisions based on the assumed level of expertise indicated by a provider’s title.

The aim of this short commentary is to outline the purpose of post-nominal titles in the field of rehabilitation, provide guidance for Canadian trainees on how to use titles, and provide an overview of common post-nominal titles in the health sciences.

Karolina Grabowska (Pexels)

Importance for Professional Relations:

Two important functions that titles serve are establishing credibility and communicating accomplishments and demarcating seniority. For example, attending physicians, who not only have an MD but also other designations (e.g. FRCPC, FRCSC), have decision-making authority over medical residents (MD), who in turn hold seniority over medical students. As such, titles enforce hierarchical structures important in medical decision making.

Having well-defined titles also promotes interdisciplinary collaboration and communication. Specifically, titles help to better communicate the roles of allied health providers to other medical professionals and patients. For example, if another health care professional refers a patient to an occupational therapist, both the patient and provider can have confidence that the OT is supported and overseen by a regulatory body, and they will appropriately support the patient’s activities of daily living using evidence-based practices. In turn, various health care providers can communicate about the patient’s goals of care and can each integrate their own expertise into the patient’s management.

Within the interdisciplinary field of rehabilitation, the use of proper titles enhances communication, collaboration, and defines each provider’s role. This cultivates a well-represented community committed to advancing patient care, education, and research.

Pavel Danilyuk (Pexels)

Titles Communicate Trust and Seniority 

Titles are important for the public as they communicate educational attainment and convey a certain level of trust in the healthcare professionals. Titles are not only important for regulated health professionals, but also for graduate trainees. For example, students may call themselves a ‘PhD student’ while they are in the beginning stages of their coursework and a ‘PhD Candidate’ when they have completed all degree requirements except for final research stages and their dissertation defense. The title ‘PhD(c) should not be used as it can be misleading. If necessary, students could indicate “advanced graduate student” and describe their degree progression (4). Students in professional programs (such as Audiology or Speech-Language Pathology) must be careful when stating their titles to the public. Students who are enrolled in/graduated from master’s programs, but who have not yet acquired licensure, must refrain from using any variation of the protected titles “audiologist”, “speech-language pathologist”, or “speech therapist” [e.g., a recent graduate should not refer to themselves as Audiology Clinician (Candidate)]. Using this language might infer to the public that this title means the person has the qualifications to practice as an audiologist or speech-language pathologist (5). In all professions, it must be clear if an individual is not yet a registered practicing clinician as they cannot be afforded the same level of confidence and credibility.

News and social media bring additional challenges to proper post-nominal titles; an online audience may not understand credentialing and professional titles. The rapid rise of misinformation and uncertainty of health issues makes it even more important for professionals to understand the proper use of credentialling(6). This misunderstanding can lead to harm from interpreting shared information with an unjustifiably increased degree of trust (7).

Respect the order:

The order of credentials varies by the specific health care profession. Some colleges require that providers list the college registration directly after their name (8). Oftentimes, permanent credentials are be listed first, which include educational degrees (e.g., PhD, MD), followed by non-permanent credentials such as certifications or organizational memberships (for example, a registered nurse could use either ‘BScN, RN’, or simply ‘RN’ after their name) (9). Highest degree earned goes right after a surname. For example, if you have a PhD and an MSc, list the PhD first since it is the highest attainable academic degree (many people do not include MSc since it is implied in earning a PhD).

After degrees, licenses from governing bodies can be listed followed by certifications. Certifications include additional training in a specialty area of practice. An example for nursing is CCHN(C) to demonstrate they are certified in community health(10). The list of all titles should be separated by commas with periods between the letters when the letters are used post-nominally (after your name in a signature). However, periods are often not used in written work (e.g., MD vs. M.D(11)).

Guidance for Specific Fields

Titles are important for the public as they communicate educational attainment and convey a certain level of trust in the healthcare professionals. Titles are not only important for regulated health professionals, but also for graduate trainees. For example, students may call themselves a ‘PhD student’ while they are in the beginning stages of their coursework and a ‘PhD Candidate’ when they have completed all degree requirements except for final research stages and their dissertation defense. The title ‘PhD(c) should not be used as it can be misleading. If necessary, students could indicate “advanced graduate student” and describe their degree progression (4). Students in professional programs (such as Audiology or Speech-Language Pathology) must be careful when stating their titles to the public. Students who are enrolled in/graduated from master’s programs, but who have not yet acquired licensure, must refrain from using any variation of the protected titles “audiologist”, “speech-language pathologist”, or “speech therapist” [e.g., a recent graduate should not refer to themselves as Audiology Clinician (Candidate)]. Using this language might infer to the public that this title means the person has the qualifications to practice as an audiologist or speech-language pathologist (5). In all professions, it must be clear if an individual is not yet a registered practicing clinician as they cannot be afforded the same level of confidence and credibility.

Medical Doctor/Dentist (MD, DO):

Physicians can call themselves a “doctor” and use “MD” once they complete a medical degree at an accredited medical school. After medical school, students must pass the MCCQE Part 1 examination, a standardized national exam to assess knowledge across the country. Physicians may also be a “Doctor of Osteopathic Medicine”, or “DO” after graduating from a 4-year program. There are no DO programs in Canada, but Canada recognizes graduates of American accredited DO programs as medical doctors. DOs must pass licensing exams and be registered in a province/territory(12).  After licensing, physicians can enter residency. Following residency, they can apply for licensure by the provincial or territorial organization. Physicians training in Canada write the MCCQE Part 2 exam to meet national standards and become a licentiate of the Medical Council of Canada (13).  Physicians must also be certified with the Royal College of Physicians and Surgeons of Canada (RCPSC) or the Canadian College of Family Physicians (CCFP), depending on their specialty training (14).

Nurse (RN, RPN, LPN, NP):

There are various nursing degrees. To be a Registered Nurse (RN), students must have a bachelor’s degree (BScN or equivalent) and complete a licensing exam (NGN), as well as other registration requirements. To be a Licensed Practical Nurse (LPN) or Registered Practical Nurse (RPN) in Ontario, students must complete two years of a college program and write the REx-PN or CPNRE exam (15,16). Some provinces/territories have Registered Psychiatric Nurses (RPN) who complete 2.5 to four years of college or university(17).  Nurse Practitioners (NP) have additional education and can autonomously diagnose and treat illnesses(18).  NPs must work as an RN for a certain number of hours, complete a master’s program, and then write an exam approved for their NP specialty. Each province/territory has its own college with which nurses must be registered (19).

The American Nurses Credentialing Center notes you should list your highest earned education degree (BScN, MSN), then licensure (RN, LPN, NP), then specialty certifications, then awards and honours(20).

Physiotherapist (PT):

Registered physiotherapists can use the title PT after they have acquired a master’s degree in physiotherapy and complete the written and clinical components (varies by province) of the Physiotherapy Competency Exam (PCE) issued by the Canadian Alliance of Physiotherapy Regulators CAPR (21).

After completing their education and written component of PCE, students may practice as a ‘resident’ or ‘intern’ under the guidance of a registered PT before completing the clinical components (22). To practice independently, they must pass all required PCE sections and follow provincial guidelines for licensure.

Occupational Therapist (OT):

To be an occupational therapist and use the title OT, students must have an entry-to-practice OT degree (most often MScOT) and then write the National Occupational Therapy Certification Exam (NOTCE) issued by the Canadian Association of Occupational Therapists (CAOT) in all provinces/territories except Quebec. Students must be registered with a province/territory (23).

Both physiotherapists and occupational therapists must use their professional titles (PT/OT) when engaging in clinical practice but cannot use it when working outside their scope of practice. If they have a doctoral degree, they can use it for non-clinical purposes (academic settings or on research publications (21,24)).  

Speech Language Pathologist (R.SLP) and Registered Audiologist (R.Aud):

Speech-language pathologist and audiologist are protected titles in Canada(25).  Speech-language pathologists and audiologists must complete a master’s degree in each respective field. Some provinces that have a regulatory college will require successful completion of the Canadian Entry to Practice (CETP) exam, or successful completion of an alternative exam recognized by the regulatory college as well as registration/licensure with the regulatory college (25). 

Audiologists and speech-language pathologists must use the title audiologist, speech-language pathologist, speech therapist, or speech pathologist when engaging in their respective clinical practice but cannot use it when working outside the scope of audiology or speech-language pathology practice (5). 

Physician Assistant (PA):

Physician Assistants are a newer profession to practice in Canada, first being introduced to Manitoba in 1999. PA education involves a two-year master’s program, following a bachelor’s degree. Within three years after graduation, students can complete the PACCC PA certification exam to become certified with the Canadian Association of Physician Assistants (26).

Conclusion:

As current medical trainees, we have provided guidance for our peers. This guidance may change, and we strongly recommend all trainees think critically about the use of their credentials once earned. Using post-nominal titles appropriately is a crucial means by which we fulfill our responsibility to uphold the values of all health professionals.

Acknowledgements

Thank you to the faculty within Western Health & Rehabilitation Sciences for reviewing this work.

To refer to this article, it can be cited as:

Wardhaugh E, Law B, Sibbald S. Mastering the Art of Post-Nominal Titles: Navigating the Use of Professional Titles and Credentials in the Health Sciences. rehabINK. 2024:Issue16. Available from: https://rehabinkmag.com

References

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