On September 19, 2025, a federal judge in the Central District of California upheld California’s “Truth in Advertising” rule that limits the use of “doctor”/“Dr.” in health care settings to licensed physicians and surgeons (M.D./D.O.). The court denied the nurse-practitioner plaintiffs’ First Amendment challenge and granted the State’s motion for summary judgment.
Why this matters:
California Business & Professions Code §2054 makes it a misdemeanor to use “doctor,” “physician,” or “Dr.” (or similar) in signs, business cards, letterhead, ads, or in a health care setting, if that usage would lead a reasonable patient to think the person is a licensed M.D. or D.O. The statute was clarified in recent amendments and includes specific carve-outs (e.g., residents in approved training, etc.). Justia Law+2LegiScan+2
The court treated use of professional titles as commercial speech and found that, in health care contexts, “Dr.” used by non-physicians can be inherently or at least potentially misleading to patients, so the restriction passes constitutional scrutiny. The ruling leans on Ninth Circuit precedent that lets California restrict professional titles where the State has given those terms a specific meaning to protect consumers. CaseLaw+1
Quick case snapshot: Palmer v. Bonta (C.D. Cal. Sept. 19, 2025)
Issue: Whether §2054 unconstitutionally bans DNP-prepared NPs from using “Dr.” or “doctor” in health care settings and related advertising.
Holding: No. The court denied the NPs’ motion, granted the State’s, and closed the case.
Reasoning: Titles in clinical contexts function like advertising; patients commonly equate “doctor/Dr.” with a licensed physician; the State’s interest in preventing confusion is substantial; the restriction directly advances that interest and is reasonably tailored. Pacific Legal Foundation
California enforces this rule. In 2022, the San Luis Obispo County DA obtained an injunction and monetary penalties against a DNP who used “Dr.” in ways deemed misleading under §2054. That matter is frequently cited in discussions of this law. San Luis Obispo County+1
So…who can use “Dr.” in California health care settings?
Generally permitted (in health care settings and related advertising):
Licensed physicians and surgeons (M.D./D.O.) using “doctor,” “Dr.,” “physician,” consistent with licensure.
Explicit statutory carve-outs (e.g., graduates in approved physician/osteopathic training programs using certain titles while in training), as specified in §2054.
Generally restricted:
Non-physician licensees (e.g., DNPs/NPs, DPTs, PharmDs, PsyDs, etc.) may not use “doctor” or “Dr.” in a way that would lead a reasonable patient to conclude they are an M.D. or D.O., especially in clinical introductions, badges, signage, ads, websites, or social profiles tied to patient care. They can accurately describe their degree and license—just not in a way that implies physician status.
This approach aligns with Ninth Circuit guidance permitting California to reserve specific professional designations (like “board-certified” or “doctor” in certain contexts) for those who meet statutory criteria, while allowing others to share truthful credentials with clarifying language.
FAQs
Q: Can a DNP write “Doctor of Nursing Practice” in a bio?
A: Yes. Accurate degree listings are allowed. The risk arises when the presentation would make a reasonable patient think the DNP is a physician. Context, placement, and prominence matter. Use “DNP” together with “Nurse Practitioner” and avoid “Dr.” in patient-facing titles, badges, and greetings.
Q: What about social media usernames/handles?
A: Avoid “Dr[Name]” handles for non-physicians on professional accounts tied to patient services. Even outside the clinic, professional profiles are commonly viewed as marketing.
Q: How did the court view the First Amendment argument?
A: The court treated the title usage as commercial speech and found it inherently or potentially misleading in clinical contexts, so California can restrict it to protect patients. This follows Ninth Circuit precedent on professional titles.
Q: If we add a disclaimer (“I’m a nurse practitioner”), can we still use “Dr.”?
A: Not in a way that would cause a reasonable patient to think you’re an M.D./D.O. Disclaimers help, but the statute focuses on reasonable patient perception in health care settings and advertising. When in doubt, leave “Dr.” off and use degree + license/role.
Need a fast audit?
Simas & Associates advises clinics, medical groups, and licensees on advertising, scope, and board enforcement. We can review your badges, scripts, website, and social presence for §2054 compliance and train your team.
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Sources & further reading
- Palmer v. Bonta, Order on Cross-Motions for Summary Judgment (C.D. Cal. Sept. 19, 2025). Pacific Legal Foundation
- AMA coverage of the ruling (Oct. 22–23, 2025). American Medical Association
- CMA summary (Sept. 24, 2025). CMA Docs
- Cal. Bus. & Prof. Code §2054 (current text; selected carve-outs). Justia Law
- SB 1451 (2023–24) text amending §2054. LegiScan
- Ninth Cir.: American Acad. of Pain Mgmt. v. Joseph, 353 F.3d 1099 (9th Cir. 2004). CaseLaw
- SLO County DA press release & judgment re: Erny (Nov. 2022).