The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 230
INTRODUCER: Senator Harrell
SUBJECT: Health Care Practitioner Titles and Abbreviations
DATE: February 17, 2023
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Winkle
Brown
HP
Pre-meeting
2. RC
I. Summary:
SB 230 creates s. 456.0393, F.S., which defines “advertisement” and “deceptive or misleading
terms or false representation,” for health care practitioners and specifies which titles and
abbreviations health care practitioners may use in their advertisements, communications, and
personal identification.
The bill requires health care practitioners to identify themselves in a specified manner when
treating patients. The bill creates grounds for disciplinary action and denial of license and
authorizes each practitioner regulatory board,
1
or the Department of Health (DOH) if there is no
board, to adopt rules to implement the bill’s provisions.
The bill provides an effective date of July 1, 2023.
II. Present Situation:
Licensure and Regulation of Health Care Practitioners
The Division of Medical Quality Assurance (MQA), within the DOH, has general regulatory
authority over health care practitioners.
2
The MQA works in conjunction with 22 regulatory
boards and four councils to license and regulate seven types of health care facilities and more
1
Under s. 456.001(1), F.S., the term “board” is defined as any board, commission, or other statutorily created entity, to the
extent such entity is authorized to exercise regulatory or rulemaking functions within DOH or, in some cases, within DOH’s
Division of Medical Quality Assurance (MQA).
2
Pursuant to s. 456.001(4), F.S., health care practitioners are defined to include acupuncturists, physicians, physician
assistants, chiropractors, podiatrists, naturopaths, dentists, dental hygienists, optometrists, nurses, nursing assistants,
pharmacists, midwives, speech language pathologists, nursing home administrators, occupational therapists, respiratory
therapists, dieticians, athletic trainers, orthotists, prosthetists, electrologists, massage therapists, clinical laboratory personnel,
medical physicists, genic counselors, dispensers of optical devices or hearing aids, physical therapists, psychologists, social
workers, counselors, and psychotherapists, among others.
REVISED: BILL: SB 230 Page 2
than 40 health care professions.
3
Each profession is regulated by an individual practice act and
by ch. 456, F.S., which provides general regulatory and licensure authority for the MQA. The
MQA is statutorily responsible for the following boards and professions established within the
division:
4
The Board of Acupuncture, created under ch. 457, F.S.;
The Board of Medicine, created under ch. 458, F.S.;
The Board of Osteopathic Medicine, created under ch. 459, F.S.;
The Board of Chiropractic Medicine, created under ch. 460, F.S.;
The Board of Podiatric Medicine, created under ch. 461, F.S.;
Naturopathy, as provided under ch. 462, F.S.;
The Board of Optometry, created under ch. 463, F.S.;
The Board of Nursing, created under part I of ch. 464, F.S.;
Nursing assistants, as provided under part II of ch. 464, F.S.;
The Board of Pharmacy, created under ch. 465, F.S.;
The Board of Dentistry, created under ch. 466, F.S.;
Midwifery, as provided under ch. 467, F.S.;
The Board of Speech-Language Pathology and Audiology, created under part I of ch. 468,
F.S.;
The Board of Nursing Home Administrators, created under part II of ch. 468, F.S.;
The Board of Occupational Therapy, created under part III of ch. 468, F.S.;
Respiratory therapy, as provided under part V of ch. 468, F.S.;
Dietetics and nutrition practice, as provided under part X of ch. 468, F.S.;
The Board of Athletic Training, created under part XIII of ch. 468, F.S.;
The Board of Orthotists and Prosthetists, created under part XIV of ch. 468, F.S.;
Electrolysis, as provided under ch. 478, F.S.;
The Board of Massage Therapy, created under ch. 480, F.S.;
The Board of Clinical Laboratory Personnel, created under part I of ch. 483, F.S.;
Medical physicists, as provided under part II of ch. 483, F.S.;
Genetic Councilors as provided under part III of ch. 483, F.S.
The Board of Opticianry, created under part I of ch. 484, F.S.;
The Board of Hearing Aid Specialists, created under part II of ch. 484, F.S.;
The Board of Physical Therapy Practice, created under ch. 486, F.S.;
The Board of Psychology, created under ch. 490, F.S.;
School psychologists, as provided under ch. 490, F.S.;
The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health
Counseling, created under ch. 491, F.S.; and
Emergency medical technicians and paramedics, as provided under part III of ch. 401, F.S.
The DOH and the practitioner boards have different roles in the regulatory system. Boards
establish practice standards by rule, pursuant to statutory authority and directives. The DOH
3
Florida Department of Health, Division of Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year
2021-2022, p. 5, https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/annual-reports.html (last
visited Feb. 10, 2023).
4
Section 456.001(4), F.S. BILL: SB 230 Page 3
receives and investigates complaints about practitioners and prosecutes cases for disciplinary
action against practitioners.
The DOH, on behalf of the professional boards, investigates complaints against practitioners.
5
Once an investigation is complete, the DOH presents the investigatory findings to the boards.
The DOH recommends a course of action to the appropriate board’s probable cause panel which
may include:
6
Issuing an Emergency Order;
Having the file reviewed by an expert;
Issuing a closing order; or
Filing an administrative complaint.
The boards determine the course of action and any disciplinary action to take against a
practitioner.
7
For professions in which there is no board, the DOH determines the action and
discipline to take against a practitioner and issues the final orders.
8
The DOH is responsible for
ensuring that licensees comply with the terms and penalties imposed by the boards.
9
If a case is
appealed, DOH attorneys defend the final actions of the boards before the appropriate appellate
court.
10
The different DOH and board rules apply to all statutory grounds for discipline against a
practitioner. Under current law, the DOH takes on the disciplinary functions of a board only for
practitioner types that do not have a board. The DOH itself takes no final disciplinary action
against practitioners for which there is a board.
Board Certification and Florida Licensure
The DOH does not license health care practitioners by specialty or subspecialty; rather,
practitioners become board-certified in specialties by private, national specialty boards, such as
the American Board of Medical Specialties (ABMS), the Accreditation Board for Specialty
Nursing Certification, and the American Board of Dental Specialties.
11
Prohibitions
Current law limits which health care practitioners may hold themselves out as board-certified
specialists. An allopathic physician may not hold himself or herself out as a board-certified
specialist unless he or she has received formal recognition as a specialist from a specialty board
5
Department of Health, Investigative Services, http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/isu.html (last visited Feb. 10, 2023).
6
Department of Health, Prosecution Services, http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-
complaint-process/psu.html (last visited Feb. 10, 2023).
7
Section 456.072(2), F.S.
8
Professions which do not have a board include naturopathy, nursing assistants, midwifery, respiratory therapy, dietetics and
nutrition, electrolysis, medical physicists, genetic counselors and school psychologists.
9
Supra, note 6.
10
Id.
11
Examples of specialties include dermatology, emergency medicine, ophthalmology, pediatric medicine, certified registered
nurse anesthetist, clinical nurse specialist, cardiac nurse, nurse practitioner, endodontics, orthodontics, and pediatric dentistry. BILL: SB 230 Page 4
of the ABMS or other recognizing agency
12
approved by the Board of Medicine.
13
Similarly, an
osteopathic physician may not hold himself or herself out as a board-certified specialist unless he
or she has successfully completed the requirements for certification by the American Osteopathic
Association (AOA) or the Accreditation Council on Graduate Medical Education (ACGME) and
is certified as a specialist by a certifying agency
14
approved by the board.
15
In addition, an
allopathic physician may not hold himself or herself out as a board-certified specialist in
dermatology unless the recognizing agency, whether authorized in statute or by rule, is
triennially reviewed and reauthorized by the Board of Medicine.
16
A podiatric physician also may not advertise that he or she is board certified unless the
organization is approved by the Board of Podiatric Medicine (BPM) for the purposes of
advertising only and the name of the organization is identified in full in the advertisement. In
order for an organization to obtain the BPM approval it must be the American Podiatric Medical
Association, the National Council of Competency Assurance, or an organization that must:
Be composed of podiatric physicians interested in a special area of practice demonstrated
through successful completion of examinations or case reports;
Subscribe to a code of ethics;
Have rules and procedures for maintaining a high level of professional conduct and discipline
among its membership;
Have an active membership of at least seventy-five (75);
Sponsor annual meeting and courses in Board approved continuing education; and
Be a national organization in scope and give a certification examination at least once a year
before the podiatric physician can advertise possession of the certification.
17
A dentist may not hold himself or herself out as a specialist, or advertise membership in or
specialty recognition by an accrediting organization, unless the dentist has completed a specialty
education program approved by the American Dental Association and the Commission on Dental
Accreditation and the dentist is:
18
Eligible for examination by a national specialty board recognized by the American Dental
Association; or
Is a diplomate of a national specialty board recognized by the American Dental Association.
If a dentist announces or advertises a specialty practice for which there is not an approved
accrediting organization, the dentist must clearly state that the specialty is not recognized or that
the accrediting organization has not been approved by the American Dental Association or the
Florida Board of Dentistry.
19
12
The Board of Medicine has approved the specialty boards of the ABMS as recognizing agencies. See Fla. Admin. Code. R.
64B8-11.001(1)(f),(2022).
13
Section 458.3312, F.S.
14
The osteopathic board has approved the specialty boards of the ABMS and AOA as recognizing agencies. Fla. Admin.
Code R. 64B15-14.001(h),(2022).
15
Section 459.0152, F.S.
16
Id.
17
Fla. Admin. Code R. 64B18-14.004 (2022).
18
Section 466.0282, F.S. A dentist may also hold himself or herself out as a specialist if the dentist has continuously held
himself or herself out as a specialist since December 31, 1964, in a specialty recognized by the American Dental Association.
19
Section 466.0282(3), F.S. BILL: SB 230 Page 5
By rule, the Board of Chiropractic Medicine (BCM) prohibits chiropractors from using
deceptive, fraudulent, and misleading advertising. However, the BCM permits chiropractors to
advertise that he or she has attained diplomate status in a chiropractic specialty area recognized
by the BCM. BCM specialties include those which are recognized by the Councils of the
American Chiropractic Association, the International Chiropractic Association, the International
Academy of Clinical Neurology, or the International Chiropractic Pediatric Association.
20
Section 464.015, F.S., specifies the titles and abbreviations that only nurses may professionally
use, based on the type of license they have obtained as follows:
Registered Nurse and the abbreviation R.N.;
Licensed Practical Nurse and the abbreviation L.P.N.;
Graduate Nurse and the abbreviation G.N.;
Graduate Practical Nurse and the abbreviation G.P.N.;
Clinical Nurse Specialist and the abbreviation C.N.S.;
Certified Registered Nurse Anesthetist, nurse anesthetist and the abbreviation C.R.N.A.;
Advanced Practice Registered Nurse and the abbreviation A.P.R.N.; and
Certified Nurse Midwife, nurse midwife, and the abbreviation C.N.M.
Section 464.015, F.S., further prohibits any person from practicing or advertising as, or assume
the title of registered nurse, licensed practical nurse, clinical nurse specialist, certified registered
nurse anesthetist, certified nurse midwife, certified nurse practitioner, or advanced practice
registered nurse, or using the abbreviation R.N., L.P.N., C.N.S., C.R.N.A., C.N.M., C.N.P., or
A.P.R.N., or taking any other action that would lead the public to believe that a person is
authorized to practice. To do so is punishable as a first degree misdemeanor under ss. 775.082 or
775.083, F.S.
Section 465.016, F.S., makes using the name or title Nurse, Registered Nurse, Licensed Practical
Nurse, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Certified Nurse
Practitioner, Certified Nurse Midwife, Advanced Practice Registered Nurse, or any other name
or title which implies that a person was licensed or certified as the same, unless that person is
duly licensed or certified, a third degree felony.
Additionally, an APRN may not advertise or hold himself or herself out as a specialist for which
he or she has not received a certification.
21
In 2019 the Broad of Nursing (BON) considered a Petition for Declaratory Statement
22
from an
A.P.R.N., who was also a C.R.N.A., requesting that he be permitted to use the phrase “nurse
20
Fla. Admin. Code R. 64B2-15.001(2)(e), (2022). Examples of chiropractic specialties include chiropractic acupuncture,
chiropractic internist, chiropractic and clinical nutrition, radiology chiropractic, and pediatric chiropractors.
21
Section 464.018(1)(s), F.S.
22
Section 120.565, F.S. Provides that, “[a]ny substantially affected person may seek a declaratory statement regarding an
agency’s opinion as to the applicability of a statutory provision as it applies to the petitioner’s particular set of circumstances.
The agency must give notice of the filing of a petition in the Florida Administrative Register, provide copies of the petition to
the board, and issue a declaratory statement or deny the petition within 90 days after the filing. The declaratory statement or
denial of the petition is then noticed in the next Florida Administrative Register, and disposition of a petition is a final agency
action.” BILL: SB 230 Page 6
anesthesiologist” as a descriptor for him or his practice and that the BON not subject him to
discipline under ss. 456.072 and 464.018, F.S.
23
The BON approved the Petition for Declaratory
Statement and this individual, under current law, can use the title of “nurse anesthesiologist.”
24
Physician assistants (PAs) certified by the National Commission on Certification of Physician
Assistants (NCCPA) may claim certification and they are the only PAs who may use the
abbreviation PA-C. PAs are permitted to advertise so long as the information is in no way false,
deceptive, or misleading and does not claim any type of specialty board certification, and the
advertisement discloses the name of the PA’s primary supervising physician.
25
An anesthesiologist assistant is subject to a citation and $250.00 fine if he or she does not clearly
identify him or herself as an anesthesiologist assistant.
26
He or she is also subject to discipline for
false, deceptive, or misleading advertising and for deceptive, untrue, or fraudulent
representations in his or her practice.
27
Similarly, most other health care practitioner practice acts, and/or board rules, contain
prohibitions against false, deceptive, or misleading advertising or fraudulent representations in
the practice, or both.
28
Health Care Practitioners: Specialty Designations
Section 456.072, F.S., authorizes a regulatory board or the DOH, if there is no board, to
discipline a health care practitioner’s licensure for a number of offenses, including but not
limited to:
Making misleading, deceptive, or fraudulent representations in or related to the practice of
the licensee’s profession; or
Failing to identify through writing or orally to a patient the type of license under which the
practitioner is practicing.
If a board or the DOH finds that a licensee committed a violation of a statute or rule, the board or
the DOH may:
29
Refuse to certify, or to certify with restrictions, an application for a license;
Suspend or permanently revoke a license;
Place a restriction on the licensee’s practice or license;
23
Petition for Declaratory Statement Before the Board of Nursing, In re: John P. McDonough, A.P.R.N., C.R.N.A., Ed.D.,
filed at the Department of Health, July 10, 2019 (on file with the Senate Committee on Health Policy).
24
The Florida Board of Nursing, Meeting Minutes, Disciplinary Hearings & General Business, Declaratory Statements, No.
2, Aug. 8, 2019, available at https://floridasnursing.gov/meetings/minutes/2019/08-august/08072019-minutes.pdf p. 28 (last
visited Feb. 14, 2023).
25
Fla. Admin. Code R. 64B8-30.0111, (2022).
26
Fla. Admin. Code R. 64B8-31.009(3)(f), (2022).
27
Fla. Admin. Code R. 64B8-31.010(d) and (k) (2022).
28
See Pharmacist, Fla. Admin. Code R. 64B16-3001(2)(u), (2022); Acupuncture, Fla. Admin. Code R. 64B1-9.001(d) and
(k),(2022); Athletic Trainer, Fla. Admin. Code R. 64B33-5.001(4)(a) and (e), (2022).
29
Section 456.072(2), F.S. BILL: SB 230 Page 7
Impose an administrative fine not to exceed $10,000 for each count or separate offense; if the
violation is for fraud or making a false representation, a fine of $10,000 must be imposed for
each count or separate offense;
Issue a reprimand or letter of concern;
Place the licensee on probation;
Require a corrective action plan;
Refund fees billed and collected from the patient or third party on behalf of the patient; or
Require the licensee to undergo remedial education.
III. Effect of Proposed Changes:
SB 230 creates s. 456.0393, F.S., which defines advertisement as any communication, printed,
electronic, or oral, that names a health care practitioner and the practice, profession, or institution
in which the practitioner is employed, volunteers, or otherwise provides health care services. The
term includes business cards, identification badges, letterhead, patient brochures, e-mails,
Internet websites or platforms, audio and video communications, text messages, and any other
form of communication. Any advertisement by a health care practitioner must disclose the type
of license under which the health care practitioner is authorized to provide services and must use
only those titles and abbreviations authorized by the bill. Only physicians may include titles and
abbreviations or medical specialties in their advertisements.
The bill defines deceptive or misleading terms or false representation as the use of titles, terms,
or other words that misstate, falsely describe, falsely hold out, or falsely detail the health care
practitioner’s professional skills, training, expertise, education, board certification, or licensure,
and includes the misappropriation of medical titles and medical specialty titles by nonphysicians.
The bill prohibits health care practitioners may not use deceptive or misleading terms or false
representation in their advertisements.
The bill specifies which titles and abbreviations health care practitioners may use in
advertisements, communications and personal identification. Physicians licensed under chs. 458
and 459, F.S., may use only the following as applicable to their license, specialties, and
certifications:
Doctor;
Physician;
Surgeon;
Doctor of medicine, M.D.;
Doctor of osteopathic medicine, osteopath, D.O.;
General surgeon;
Neurosurgeon;
Orthopedic surgeon;
Medical resident;
Resident physician;
Medical intern;
Anesthesiologist;
Cardiologist;
Dermatologist; BILL: SB 230 Page 8
Endocrinologist;
Gastroenterologist;
General practitioner;
Gynecologist;
Hematologist;
Hospitalist;
Intensivist;
Internist;
Interventional pain medicine physician;
Laryngologist;
Nephrologist;
Neurologist;
Obstetrician;
Oncologist;
Ophthalmologist;
Orthopedic surgeon;
Orthopedist;
Otologist;
Otolaryngologist;
Otorhinolaryngologist;
Pathologist;
Pediatrician;
Primary care physician;
Proctologist;
Psychiatrist;
Radiologist;
Rheumatologist;
Rhinologist; and
Urologist.
In addition, physicians licensed under chs. 458 and 459, F.S., may use any other title, word,
abbreviation, description of services, or designation, alone or in combination with any other title,
to indicate to others the specialty he or she is licensed to practice.
The bill permits podiatric physicians to use any of the following titles and abbreviations as
applicable to their license, specialties, and certifications: podiatric physician, doctor of podiatric
medicine, D.P.M., podiatrist, podiatric surgeon, Fellow in the American College of Foot and
Ankle Surgeons, and F.A.C.F.A.S.
The bill allows chiropractic physicians to use the titles chiropractic physician and “doctor of
chiropractic medicine. and the abbreviation D.C.A chiropractic physician who has attained
diplomate status in a chiropractic specialty recognized by the American Chiropractic
Association, the International Chiropractic Association, or the International Academy of Clinical
Neurology may also use his or her applicable diplomate titles in conjunction with his or her name
and title to reflect the specialty area. BILL: SB 230 Page 9
The bill allows dentists to use the titles and abbreviations applicable to their license, specialties,
and certifications including: doctor of medicine in dentistry, doctor of dental medicine, D.M.D.,
doctor of dental surgery, D.D.S., oral and maxillofacial surgeon, O.M.S., periodontist,
prosthodontist, endodontist, pediatric dentist, orthodontist, oral pathologist, and oral radiologist.
A dentist who has completed a dental anesthesiology residency recognized by the American
Dental Board of Anesthesiology before July, 2025, may also use the titles applicable to dentists
in conjunction with his or her name and title to reflect that residency training.
SB 230 authorizes nurses licensed under part I, Ch. 464 , F.S., to use only the following titles and
abbreviations based on their level of nursing education and licensure:
Licensed practical nurses, L.P.N;
Registered nursed, R.N.,
Advanced practice registered nurses, A.P.R.N. and the following role titles and
abbreviations, as applicable:
o Certified registered nurse anesthetist, C.R.N.A.;
o Clinical nurse specialist, C.N.S.;
o Certified nurse practitioner, C.N.P.;
o Certified nurse midwife, C.N.M.,
o Certified psychiatric nurse, psychiatric mental health advanced practice nurse, C.P.N.;
o Autonomous advanced practice registered nurse, A.-A.P.R.N.
Under the bill, physician assistants may use only the title “physician assistant” and the
abbreviations P.A. or P.A.-C.; and anesthesiologist assistants may use only the titles
anesthesiologist assistant, and certified anesthesiologist assistant, and the abbreviation “C.A.A.
All other health care practitioners may only use the titles and abbreviations authorized by their
respective practice acts or the bill. The bill authorizes nonphysician health care practitioners who
have obtained a doctoral degree under the profession governed by the applicable practice act to
use the letter “D.” in front of the abbreviations authorized by their practice act. However, a
nonphysician health care practitioner may not use the title “doctor” in any form of advertisement,
telehealth interaction, text message, or verbal communication without clearly identifying himself
or herself as a “doctor” of a specific profession, citing the applicable chapter under which the
health care practitioner is licensed.
The bill requires health care practitioners who treat patients in person to wear a name badge or
other form of identification on their clothing that clearly discloses the practitioner’s name, the
practitioner’s staff position, if any, and the type of license, registration, or certification held by
the practitioner. Any title or abbreviation used in the identification must be consistent with the
requirements of the bill. If a health care practitioner treats patients in a setting other than a health
care facility licensed under chs. 395 or 400, F.S., the health care practitioner must prominently
display a copy of his or her license in a conspicuous area of the practice so that it is easily visible
to patients. The copy of the license must be no smaller than the original license.
Any violation of the bill’s provisions constitute grounds for the denial of a license or disciplinary
action under the health care practitioner’s respective practice act and under s. 456.072(2), F.S.
BILL: SB 230 Page 10
The bill authorizes each board, or the DOH where there is no board, to adopt rules to implement
the provisions of the bill.
The bill provides an effective date of July 1, 2023.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
At line 70 the language “or osteopathic medicine” should be added at the end of the sentence as
paragraph (2)(a) of the bill applies to both allopathic (medical) and osteopathic physicians.
BILL: SB 230 Page 11
VII. Related Issues:
The bill’s permissive use of the letter “D.” in front of the abbreviations that a nonphysician
health care practitioner, who have obtained a doctoral degree may use, may need to be amended
to include or behind the abbreviations to accurately reflect current standard abbreviations for
some of the DOH licensed nonphysician health care practitioners, such as a person with a Ph.D.
in pharmacy (Pharm. D.), optometry (O.D.), audiology (Au.D.), or psychology (Psy.D.).
VIII. Statutes Affected:
This bill creates section 456.0393 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.