I should make a flow chart of when I use the title "Dr." Sometimes it's to show respect, and sometimes the opposite. The older docs I'll always call "Dr." The ones my age or younger I'll call by their first name unless I'm trying to get their attention in some way, as in, "I really need your help right now" or "straighten up and fly right, doctor". In front of a patient, I'll usually say "Dr." I'll always refer to them as "doctor" when talking to a patient.

It's funny when I read a medical article published in anoher country, and the letters after their names mean nothing to me! I can put six sets of letters after my name if I want. But why? CNM is what tells you what I do. That's the national certification. I doubt you care what degrees I have or licenses the state gave me. And no, it's not on my credit cards or checks!