Doctor (title)

Origins

The doctorate (Latin: doceō, I teach) appeared in medieval Europe as a license to teach (Latin: licentia docendi) at a medieval university. Its roots can be traced to the early church when the term "doctor" referred to the Apostles, church fathers and other Christian authorities who taught and interpreted the Bible. The right to grant a licentia docendi was originally reserved to the church which required the applicant to pass a test, take an Oath of allegiance and pay a fee. The Third Council of the Lateran of 1179 guaranteed the access – now largely free of charge – of all able applicants, who were, however, still tested for aptitude by the ecclesiastic scholastic. This right remained a bone of contention between the church authorities and the slowly emancipating universities, but was granted by the pope to the University of Paris in 1213 where it became a universal license to teach (licentia ubiquie docendi). However, while the licentia continued to hold a higher prestige than the bachelor's degree (Baccalaureus), it was ultimately reduced to an intermediate step to the Magister and doctorate, both of which now became the exclusive qualification for teaching.

The earliest doctoral degrees (theology, law, and medicine) reflected the historical separation of all university study into these three fields. Over time the D.D. has gradually become less common and studies outside theology, law, and medicine have become more common (such studies were then called "philosophy", but are now classified as sciences and humanities – however this usage survives in the degree of Doctor of Philosophy).

The Ph.D. was originally a degree granted by a university to learned individuals who had achieved the approval of their peers and who had demonstrated a long and productive career in the field of philosophy (in the broad sense of the term, meaning the pursuit of knowledge). The appellation of "Doctor" (from Latin: teacher) was usually awarded only when the individual was in middle age. It indicated a life dedicated to learning, knowledge, and the spread of knowledge. The Ph.D. entered widespread use in the 19th century at Friedrich Wilhelm University in Berlin as a degree to be granted to someone who had undertaken original research in the sciences or humanities. Prior to the formal degree, the contemporary doctorate (PhD), arguably, arose in Leipzig as a successor to the Master's (MA) degree in 1652 (Dr. habil).

In some European countries, such as Italy and Portugal, Doctor became a title given to all or most degree holders, not just those with doctorates. As a result, the title is used by many professionals in these countries, including those such as lawyers who are not normally granted the title elsewhere. The title is also used for lawyers in South America, where they have traditionally earned doctoral degrees, as well as in the former Portuguese territory of Macau in China.

Development in English-speaking countries

The primary meaning of Doctor in English has historically been with reference to the holder of a doctoral degree. These particularly referred to the ancient faculties of divinity, law and medicine, sometimes with the addition of music, which were the only doctoral degrees offered until the 19th century. During the 19th century, Ph.D.s became increasingly common in Britain, although it was necessary to obtain the degree to travel to continental Europe or (from 1861) to the United States, as the degree was not awarded in the UK until 1917.

However, the title, not being protected by law, was adopted by quacks. As a result, by the mid 19th century, it was normal in the UK to omit the title "Dr" when addressing letters to those holding doctoral degrees, and instead write the abbreviated form of the degree after the name, e.g. "The Reverend Robert Phelps, D.D.", "Thomas Elliotson, Esq. M.D.", or "John Lindsey, Esq. Ph.D.", in order to avoid classing academic doctors "with the village apothecary and the farrier" and various "quacks in literature, science, or art". In the US it similarly became customary to use post-nominals rather than the title of Doctor when addressing letters. All those with doctoral degrees continued to use the title professionally, although the title was not used socially.

Despite being historically associated with doctorates in law, the title of doctor for lawyers has not customarily been used in English-speaking countries, where lawyers were traditionally not required to have a university degree and were trained by other lawyers by apprenticeship or in the Inns of Court. The exception being those areas where, up to the 19th century, civil law rather than common law was the governing tradition, including admiralty law, probate and ecclesiastical law: such cases were heard in the Doctor's Commons, and argued by advocates who held degrees either of doctor of civil law at Oxford or doctor of law at Cambridge. As such, lawyers practicing common law in England were not doctoral candidates and had not earned a doctorate. When university degrees became more common for those wanting to qualify as a lawyer in England, the degree awarded was the Bachelor of Laws (LL.B.). Similarly in the US, even though degrees became standard for lawyers much earlier, the degree was again the LL.B., only becoming the Juris Doctor generally in the latter half of the 20th century.

In many English-speaking countries, it is common to refer to physicians by the title of doctor, even when they do not hold a doctoral level qualification. The word Doctor has long had a secondary meaning in English of physician, e.g. in Johnson's Dictionary, which quotes its use with this meaning by Shakespeare. In the US, the medical societies established the proprietary medical colleges in the 19th century to award their own MDs, but in the UK and the British Empire, where degree granting was strictly controlled, this was not an option. The usage of the title to refer to medical practitioners, even when they didn't hold doctoral degrees, was common by the mid 18th century. However, the first official recognition of Doctor being applied as a title to medical practitioners regardless of whether they held a doctoral degree was in 1838, when the Royal College of Physicians resolved that it would "regard in the same light, and address by the same appellation, all who have obtained its diploma, whether they have graduated elsewhere or not."

The Medical Act 1858 made it illegal for anyone not qualified in medicine to use a title that implied they were. This led to prosecutions of people making unauthorised use of the title"Dr". However, it also called into question the use of the title by licentiates of the Colleges of Physicians – all of whom were, under the new act, allowed to practice throughout the UK. In 1859, the London College reversed its earlier decision, resolving "That the title of Doctor shall not be given in any official document issued from this College to any person who is not possessed of the Degree of Doctor of Medicine". This was followed up in 1860 by new bylaws that stated "No Fellow, Member, or Licentiate of the College shall assume the title of Doctor of Medicine, or use any other name, title, designation or distinction implying that he is a Graduate in Medicine of an University, unless he be a Graduate in Medicine of an University". In Ireland, the question of whether the licensed of the Royal College of Physicians of Ireland granted the title of Doctor of Medicine led to a court case in 1861, with the conclusion that it did not. The British Medical Journal (BMJ) observed, however that anyone wanting the right to the title of "Doctor" could gain it "with a five-shilling degree of Doctor of Philosophy" from abroad, or could simply assume the title, as only "Doctor of Medicine" was actually protected. Debate continued as to the use of "Doctor" as a courtesy title by those who did not use it by right as holders of doctoral degrees, with the BMJ noting in 1876 that "We have again a sort of flood of letters for and against the use of the title of Doctor by physicians" and in 1882 that "There is not any other subject which appears to excite so wide spread an interest as this". In February 1876, a report recommended that the Royal College of Physicians should use the courtesy title of Doctor for all fellows and members, but this was rejected. Then in April of the same year, the College amended its bylaws to forbid any fellow, member, extra-licentiate or licentiate from using the title of Doctor unless they had a doctorate in medicine from a recognised university – closing the loophole the BMJ had identified. It was not until the early 20th century that this was reversed. In 1905 the Royal College of Surgeons passed a motion instructing their council "to take the necessary steps in conjunction with the Royal College of Physicians to ensure that all persons who pass the Conjoint examination shall be legally entitled to call themselves Doctors". The council of the surgeons' College felt it to be impractical to secure the legal right to the title as this would mean gaining the right to award M.D.s, but noted that the title had been used by the public to refer to medics for generations and was used without any legal right by Bachelors of Medicine – the only obstacle to licentiates of both colleges doing the same was the prohibition in the physicians' bylaws. On this occasion the College of Physicians refused to act, but they did finally relent in 1912, removing the clause forbidding the assumption of the title of Doctor. This was described in the American press as "the British apostles of red-tape have been forced to bow to the popular will".

Regulation of the medical profession also took place in the United States in the latter half of the 19th century, preventing quacks from using the title of Doctor. However, medical usage of the title was far from exclusive, with it being acknowledged that other doctorate holders could use the title and that dentists and veterinarians frequently did. The Etiquette of To-day, published in 1913, recommended addressing letters to physicians "(full name), M.D." and those to other people holding doctorates "Dr. (full name)", although both were "Dr." in the salutation and only physicians were explicitly said to include their title on their visiting card. By the 1920s there were a great variety of doctorates in the US, many of them taking entrants directly from high school, and ranging from the Doctor of Chiropractic (DC), which required only two or three years of college-level education, up to the PhD. All doctoral degree holders, with the exception of the JD, were customarily addressed as "Doctor", but the title was also regularly used, without doctoral degrees, by pharmacists, ministers of religion, teachers and chiropodists, and sometimes by other professions such as beauty practitioners, patent medicine manufacturers, etc.

Doctor as a noun

Throughout much of the academic world, the term Doctor refers to someone who has earned the highest degree from a university. This is normally the Doctor of Philosophy, abbreviated PhD (sometimes Ph.D. in North America) from the Latin Philosophiae Doctor or DPhil from its English name, or equivalent research doctorates at level 8 of the International Standard Classification of Education 2011 classifications (ISCED 2011) or level 6 of the ISCED 1997 classifications. Beyond academia, Doctor as a noun normally refers to a medical practitioner, who would usually hold a qualification at level 7 of ISCED 2011/level 5 of ISCED 1997 such as the British MBBS or the American MD.

Forms of address

When addressing several people, each of whom holds a doctoral title, one may use the plural contraction "Drs" (or "Drs." in American English) – or in some languages (for example, German) "Dres." (Latin: doctores) may be used – for example, instead of Dr. Miller and Dr. Rubinstein: Drs. Miller and Rubinstein. When referring to relatives with the same surname the form "The Doctors Smith" can be used. The abbreviation Drs. can also refer to doctorandus, a Dutch academic title.

In English, Dr is not combined with other titles, except for The Reverend in "The Revd Dr" before the surname of a minister of religion, e.g. "The Revd Dr Smith" but "The Revd John Smith, DD", and similarly "Rabbi Dr". Usage in many other languages is similar but some, notably German, allow for the stacking of titles.

Usage by medical practitioners in the UK and culturally-related countries

In the United Kingdom, Hong Kong, South Africa, Australia, New Zealand, Ghana and other countries whose cultures were recently linked to the UK, the title Dr is generally used both for those who hold doctoral degrees and for registered medical practitioners. History has dictated the use of the courtesy title Dr by physicians and general practitioners. However, surgeons do not use the title of Dr but, due to the origins of surgery with the barber surgeons, instead use Mr, Mrs, Ms, Miss, etc. This custom applies to surgeons of any grade who have passed the appropriate exams and is not the exclusive province of consultant-level surgeons. In recent times, other surgically orientated specialists, such as gynaecologists, have also adopted these prefixes. A surgeon who is also a professor is usually known as "Professor" and, similarly, a surgeon who has been ennobled, knighted, created a baronet or appointed a dame uses the corresponding title (Lord, Sir, Dame). Physicians, on the other hand, when they pass their "MRCP(UK)" examinations, or equivalent, do not drop Dr but retain it, even as consultants. The status and rank of consultant surgeons, addressed as "Mister", and consultant physicians, addressed as "Doctor", is equivalent.

Bangladesh

In Bangladesh, use of the title of Doctor (Dr.) is permitted for Ph.D. degree holders and registered medical practitioners. According to an amendment, universities are allowed to approve or reject any subject proposed for a thesis by a candidate for the degree of "Doctor" in any subject. For registered medical practitioners, only MBBS and BDS degree holders are allowed to use the title "Dr." and be called "Medical Doctors". Registered veterinary practitioners may use the title "Dr." after earning the "Doctor of Veterinary Medicine" (DVM) degree. However, Registered Homeopath practitioners also use the title "Dr." even though, according to Homeopathic Practitioners Ordinance 1983, they are only permitted to use "Homeopath". Currently, Physiotherapy has no separate council and no authorized act at present permits the use of the prefix "Dr." for physiotherapist. According to Bangladesh Unani & Ayurvedic Practitioners Ordinance 1983, practitioners of the Unani system are called “Tabib” or “Hakim” and are strictly prohibited from using the title "Dr."; similarly, practitioners of Ayurvedic system are called “Vaid” or “Kabiraj” and are also strictly prohibited from using "Dr.". Currently, medical practitioners having MBBS degree or dental surgeons having BDS are legally permitted to use "Dr." prefix. Using "Dr." for other medical practitioners remains controversial.

Hong Kong

Hong Kong follows British practice in calling physicians "Doctor" even though many of them hold only a degree of Bachelor of Medicine and Bachelor of Surgery (MBBS or MBChB). An attempt by their professional body to prevent chiropractors from calling themselves "Doctor" failed in the courts, in part because it was pointed out that practicing chiropractors may hold an academic doctorate in their discipline, and it would be anomalous to prevent them using the title when holders of doctorates in non-medical disciplines faced no such restriction.

India

In India, a person who has completed the Doctoral academic research requirements (usually consisting of rigorous prescribed course work followed by the publication of a thesis which makes a substantial contribution to existing knowledge, or a Doctoral dissertation embodying the results of guided research and public defence of their thesis in an Open Viva Voce) when awarded with a PhD (or any other Doctoral level degree) by a University recognised by The University Grants Commission of India or an Institution of National Importance, is Individually entitled by Right to be addressed as "Doctor" and prefix the abbreviation Dr. to his name.

However, General Practitioners in the field of medicine (even though holding Bachelor level degrees such as MBBS, BDS ) are usually addressed as Doctor, by courtesy to the Noble Profession, (though the appellation "Doctor" in this case is used as a noun to refer generically to any practitioner of medicine rather than as an adjective indicating the level of the degree attained by the individual physician). This is exemplified by the fact that even practitioners of AYUSH systems of Medicine and Pharmacists and Physiotherapists are routinely referred to as "Doctors" (though the appropriate term for practitioners of AYUSH alternative medicine (BAMS, BHMS, BUMS, BSMS, BNYS,DNYS) would be Vaid, Yogi, Hakim, Siddhar and Homoeopath, Naturopath respectively, considerly the appropriate appellation in cases of Pharmacists the correct term would be Assistant Physician or Up-Vaid (Ayurveda) . However, lawyer or medical professional earning a Doctoral Degree in the respective fields (Ph.D. in Law or MD in Medicine etc.) becomes entitled to be addressed as "Doctor" individually by right and not mere convention or courtesy to his profession.

Indonesia

The Indonesian titles "dr." is used in front of the name of medical doctor who holds a specification as general practitioner, also when the doctor already holds his specialization to ___, such as "Sp.THT" or "Spesialis Telinga, Hidung, Tenggorokan" (ENT or Ear, Nose, and Throat Specialist).

Dr. is used in front of the name as the title "Doktor" for doctorate title, the same level as Ph.D. title.

Pakistan

In Pakistan, the title of Doctor (Dr.) can be used both by Ph.D. degree holders and medical doctors. DVM (Doctor of Veterinary Medicine) degree holders use the title Dr. or Vet. Dr.

In 2004 the Pharmacy Council of Pakistan (PCP) approved the awarding of a Doctor of Pharmacy (PharmD), a five year professional degree. This was followed by the Doctor of Physical Therapy (DPT), approved by the Pakistan Physical Therapy Association (PPTA) in 2010. The use of the title of Doctor by pharmacists and physiotherapists holding these degrees is disputed. In March 2015, the PCP affirmed its use by holders of the PharmD, following a similar affirmation in November 2014 by the Punjab Pharmacy Council. However the Pakistan Medical and Dental Council (PMDC) issued a directive in July 2015 barring pharmacists and physiotherapists from using the title. The right of the PMDC to issue such a directive has been questioned, as they are not the regulatory body for pharmacists or physiotherapists.

The Philippines

In the Philippines, titles and names of occupations usually follow Spanish naming conventions which utilize gender-specific terms. "Doktór" is the masculine form, which retains the abbreviation Dr.; the feminine form is "Doktóra", and is abbreviated usually as "Dra."; others, however, some being Anglophones who wish to sound modern and Westernised (or were raised in an almost exclusively English-speaking family environment), or some who advocate gender equality, would dispense with the distinction altogether. There does exist in Filipino an equivalent, gender-neutral term for the professional that carries the more general notion of "healer", traditional (for example, an albuláryo) or otherwise: manggagámot.

Sri Lanka

In Sri Lanka the title doctor "Dr." is used for both physicians (including dentists and veterinarians) and Ph.D. holders. However, when addressing in native Sinhalese a physician is addressed as "Vaidya" (වෛද්ය) or "Dosthara" (දොස්තර) while a Ph.D. holder is addressed as "Archarya" (ආචාර්ය).

Thailand

The usage of Doctor (ดอกเตอร์) or Dr (ดร.) has been borrowed from English. It can be seen as a title in academic circles and in the mass media. In contrast to other academic titles (Professor, Associate Professor and Assistant Professor), the use of Doctor as a title has not been recognized by the Royal Institute of Thailand. Therefore, this title, in theory, cannot be used officially. For example, in court of justice where strictly formal Thai language is used, Dr cannot be mentioned as a person's title.

Canada

Canada lies somewhere between British and American usage of the degree and terminology of "doctor". Research doctorates – PhDs and ScDs – are entitled to use the title "doctor". Healthcare professions for which members may be called by the title of doctor are: medicine, dentistry, clinical psychology, optometry, chiropractic, veterinary medicine, podiatry and, more recently, pharmacy. In Alberta, Registered Nurses or Nurse Practitioners with an earned doctoral degree may use the title "doctor" in conjunction with professional practice. Members of these professions generally complete a minimum of 2 years of undergraduate studies, followed by a four- to six-year professional program (considered, despite the name of the degree, to be at bachelor's-level) to earn the Doctor of Medicine (M.D.), Doctor of Dental Surgery (D.D.S.), Doctor of Psychology (Psy.D.), Doctor of Optometry (O.D.), Doctor of Chiropractic (D.C.) or Doctor of Veterinary Medicine (D.V.M.). In some provinces it is also possible to earn the Doctor of Podiatric Medicine (D.P.M) or Doctor of Pharmacy (Pharm.D.). In some provinces, such as Ontario, psychologists take a PhD in Psychology rather than the PsyD degree. In Ontario, only chiropractors, dentists, medical doctors, optometrists and psychologists can use the title "doctor", when offering or purporting to offer health related services, while registered naturopathic doctors (N.D.) may only use the title "doctor" in written format if they also use the phrase, "naturopathic doctor" immediately following their name. A 2006 amendment that would allow practitioners of Traditional Chinese Medicine to use the title has not, as of 1 August 2016, entered into force.

Some confusion has recently arisen with respect to Canada's legal profession, after many Canadian law schools started offering to grant the J.D. ("Juridicae Doctor" or "Juris Doctor") degree (considered, like the medical professional degrees, to be at bachelor's level) to their existing students and to their alumni - as a replacement for the degree they traditionally awarded: the LL.B. ("Legum Baccalaureus" or "Bachelor of Laws"). The course requirements did not change, only the name. Canadian law schools started offering this option to their graduates to make it easier to practise in the United States (where law schools have traditionally granted a J.D. rather than an LL.B.). The convention governing use of the title "Dr" by lawyers has not changed in Canada. The only lawyers who typically use "Dr" are those who have continued with their studies, in order to obtain both an LL.M. ("Legum Magister" or "Master of Laws") and an S.J.D. ("Scientiae Juridicae Doctor" or "Doctor of the Science of the Law"). Sometimes also referred to as a "J.S.D.", the S.J.D. degree is legal discipline's equivalent to a Ph.D. degree. The McGill University Faculty of Law offers a doctoral level program in law, but it grants a D.C.L. ("Doctor of Civil Law") instead. To save money, some Canadian law schools (including U.B.C. and Calgary) have opted to work with their respective faculties of graduate studies to offer Ph.D. degrees in law instead of founding new S.J.D. programs.

Quebec

The usage of the French Docteur and Docteure, and their abbreviated forms Dr, Dre, D^r and D^re, is controlled by the Code des professions. As a pre-nominal title it can be used without any further explication by physicians, veterinarians, and dentists. It can also be used prenominally, when accompanied by the name of the profession immediately after the name, by professionals who require a doctorate for their professional licence, such as psychology or chiropractic, e.g. Dr X, psychologue or Dr Y, chiropraticien. Academic doctors, where the doctorate is not required to practice, bear the title only after their name; this is not abbreviated, e.g. M. Z, docteur en philosophie not M. Z, Ph.D.

United States

In the United States, the use of the title "Doctor" is dependent upon the setting. The title is commonly used socially by physicians and those holding doctoral degrees; however, there was formerly a division between Letitia Baldrige and Miss Manners on its social usage by those who are not physicians. Baldrige saw this usage as acceptable, while in contrast, Miss Manners wrote that "only people of the medical profession correctly use the title of doctor socially," but supports those who wish to use it in social contexts in the spirit of addressing people according to their wishes. Miss Manners has since softened her approach, noting in her Washington Post column that there are two approaches: "having been earned, it should be used" and "that level of education being assumed, it need not be expressly mentioned"; while she maintains that everyone should be addressed according to their wishes, she no longer states that only medical professionals use the title correctly but instead acknowledges that the title has been earned by those with Ph.D.s. The Emily Post Institute similarly advises that "Socially as well as professionally, medical doctors, dentists, and other professionals are addressed by, and introduced with, their titles. People who have earned a Ph.D. or any other academic, nonmedical doctoral degree have the choice of whether to use "Dr." both professionally and socially." Other advice columns have also noted that "it has become common to see someone with a Ph.D. addressed on the envelope as Dr., and as a consequence, deviation from convention has become acceptable." It should be noted that while the usage of the title by Ph.D. graduates has become common, its use socially by holders of professional doctorates (other than physicians) is neither explicitly endorsed nor explicitly discouraged by writers on etiquette. It is unusual for those who hold honorary doctorates to use the title "Doctor".

Recent publications from the office of the President of the United States of America also refer to Ph.D. holders as Dr. Soandso, and Second Lady Jill Biden used the style "Dr. Jill Biden" after earning her Ph.D. For addresses (defined as "the conventional forms of address as determined by social and official custom") NASA uses "Dr. (full name)" for Ph.D. holders while for physicians it uses "(full name), MD", although both are addressed as "Dr. (surname) in the salutation (which is described as "informal"). Many newspapers in the US, however, follow the AP Stylebook and reserve the title for medical doctors in their house styles; notable exceptions include the New York Times, which follows the preference of the individual when referring to PhD holders (although the title is not used for those with honorary doctorates), and the Wall Street Journal, which similarly prefers "Dr." for Ph.D. holders and physicians (if this is the person's choice) while stating explicitly that the title is not used for lawyers with J.D.s or people with honorary doctorates. Until 1989, the Washington Post used the title for "practitioners of the healing arts (including chiropractors and osteopaths) but not for holders of PhDs or honorary degrees", after which it dropped its use entirely.

The expansion of professional doctorates in clinical fields in the late 20th and early 21st centuries has led to disputes between physicians and other medical professions over who can use the title in a clinical context. This has been interpreted by some as part of larger battles within medicine, such as who gets to treat patients first and who has prescribing authority. The American Medical Association calls for non-physicians (those not holding an M.D. or D.O.) who use the title "Doctor" and are in direct contact with patients to clarify that they are not physicians and to "define the nature of their doctorate degree", while the American Osteopathic Association opposes the use of the title by non-physicians in clinical settings absolutely as (in their view) "such use deceives the public". Contrary to this, the Emergency Nurses Association has adopted as a position statement that "1. Nurses are entitled to have their educational degrees recognized and acknowledged in the same manner as other professions. 2. The proper title protection and use of accurate credentials is appropriate in the clinical setting. 3. When being addressed or introduced as doctor in the clinical environment, it is responsible practice for all healthcare providers to clarify their professional role. 4. Patients, families and the general public have a right and expectation to be informed regarding the credentials of their caregivers, including the use of the title “doctor”."

The American Medical Association launched a campaign in 2011 for states to adopt "truth in advertising" legislation. As a result, many states now have laws in place that protect the title of doctor when offering medical services. In some jurisdictions, the use of the title in health care is limited to those who have both a doctorate and are licensed to practice medicine, and there is a requirement that the field of the doctorate be disclosed. Some other jurisdictions require the practitioner to hold a doctorate and to disclose the field, but make no stipulations as to licensing. Professional boards may also place limits on its use by the practitioners they regulate, e.g. requiring either a Ph.D. in psychology or a Doctor of Psychology degree to use the title while practicing as a psychologist. Some states require name badges to be worn in medical facilities giving first name, licensure status, and staff position, although these laws may not explicitly address the use of the title "Doctor".

Though lawyers in the United States do not customarily use the title, the law degree in that country is the Juris Doctor, a professional doctorate. Some J.D. holders in the United States use the title of doctor in professional situations, although ethics board decisions have varied on whether this is permissible or might mislead the public into believing the lawyer was medically qualified or had a PhD. It is also sometimes used by J.D. holders in academic situations. In 2011, Mother Jones published an article claiming that Michelle Bachmann was misrepresenting her qualifications by using the "bogus" title Dr. based on her J.D. They later amended the article to note that the use of the title by lawyers "is a (begrudgingly) accepted practice in some states and not in others", although they maintained that it was rarely used as it "suggests that you're a medical doctor or a Ph.D.—and therefore conveys a false level of expertise".

American professional doctorates are not generally considered doctoral level degrees internationally, instead being classified as bachelor's or master's level. The ISCED mapping for these degrees, developed collaboratively between the US and UNESCO, places them at master's level. As a result, holders of MD, JD, PharmD, etc. may not be permitted to use the title of Doctor in countries, such as Germany, where this is strictly controlled.

Europe

In the European Union, the title of doctor refers primarily to holders of post-graduate research doctorates, such as the PhD. In many European languages the term doctor is distinct from a medical practitioner, which can be referred to as e.g. läkare in Swedish, Arzt in German, dokter or arts in Dutch, or lääkäri in Finnish.

Standardisation of degrees into the three cycles of bachelor's–master's–doctorate across the European Higher Education Area (EHEA) is being carried out through the Bologna process, although not all EHEA member states have fully conformed to the 1999 Bologna declaration in favour of their own historic customs. With respect to the title "doctor", it should be noted that the Bologna process makes no prescriptions regarding the names of degrees nor the titles they may confer. However, under the Lisbon Recognition Convention, recognition of a foreign degree allows "the use of an academic title, subject to the laws and regulations of the country in which recognition is sought". According to the Explanatory report, this means that: "The competent authorities of the Parties may grant the right to use the title in the exact form in which it was awarded in the Party concerned or in any other form. They may alternatively grant the right to use the corresponding title of the country in which recognition is sought."

Austria

In Austria, the degree "Doktor" is granted to holders of research degrees (Dr. techn., Dr. phil., Dr. rer. nat., etc.).

In addition, the title of "Doktor" is granted to physicians (Dr. med. univ.) and dentists (Dr. med. dent.), which do not technically possess doctorate degrees, but Diplom-level degrees. A post-graduate research doctorate (Dr. med. univ. et sci. med.) can be obtained, for example, after three years post-graduate studies at a Faculty of Medicine.

All doctors may be addressed as "Doktor ______", and the title is usually contracted to "Dr. ______". Contrary to popular belief, "Dr." is not part of the name but a degree like "Mag." or "Dipl.-Ing.". It is not mandatory to use the title, although it can be added to official documents (driver's license, passport, etc.), if desired.

Finland

In Finland, the title of tohtori or doktor denotes holder of a research doctorate comparable to a PhD. Until recent years it was customary to first become licentiate (after the master's degree), which meant persons becoming doctors already had had quite a long academic career. Nowadays doctorate programs are available after the master's degree in many fields and becoming doctor at young age is much more common.

Getting the doctorate requires advanced studies after the master's degree, writing a thesis, nowadays often a thesis by publication, and publicly defending the thesis.

Physicians are in Finnish referred to as lääkäri (physician) unless they have a research doctorate.

France

In France, the title of Docteur is only used generally for physicians (médecin), but can also be used (although this is uncommon) by dentists and pharmacists, along with holders of research doctorates. Medical professionals do not normally hold a doctorate, which in France is used only to refer to a research doctorate, but a "State Diploma of Doctor of Medicine" (Diplôme d'État de docteur en médecine).

The law in France allows the title of Dr to be used professionally by the above medical professionals and by holders of research doctorates, with the field of their speciality being mentioned after the name. The courts have ruled that stating the specialisation is not necessary except in circumstances specifically related to professional practice; at other times the title alone may be used. The courts have also determined that questioning the right of the holder of a research doctorate to use the title Dr is a form of libel. The National Union if Hospital Scientists (Syndicat National des Scientifiques Hospitaliers) launched a campaign in 2015 to raise awareness of the right of scientists to use the title.

Germany

In German language-speaking countries, the word Doktor refers to a research doctorate awardee in formal language (similar to a PhD), and is distinct from Arzt, a medical practitioner, though colloquial use of the word Doktor for physician is common.

In Germany, the most common doctoral degrees are Dr. med. (medicine), Dr. med. dent. (dentistry), Dr. med. vet. (veterinary medicine), Dr. rer. nat. (natural sciences), Dr. phil. (humanities), Dr. iur. (law), Dr. rer. pol. (economic and political sciences, also as Dr. rer. oec. in Switzerland), Dr.-Ing. (engineering), and Dr. theol. (theology). All holders of doctoral degrees are appropriately addressed as "Herr/Frau Dr. _____" in all social situations.

In Germany, double doctorates are indicated in the title by "Dr. Dr." or "DDr." and triple doctorates as "Dr. Dr. Dr." or "DDDr.". More doctorates are indicated by the addition of "mult.", such as "Dr. mult.". Honorary titles are shown with the addition of "h.c.", which stands for "honoris causa". Example: "Dr. h.c. mult."

All people holding a doctorate from an EU member state are, since 2001, entitled to use and be titled (addressed) as "Doctor" or "Dr." in all formal, legal and published communications without any further addenda. For academics with doctorates from non-EU member states, the qualification must be recognised formally ("validated") by the Federal Educational Ministry in Bonn. The recognition process can be done by the employer or employee and may be part of the official bureaucracy for confirming professional status and is dependent on individual bilateral agreements between Germany and other countries and, since 2007, the Lisbon Recognition Convention. An example of mutual recognition of Doctor titles among EU countries is the "Bonn Agreement of November 14, 1994", signed between Germany and Spain (prior to the general recognition of EU doctorates).

In 2008, The Standing Conference of the Ministers of Education and Cultural Affairs of the Länder in the Federal Republic of Germany extended their 2001 decision to recognise EU PhDs to cover PhDs that were awarded in Australia, Israel, Japan, Canada, and some American universities. It was announced in 2012 that this would be further extended to cover PhDs awarded in New Zealand. PhDs that were awarded in the United States are recognized if the awarding institution is classified by the Carnegie Foundation for the Advancement of Teaching as a "Research University (high research activity)" or as a "Research University (very high research activity)." Permission to use the title covers only scientific research degrees and does not extend to professional degrees such as the M.D. or J.D.

Greece

In Greece, the title "Διδάκτωρ" (didaktōr) is used to reference holders of a doctorate degree, while the term "Ιατρός" (iatros) is used for physicians of any specialty.

Hungary

In Hungary, graduates of six-year medical schools (dr. med.), five-year dentistry schools (dr. med. dent.), five-year law schools (dr. jur.) and five-year veterinary medical schools (dr. vet.) receive the title of a doctor at the end of their studies, after completing and successfully defending their thesis; their undergraduate studies must have lasted for a minimum of three years. Completing a PhD research programme (or DLA in arts and music) also leads to the doctor title. Since 2008, also those who graduated of five-year pharmacy schools have the right to use the title "dr" (dr. pharm.).

A large part of Hungarians with doctor titles received their titles for research in the old academic system before PhD was introduced in Hungary. Since the introduction of PhD title (1993), the dr. univ title (given before 1993) is not recognised as a scientific title. The CSc Candidate of Science title was a scientific title in the old academic system and is now treated as an equivalent of PhD. CSc titles were awarded by the Hungarian Academy of Sciences.

The highest level doctoral degree in Hungary is DSc Doctor of Sciences, awarded by the Hungarian Academy of Sciences. It is also called Doctor of the Hungarian Academy of Sciences.

The title of doctor used to become a part of the name and was added as such to personal identity documents. This practice is still common and graduates after receiving their diploma would usually change their personal documents in order to officially indicate the achievement.

Ireland

Usage in Ireland is similar to that in the UK. The title of doctor is used for holders of doctoral degrees as well as for medical practitioners (except surgeons), dentists, and vets.

Italy

The first university of Western civilization, the University of Bologna, is located in Italy, where until modern times the only degree granted was that of the doctorate, and all other Italian universities followed that model. During the 20th century Italian universities introduced more advanced research degrees, such as the Ph.D., and now that it is part of the E.U. Bologna Process, a new three-year first degree, or "laurea" (equivalent to a B.A. of other countries), has been introduced. The old-style "laurea" is now known as "laurea magistrale/specialistica" (Bologna Process second cycle/ISCED 2011 Level 7). For historical reasons, even to this day, the title of "dottore/dottoressa" (abbrev. both as dott/dott.ssa or as dr./dr.ssa ) is awarded even to those who have studied for a "laurea". Upper levels of degree are anyway shown in the title, as those who obtain a master's degree can be referred to as "dottore/dottoressa magistrale" (masterly doctor) while those who achieve the relatively new program of "dottorato di ricerca" (research doctorate, equivalent of a Ph.D.), carry the title of "dottore/dottoressa di ricerca" (research doctor), which can be abbreviated as "Dott. Ric." or "Ph.D."

Malta

In Malta, the title of Doctor is used by academic doctors (with Ph.D.s), medical practitioners, dentists and lawyers. Its use by lawyers is due to the qualifying degree for practicing law having been the LLD until reforms in 2014, and has been described as "historical baggage" by the Dean of the University of Malta's law school. Lawyers do not generally use the title when practicing outside of Malta.

The Netherlands

In the Dutch language the word "dokter" refers to a physician, whereas "doctor" refers to the academic title. The doctor title is abbreviated as dr. placed before the holders name (note the lowercase).

To enter a Dutch doctoral defense, the candidate must hold a validated master's degree (a master's degree of an acknowledged university, or a master equivalent degree validated on a case by case basis by the Dutch government). In some cases the candidate can be granted special dispensation if no master's degree is held. There is no specific notation of the discipline in which the doctorate is obtained. Exceptions only exist for the disciplines with specific master titles of engineering "ir." ("ingenieur", i.e. Engineer) and law "mr." ("meester", i.e. Master of Law) where the title dr. is added to the original master title. For these disciplines, the original master's degree abbreviation is combined with the dr. abbreviation thus resulting in for example "dr. ir. Familyman". The dr. title is always placed in front of the ir. title. In the case of a PhD in law, the original mr. title is placed before the dr. title (mr. dr., see e.g. Jan Peter Balkenende). For a person having a law master's degree, but holding a PhD in another field than law the mr. title is placed after the dr. title (dr. mr.). No specific notation or title for the medical disciplines exists in the Netherlands. Although a physician is usually referred to as "dokter" (note the spelling difference) this does not necessarily imply the physician holds a doctoral degree; nor does it give the physician a title equivalent to that of PhD.

Confusion can be caused by the original Dutch Master level title "drs." (for all non-engineering and non-law master's degrees). This abbreviation stands for the Dutch title doctorandus Latin for "he who should become a doctor" (female form is "doctoranda"). Dutch drs. should not be confused with the plural 'doctorates': having a PhD in multiple disciplines. Once a doctorate is achieved the doctorandus is promoted to doctor, and no longer uses the drs. abbreviation.
Stacking of multiples titles of the same level, as seen in countries like for example Germany (Dr. Dr. Dr. Musterfrau) is highly uncommon in the Netherlands (although stacking of titles with different levels is common: prof. dr. ir. Appelmans). Those who have multiple doctor titles may use dr.mult. before their name, although this is rarely used.

After obtaining a doctorate successfully, Dutch doctors may bear either the title dr. (lower case) before, or the letter D (rarely in practice) behind their name, but not both simultaneously. In the Netherlands, Academic titles are used exclusively within academia. Holding a PhD title has become a standard requirement for a university career. The doctor title has little to no meaning or implications for public life outside academia. It cannot be added to documentation (e.g. passport, drivers licence), and is used infrequently in daily practice.

Historically, The Netherlands used their own academic degree nomenclature, but for many years now have recognised and implemented the Bologna declaration. In everyday practice, the Anglo Saxon titles (e.g. PhD) are frequently used. Dutch academic titles are legally protected. PhD degrees can only be granted by recognised (research) universities. Illegal use is considered a misdemeanor and subject to legal prosecution.

Portugal

In Portugal, up to recent times after the completion of an undergraduate degree – except in architecture and engineering – a person was referred to as doutor (Dr.) – male or doutora (Dra.) – female. The architects and engineers were referred by their professional titles: arquitecto (Arq.) and engenheiro (Eng.). Nurses ares also referred to as "nurse", enfermeiro (male) or enfermeira (female), the title being Enf. for both.

Nowadays Portugal is a signatory to the Bologna process and according to the current legislation the title of Doctor (doutor, doutora) is reserved for graduate holders of an academic doctorate. Professions such as physicians, attorneys, pharmacists, veterinarians, and few others are usually referred to by the title Dr. (doutor) even if they have not been awarded a doctoral degree.

However, custom gives the legislation little strength and most graduates use the Dr. title in its abbreviated form, although use of the full Doutor is normally restricted to those with doctorates.. Those who are both holders of an academic doctorate and Professors at a college level are generally referred to as Professor Doutor.

Spain

The social standing of Doctors in Spain is evidenced by the fact that only Ph.D. holders, Grandees and Dukes can take seat and cover their heads in the presence of the King.

Ph.D. Degrees are regulated by Royal Decree (R.D. 1393/2007), Real Decreto (in Spanish). They are granted by the University on behalf of the King, and its Diploma has the force of a public document. The Ministry of Science keeps a national database of doctoral theses called TESEO. Any person who uses the Spanish title of doctor/doctora (or Dr./Dra.) without being included in this Government database can be prosecuted for fraud. However, the Spanish Royal Academy recognises that it is used colloquially to describe medics, even without doctoral degrees, as well as (in the feminine form, doctora, abbreviated Dra.) the wives of doctors (i.e. holders of doctoral degrees) and medics, as well as "women who shine with wisdom and understanding".

Unlike other countries, until recently Spain has registered a comparatively small number of Doctor degree holders, but the tendency is changing. According to the Spanish Statistical Office (INE), less than 5% of M.Sc. degree holders are admitted to Ph.D. programs. This reinforces the prestige that Doctors have historically enjoyed in Spain's society.

United Kingdom

Doctor is commonly used in the United Kingdom as the title for a person who has received a doctoral degree or, as courtesy title, for a qualified medical practitioners who does not have a doctorate. There are no restrictions on the use of the title "Doctor" in the United Kingdom, except where, in commercial advertising, it might imply that the user holds a general medical qualification. The UK government allows medical doctors and holders of doctorates to have the title recorded on the observations page of their UK passport. The lack of legal restrictions was confirmed in Parliament in 1996 by health minister Gerald Malone, who noted that the title doctor had never been restricted by law to either medical practitioners or those with doctoral degrees in the UK, although the titles "physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner and apothecary" were protected.

According to the etiquette guide, Debrett's, holders of doctoral degrees and medical doctors (but not surgeons) should be addressed as "Doctor". It should be noted that for medical doctors, "Doctor" is a professional title rather than an academic one: it is due to their being a doctor rather than their having gained a doctoral degree. The Quality Assurance Agency states that "The use of the title 'Dr' by medical doctors is a historical abbreviation for the profession; it does not indicate a qualification at doctoral level".

Medical students in the UK normally complete a course of study leading to the degree of Bachelor of Medicine and Bachelor of Surgery (MBBS, BMBS or MBChB). The MD degree is not a qualifying degree in the UK, but can be either a professional doctorate (at the same academic level as a PhD), a doctorate by thesis, or a higher doctorate, depending on the university. To be eligible for an MD degree in the UK one must already hold an entry level medical degree (for example, MBBS, MBChB, BMed, or a North American MD degree) and usually must have had at least 5 years of postgraduate training and experience. Trainee doctors are permitted to use the title Doctor once they have started their post-graduation "Foundation Programme". The Advertising Standards Agency has ruled that practitioners of traditional Chinese medicine should not use the title doctor in adverts unless they hold a general medical qualification and are registered with the General Medical Council.

Debrett's states that medical doctors (except surgeons) should be addressed on envelopes as "Dr (full name), (medical qualifications)", e.g. "Dr John Smith, MD", "Dr Anne Jones, MB BS, FRCP", "Dr David Evans, MB ChB", contrary to the normal rule of not mixing titles and post-nominals. Surgeons (and dentists, if not holding a doctoral degree) should be "(full name), esq, (medical/dental qualifications)", e.g. "John Smith, Esq, MS, FRCS", "David Evans, Esq., BDS", but "Dr Anne Jones, DDS, FDS RCS",. By contrast, those holding (non medical or dental) doctoral degrees, if not surgeons, should be "Dr (full name)" without post-nominals on envelopes, e.g. "Dr John Smith".

The custom of not referring to surgeons (members and fellows of the Royal College of Surgeons) as Dr has been commented on in the British Medical Journal and may stem from the historical origins of the profession such as that some barbers also used to function as surgeons. In 2005, the then-president of the Royal College of Surgeons called upon surgeons to use the title of Dr, saying that the use of Mr or Miss was confusing to patients.

In a similar manner to the medical MBBS, dentists qualify with a Bachelor of Dental Surgery (BDS) and vets with a Bachelor of Veterinary Science (BVSc), Bachelor of Veterinary Medicine (BVetMed) or Bachelor of Veterinary Medicine and Surgery (BVMS). All of these are, like the MBBS, master's level qualifications that bear bachelor's designations for historical reasons.

Dentists have traditionally (as dental surgeons) been referred to in the same way as surgeons, but since 1995 the General Dental Council have permitted dentists to use the title "Doctor", though many do not choose to do this, thereby stressing their surgeon status. However, Debrett's continues to advises that dentists are normally addressed as surgeons and that the title "Doctor" is usually only used for dentists who have a doctoral degree.

On 5 March 2015 the council of the Royal College of Veterinary Surgeons (RCVS) voted to permit its members to use the courtesy title of "Doctor". Guidance from the RCVS says the title should be used either with the description "veterinary surgeon" or the postnominals "MRCVS" to ensure there is no confusion with doctors of human medicine or holders of doctoral degrees.

The General Chiropractic Council permits registered chiropractors to use the title "Doctor", although it advises chiropractors to avoid using the title in advertising or, if they do, to spell out that they are "Doctors of Chiropractic".

Holders of honorary doctorates in the UK have the right, in most cases, to use the title of Doctor, although holders are encouraged to refrain from doing so.

Wales

Wales follows UK usage in English. In Welsh, the holder of a doctoral degree is doethur while a medical doctor is doctor or meddyg. The title "y Doethur" is used by those holding doctorates, e.g. "y Doethur Brinley Jones", "y Doethur John Elfed Jones, which can be abbreviated "Dr". Medical doctors use, as in English, the title "Doctor", also abbreviated "Dr".

Australia

With the introduction of National Health Practitioner registration legislation on July 1, 2010, the title "doctor" is not restricted in any Australian state. The title "medical practitioner" is restricted for use by registered medical practitioners, while the title "doctor" is not restricted by law.

Abbreviation

In British English it is not necessary to indicate an abbreviation with a full stop (period) after the abbreviation, when the last letter of the abbreviation is the same as the unabbreviated word, while such a full stop is required in American English. This means that while the abbreviation of Doctor is usually written as "Dr" in most of the Commonwealth, it is usually written as "Dr." in North America. However, the US Postal Service prefers punctuation to be omitted from addresses.

Similarly, conventions regarding the punctuation of degree abbreviations vary. In the United Kingdom, it is normal also to omit stops from postnominal letters, thus the usual abbreviation of "Esquire" in postnominals is "Esq", and the usual abbreviation for "Doctor of Philosophy" is "PhD" (or "DPhil", where this is used). The fully punctuated "Ph.D." or "D.Phil." is anachronistic and, where the abbreviated form of the degree is defined by regulation rather than custom (e.g. Oxford), may be technically incorrect.

Honorary doctorates

An honorary doctorate is a doctoral degree awarded for service to the institution or the wider community. It may also be awarded for outstanding achievement in a particular field. This service or achievement does not need to be academic in nature. Often, the same set of degrees is used for higher doctorates, but they are distinguished as being honoris causa: in comprehensive lists, the lettering used to indicate the possession of a higher doctorate is often adjusted to indicate this, for example, "Hon. Sc.D.", as opposed to the earned research doctorate "Sc.D.". The degrees of Doctor of the University (D.Univ.) and Doctor of Humane Letters (D.H.L.), however, are only awarded as honorary degrees.

By convention, recipients of honorary doctorates do not use the title "Dr" in general correspondence, although in formal correspondence from the university issuing the honorary degree it is normal to address the recipient by the title. However, this social convention is not always scrupulously observed; notable people who defied social convention and used the honorary prefix include:

Other uses of "doctor"