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", 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."
In Austria, the degree Doktor is granted to holders of research degrees (ISCED 8) with a denoting Latin particle being added (Dr. techn., Dr. phil., Dr. rer. nat., Dr.iur., Dr.theol. etc.). Newer study programmes award a PhD, but these exist alongside the older degrees since many prefer obtaining a Dr. to a PhD. These degrees take 3–4 years full-time and are organised in doctoral schools.
In addition, the academic degree Doktor (ISCED 7) is granted to physicians (Dr. med. univ.) and dentists (Dr. med. dent.), who since 2002 do not obtain doctoral degrees (ISCED 8) but instead follow a master's level six-year training (360 ECTS) programme, similar to an American MD or DDS. For these degrees, students have to write a Diplomarbeit thesis of 50-100 pages. Research doctorates in medicine (Dr. scient. med. or PhD) can also be obtained after a three-year full-time post-graduate study programme at a medical university.
All doctors may be addressed as "Doktor _____"; the title is usually contracted to "Dr. _____", oftentimes they are just addressed as "Herr/Frau Doktor" (Mr/Ms Doctor), omitting the family name unless they are being introduced to someone.
Contrary to popular belief in the country, the title "Dr." is not part of a person's name or a specific honour but simply a degree like BSc/BA, Mag (MA/MSc) or Dipl.-Ing. (MEng). It is not mandatory to use it, although it may be added to official documents (e.g. driver's licence, passport), if desired.
In Finland, the title of tohtori or doktor denotes holder of a research doctorate comparable to a PhD. 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. Customary doctorates do not exist even in the field of medicine: physicians hold the degree of lääketieteen lisensiaatti (Licentiate of Medicine), and are referred to simply as lääkäri (physician); "tohtori" would be rustic or old-fashioned. A research doctorate in medicine, lääketieteen tohtori, requires further research work and a separate doctoral thesis, and is not taken by all medical graduates. Regardless, in Finnish usage, the use of titles is uncommon and restricted to only the most formal of contexts.
In France, the title of Docteur is only used generally for physicians (médecin) but can also be used by holders of research doctorates. Medical professionals do not normally hold a doctorate, which in France always refers 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 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 of Hospital Scientists (Syndicat National des Scientifiques Hospitaliers) launched a campaign in 2015 to raise awareness of the right of scientists to use the title.
In German language-speaking countries, the word Doktor refers to a doctorate awardee in formal language (similar to a PhD). It is distinct from Arzt, since a doctoral degree is not a requirement for medical practitioners, though colloquial use of the word Doktor for physician is common and ordinary people often incorrectly assume that only Doktors may practice medicine. For this reason, 80% of all students in medicine write "doctoral" dissertations, often comparable to a master's thesis in science, alongside their undergraduate studies to obtain a Dr. med. degree. The European Research Council decided in 2010 that those Dr. med. doctorates do not meet the international standards of a PhD research degree.
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." Some honorary titles are shown by addition of German equivalents of "h.c.", like "e.h.", "E.h.", or "eh.", which stand for "ehrenhalber" (honorary). Example: "Dr. e.h. mult."
All people holding a doctorate from an EU member state are, since 2001, entitled to use "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 MD or JD.
In Greece, doctor "Διδάκτωρ" (didáktor) is indicated in the title as Δρ and it is used for holders of doctoral degrees. Other alternative names are also used, namely «δόκτωρ» and «δόκτορας», derived from the French "docteur". The term "Ιατρός" (iatrós) indicates medical practitioners.
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). 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.
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. The title is also used in Ireland for Catholic bishops, who are styled "The Most Reverend Dr X, Bishop of Y" on envelopes.
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 PhD.
Italian academia is part of the Bologna Process, and has standardised its degrees as part of the 3+2+3 formula. The undergraduate degree "laurea" was reduced to 3 years (making it equivalent to a bachelor's degree). This is followed by a 2-year "laurea magistrale" (literally "magistral degree", equivalent to a master's degree). The old-system "laurea", which lasted about 5–6 years and is now discontinued, were made equivalent to a "laurea magistrale". Few fields retain the 5-6 year system (such as law and medicine) but are called "laurea magistrale a ciclo unico" and are an integrated master's degree. Finally, the Italian system also introduced a doctorate ("dottorato di ricerca"), which lasts 3 years and is the terminal degree of the educational hierarchy, corresponding to a PhD.
For historical reasons, the title of doctor is awarded to all university degree holders. "Laurea" holders are awarded the title of doctor (dottore/dottoressa), "laurea magistrale" holders are awarded the title of magistral doctor (dottore magistrale/dottoressa magistrale), and doctorate holders are called research doctors (dottore di ricerca/dottoressa di ricerca).
In Malta, the title of Doctor is used by academic doctors (with PhDs), 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.
In the Dutch language doctor is used both for physicians and for the academic title, however the spelling differs with "dokter" referring to a physician, whereas "doctor" refers to the academic title. Both doctor titles are 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. Once the doctorate is obtained the preceding master's degree is generally no longer reported. 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 multiple PhDs. 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 doctorate 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 and degrees are legally protected, and as of 2021 the traditional ’dr.’ and the PhD are legally equivalent and can be used interchangeably. Doctoral degrees (PhD degrees) can only be granted by recognised (research) universities. Illegal use of the title is considered a misdemeanour and subject to legal prosecution.
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 are 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.
The social standing of Doctors in Spain is evidenced by the fact that only PhD holders, Grandees and Dukes can take seat and cover their heads in the presence of the King.
PhD Degrees are regulated by Royal Decree (RD 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 physicians, 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 MSc degree holders are admitted to PhD programs. This reinforces the prestige that Doctors have historically enjoyed in Spain's society.
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 practitioner or dentist 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". For medical doctors, "Doctor" is a professional title rather than an academic one: it is due to their being a medical practitioner 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". On guest lists and seating plans for formal events, holders of academic doctorates (but not medical doctors or other people using the title as a courtesy title) are listed either as "Dr John Smith" or "John Smith, Esq, PhD", while untitled men (other than those holding doctorates) are shown as either "Mr John Smith" or "John Smith, Esq" (as appropriate to ensure the styling remains consistent). The title "Dr" is also used on visiting cards.
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".
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".
A & C Black's Titles and Forms of Address diverges from Debrett's on how to address envelopes to medical doctors, omitting the pre-nominal title of Dr (e.g. John Smith, Esq, MD; John Smith, MD; John Smith, MB) except in Scotland and for general practitioners, where the post-nominals are instead usually omitted (e.g. Dr John Smith). Black's also state that it is down to individual choice whether non-medical doctors are addressed on envelopes as "Dr John Smith" or "John Smith, Esq, PhD" (or appropriate letters for the doctorate held), with the exception of doctors of divinity, who would be "The Rev. J. Smith, DD" on the envelope and "Reverend Sir" in a formal salutation (informally in the salutation "Dear Dr Smith", and "Dr Smith" in speech).
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. Black's note that gynaecologists are addressed as surgeons in England and Wales but as doctors elsewhere.
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.
Optometrists are not permitted to use the title "Doctor" based on their initial qualification (BOptom or BSc (Optom)). Optometrists can earn PhDs or Doctor of Optometry degrees (in the UK a PhD-level qualification for qualified optometrists with experience in practice). Ophthalmologists are fully qualified medical doctors. However, ophthalmology is considered a branch of surgery, thus ophthalmologists, like other surgeons in the UK, do not use the title "Doctor".
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". The Committee of Advertising Practice advises, however, that "references to 'DC' or 'doctor of chiropractic' are unlikely to dispel that misleading impression [of being a medical practitioner], when used in conjunction with unqualified references to the prefix 'Dr'", saying that the use of the title by chiropractors may be acceptable in advertising if "clearly and prominently qualified with additional text which makes clear it is a courtesy title and that the practitioner does not hold a general medical qualification".
The Advertising Standards Authority 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. It similarly advises that osteopaths should not use the title unless holding a general medical qualification. There have also been rulings that an advert for an osteomyologist which referred to him as a doctor was misleading, as was an advert which used the title "Dr" and the post-nominals "PhD" on the basis of a PhD from an unaccredited university.
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. Black's says that "The same rules apply as to other holders", although notes that the post-nominals would not normally be used.
In some circumstances, "doctor" may be used on its own as a form of address rather than as a title before a name. This is limited to when the person is being addressed by their job title and so is only used for medical doctors.
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".
In countries that were formerly Yugoslavian republics, such as Bosnia and Herzegovina, Croatia, North Macedonia, Montenegro, Serbia and Slovenia the title formally belongs to holders of academic doctoral degree such as doctor of science (dr. sc.) or doctor of arts (dr. art.) degree. There is no "Ph.D." in any of those countries, even though when holders are translating their dr. sc. degree to English, they nevertheless use "Ph.D.", even though it should be "D.Sc." or "Sc.D.".
Informally, the title, in both its full and abbreviated form (i.e. "dr.") is used honorifically to address medical doctors even in more formal environment like in lectored media texts, however officially it is reserved only for the holders of academic degrees. Formally the professional title for medical doctor is "lijekar" in Bosnian and Montenegrin, "liječnik" in Croatian, "lekar/лекар" in Macedonian and Serbian and "zdravnik" in Slovenian and they can hold different academic degrees, as well as additional honorific title of Primarius that is given to distinguished specialists with exemplary reputation and achievements.