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Doctor (title)

Academic title for a holder of a doctoral degree

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Aquatint of a Doctor in divinity at the University of Oxford, shown wearing convocation dress.
Rudolph Ackermann (1764 - 1834) · Public domain

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Through University, Middle Ages and Christianity

Having become established in European universities, this usage spread around the world. Contracted "Dr" or "Dr.", it is used as a designation for a person who has obtained a doctorate (commonly a PhD). In past usage, the term could be applied to any learned person. In many parts of the world today it is also used by medical practitioners, regardless of whether they hold a doctoral-level degree or not.

Origins

The doctorate (Latin: doceō, lit. 'I teach') appeared in medieval Europe as a license to teach (licentia docendi) at a medieval university.

The roots of the term doctor 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 church authorities and the slowly emancipating universities, but was granted by the pope to the University of Paris in 1213, when it became a universal license to teach (licentia ubiquie docendi). However, while the licentia continued to hold more prestige than the bachelor's degree (Baccalaureus), it was eventually positioned below the magister and the doctorate, which became the only titles with which one could teach.

The earliest doctoral degrees — in theology, law, and medicine — reflected the historical separation of university study into these three fields. Over time, the Doctor of Divinity has become less common, whereas studies in law and medicine have become more common. These areas were historically referred to as "philosophy" (used as a general term for academic studies, not the specific academic discipline of philosophy), but are now classified as humanities and sciences, respectively. The historical usage survives in the degree of Doctor of Philosophy.

The Doctor of Philosophy 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 "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 PhD 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 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 now 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 territories of Goa in India and 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, PhDs became increasingly common in Britain, although to obtain the degree it was necessary 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 and 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 (LLB). Similarly in the US, even though degrees became standard for lawyers much earlier, the degree was again the LLB, only becoming the Juris Doctor (JD) 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 did not 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 license 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 MDs, 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 (at the time) 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.

By the 1940s, the widespread usage of the title in the US was under threat. A 1944 article claimed that "the Ph.D. has immediate and far-reaching value of social as well as economic nature" due to America's "national fondness for the tinsel of titles", but went on to note that some universities were moving away from using the title, concluding that "it is ungracious in most environments not to render unto the Doctor of Philosophy his 'Doctor' title". The same writer noted in a letter to the Journal of Higher Education in 1948 that Alfred University had banned the use of the title for faculty (while retaining it for the president and deans) "in a strange move professedly designed to uphold and promote 'democracy' and 'Americanism'". However, it was noted in 1959 that professors with PhDs were now generally addressed as "Doctor", with the title of "Professor" sometimes being substituted for those without doctorates, leading to a decline in the perceived value of that title. In the 1960s the inconsistent usage at American universities and colleges was mentioned in the New York Times Book Review and the editor of Science noted that: "In some universities, administrators call all Ph.D.'s 'Mister,' but students and colleagues call them 'Doctor.' Often, but not always, Ph.D.'s are 'Misters' socially. In industry and government, both socially and professionally, they are 'Doctors,' as they are also in the pages of the New Yorker, Time, the Saturday Review, and the New York Times." In 1965, the League of Women Voters designated MDs "Dr." and PhDs "Mr." at a hustings in Princeton, leading to a letter of protest in Science; it was reported that the League believed PhDs would be embarrassed by the title, and that etiquette writers differed in whether PhDs used the title. In 1970, reverse snobbism in the face of the rising number of "discount doctorates" was linked to professors at prestigious universities wanting to be called "mister".

In the late 1960s the rising number of American law schools awarding Juris Doctor (JD) degrees led to debate over whether lawyers could ethically use the title "Doctor". Initial informal ethics opinions, based on the Canons of Professional Ethics then in force, came down against this. These were then reinforced with a full ethics opinion that maintained the ban on using the title in legal practice as a form of self-laudation (except when dealing with countries where the use of "Doctor" by lawyers was standard practice), but allowed the use of the title in academia "if the school of graduation thinks of the J.D. degree as a doctor's degree". These opinions led to further debate. The introduction of the new Code of Professional Responsibility in 1969 seemed to settle the question – in states where this was adopted – in favour of allowing the use of the title. There was some dispute over whether only the PhD-level Doctor of Juridical Science should properly be seen as granting the title, but ethics opinions made it clear that the new Code allowed JD-holders to be called "Doctor", while reaffirming that the older Canons did not. As not all state bars adopted the new Code, and some omitted the clause permitting the use of the title, confusion over whether lawyers could ethically use the title "Doctor" continued. The introduction of further professional doctorates in the US at ISCED level 7, the same as the MD and JD, has led to continuing debate about the use of the title by holders of such degrees, particularly in medical contexts.

In 2018, a decision by The Globe and Mail newspaper in Canada to update its style guide so as to restrict the use of the title Doctor to medics led to a backlash on Twitter, particularly by women with PhDs, using the #ImmodestWomen hashtag. This was widely reported on internationally and led to The Globe and Mail reverting to its earlier style of using Doctor for both physicians and PhD holders. The Canadian University of Calgary also announced that it would adopt the use of Doctor for those with doctoral degrees, breaking with the style recommended by the Canadian Press.

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