Health professional qualifications may be difficult to understand even, in my experience, by health professional students. In this post I consider these questions and others:
What do all my doctor’s qualifications mean? Why are some surgeons referred to as Mr/Miss and some as Dr? Why is my English doctor not an MD but my American one is? When is a nurse a doctor? Do all health professionals have university degrees?
I qualified as a medical doctor in the United Kingdom (UK) and my medical degree is MBBS. My colleagues in the USA, Canada and many other countries have the degree MD after their names. The reasons for this are partly historical and partly due to a country’s university regulations.
In the UK until 1815 practitioners with a medical degree from a university were physicians and were addressed as ‘doctor’ because of their qualification: MD = Doctor of Medicine. Surgeons were a different group all together and largely learnt their trade as apprentices to experienced surgeons. They had no university qualifications, and so were addressed as Mr (They were all male.). In addition, there was a third group, the apothecaries, who sold medicines and dispensed physicians’ prescriptions from their high street shops. They also gave much cheaper advice than the gentlemen physicians and were early precursors of the general practitioner. In 1815 it became compulsory for all apothecaries to have a licence to practise from the Society of Apothecaries, and for surgeons to have a qualification from the Royal College of Surgeons. Subsequently, the Medical Act of 1858 decreed that all medical practitioners graduating from university should have qualifications in medicine, surgery and midwifery (later called obstetrics).
Medical students typically went to university straight from school and their medical qualifications were defined as a first degree, known as a Bachelor degree (from the Latin baccalaureus). Thus, MBBS = Bachelor of Medicine and Bachelor of Surgery. Variants are MBChB (Ch being chirurgie from the Latin) and BMBS depending on the medical school. As their program lasted 5-6 years, and in keeping with tradition, all medical students on graduation have the title Dr and this continues today. These qualifications are also found in other English-speaking countries such as Australia and New Zealand.
In some countries such as the United States and Canada aspiring doctors need to take a foundation degree of 3-4 years (eg pre-med) typically in health sciences at college/university before going to medical school for a further 4 years. Thus, their medical program is considered a higher degree than Bachelor and is a doctorate or MD. Some medical doctors in the USA have the qualification DO = Doctor of Osteopathic Medicine depending on the medical school.
In the last decade some medical schools in the UK and Australia have also offered graduate entry medical programs, similar to those of North America. Students obtain a first degree before studying medicine for 4 years. The qualification until very recently would still have been MBBS or similar, but now students are graduating as MD. (Yes – this is confusing!)
Following university, doctors enter a period of postgraduate training in order to become specialists/consultants (attending physicians in the US) in a particular area of medicine, for example surgery, internal medicine (adult medicine not including surgery), paediatrics, psychiatry or general practice. They may also later sub-specialise, for example abdominal surgery, cardiology (the heart and circulation), hand surgery etc. The length and structure of training vary depending on the specialty. Training ends in assessment and, if successful, a further qualification. In the UK, Australia, New Zealand and Canada, these qualifications are awarded by a royal college (royal because they have patronage from the British king or queen). Postgraduate qualifications may be membership or fellowship depending on the college and (sub)specialty, with fellowship usually being the more difficult to attain.
MRCP: Member of the Royal College of Physicians
FRCP: Fellow of the Royal College of Physicians
MRCGP: Member of the Royal College of General Practitioners
MRCS: Member of the Royal College of Surgeons
FRCS: Fellow of the Royal College of Surgeons
Australian, New Zealand and Canadian colleges have similar but are typically fellowships rather than memberships, for example:
FRACP: Fellow of the Royal Australasian College of Physicians
FRACS: Fellow of the Royal Australasian College of Surgeons
FRACGP: Fellow of the Royal Australian College of General Practitioners
FRNZCGP: Fellow of the Royal New Zealand College of General Practitioners
FRCPC: Fellow of the Royal College of Physicians of Canada
One example of a non-royal college:
FACRRM: Fellowship of the Royal Australian College of Rural and Remote Medicine
In the United States doctors must pass the examinations of the American Board of Medical Specialties (AMBS) in their specific area to become ‘board certified’. There are no abbreviations to demonstrate this, and many doctors just use MD rather than adding, for example, Board Certified in Internal Medicine.
But why are some surgeons still called Mr?
Again, this relates to tradition. In the UK when doctors become FRCS, they revert to their title of Mr just as in earlier centuries. Female surgeons may be Miss or Mrs – most seem to use Miss and I have never met a Ms.
In my opinion, one of the great advantages in being Dr is that the title is non-gendered and for females avoids the need to be categorised as Ms, Miss or Mrs. Younger doctors in the UK are starting to discuss getting rid of Mr/Miss altogether to avoid confusion.
What qualifications do other health professionals have and why are some called doctor?
Most health professions now require university qualifications either at Bachelor or Master level. (A Master degree is a postgraduate degree on top of a Bachelor that typically takes two or more years to achieve.)
There are many different qualifications in the same and across different professions and countries. Examples are:
BNurs: Bachelor of Nursing
BMid: Bachelor of Midwifery
MN: Master of Nursing
MNurs: Master of Nursing Science
MPharm: Master of Pharmacy
Master of Physiotherapy
Master of Radiography …
Some health professionals choose to do a university doctorate, such as a PhD = Doctor of Philosophy (this is typically a research-based degree taking from 3-7 years and is not restricted to philosophy!). This could be more specialised work in their profession. Some with an interest in health professions education may do a PhD in medical/clinical/nursing education.
A health professional with a PhD is entitled to be addressed as Dr. This has caused some consternation primarily amongst medical doctors who are worried that patients will be confused. Confusion may be avoided if everyone introduces themselves – see below.
Dealing with all those letters as a consumer
Health professionals may list their postnominals (the letters after their name) on their surgery or clinic doors, in their facility’s information brochure and/or on their websites. If you don’t know what they mean – ask. Or look them up. There are many more than listed here.
People can also check if a health professional is qualified and registered to practise their profession by looking them up on their national professional register, for example the General Medical Council (GMC) in the UK; AHPRA (Australian Health Professional Regulation Agency) in Australia.
Health professionals should introduce themselves in a first consultation and state their role/profession. In many locations, they will wear a badge with their name, title and role, but should still introduce themselves.
Hello my name is