Mister or Doctor?

Why are surgeons trained in the UK called Mr or Miss or Mrs, rather than Dr?

In most other parts of the world all medical practitioners, physicians and surgeons alike, are referred to as ‘Dr’ whereas in the UK surgeons are usually referred to as Mr, Miss or Mrs. This is because, from the Middle Ages physicians had to embark on formal university training to gain possession of a degree in medicine before they could enter practice. The possession of this degree, a doctorate, entitled them to the title of ‘Doctor of Medicine’ or Doctor.

The training of surgeons until the mid-19th century was different. They did not have to go to university to gain a degree; instead they usually served on apprenticeship to a surgeon. Afterwards they took an examination. In London, after 1745, this was conducted by the Surgeons’ Company and after 1800 by The Royal College of Surgeons. If successful they were awarded a diploma, not a degree, therefore they were unable to call themselves ‘Doctor’, and stayed instead with the title ‘Mr’.

Outside London and the largest cities the surgeon served an apprenticeship like many other tradesmen, but did not necessarily take any examination. Today all medical practitioners, whether physicians or surgeons have to undertake training at medical school to obtain a qualifying degree. Thereafter a further period of postgraduate study and training through junior posts is required before full consultant surgeon status is achieved. Thus the tradition of a surgeon being referred to as ‘Mr/Miss/Mrs’ has continued, meaning that in effect a person starts as ‘Mr/Miss/Mrs’, becomes a ‘Dr’ and then goes back to being a ‘Mr’; ‘Miss’ or ‘Mrs’ again!

BUT

Surgeons are set to end 150 years of inverse snobbery by dispensing with the title of "Mr" or "Miss" and adopting the more elevated "Dr", like their physician colleagues.

Moves are afoot to end the centuries-old tradition which sees the most highly lauded and best rewarded members of the medical establishment addressed by the same title as plumbers and butchers.

Increasing confusion among patients over the proliferation of medical titles has forced a rethink. Nurses, dentists and podiatrists are among those trained to wield the knife. Some surgeons have grown anxious that the modesty of their title may lead patients to overlook their importance.

Hugh Phillips, president of the Royal College of Surgeons, writes in the May issue of the Annals of the College: "The important thing [is] that the patient knows who is treating them. Titles are confusing to patients; perhaps there is a good case for surgeons returning to the title of 'doctor' as in the rest of the world."

He said yesterday: "There will be people who feel very strongly about the use of 'Mr'. If you wear a white coat and you are called 'Mr' you are slightly different. It's the old tribalism and we have to get rid of it. I have started the debate and no doubt people will respond to it."

The use of the title dates back to the Middle Ages when surgeons served an apprenticeship, like other tradesmen, while physicians required a university degree in medicine before they could enter practice. On account of their university training physicians were entitled to call themselves "doctor of medicine".

Since the mid-19th century, surgeons have also had to obtain a university degree in medicine. As a result, today's surgeons start out as "Mr" or "Miss" in medical school, become "Dr" on qualifying and revert to "Mr" or "Miss" when they pass surgical exams for the Royal College.


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In 1800, the Royal College of Surgeons of England (RCS) in London began to offer surgeons a formal status via RCS membership. The title Mister became a badge of honour, and today after someone graduates from medical school with the degrees MBBS or MB ChB, (or variants thereof) in these countries they are called "Doctor" until they are able, after at least four years training, to obtain a surgical qualification: formerly Fellow of the Royal College of Surgeons but also Member of the Royal College of Surgeons or a number of other diplomas, they are given the honour of being allowed to revert back to calling themselves Mr, Miss, Mrs or Ms in the course of their professional practice, but this time the meaning is different.

Holders of FRCS (and the new, but not old, Membership - MRCS) often choose to relinquish their title of "Doctor", reverting to "Mr", "Mrs" or "Miss". This is a relic from times past when surgeons did not attend medical school and were simply skilled tradesmen, amputating limbs or removing bladder stones, and learning their skills through apprenticeship. Note that in 1540, the United Barber Surgeons Company, a tradesmen's guild, was formed by Henry VIII, as many people practised both. In 1745, surgeons were formally separated from barbers by George II.

An alternative explanation is the section of the Hippocratic Oath which runs: "I will prescribe regimens for the good of my patients according to my ability and my judgement and never do harm to anyone," - surgery by its implicit nature does harm to the patient, so the surgeon was not considered worthy of the title "Doctor". Again, this is an ancient practice, that has remained to this day even though it has no real grounding.

"Doing no harm" can be applied to prescribing (by physicians) as much as to operating. Also, many Greek practitioners who followed Hippocrates performed surgery as well as prescribing medicine. Additionally, the change of title is confined to the United Kingdom, and is not practised in other countries where the Hippocratic Oath may be widely espoused.