What is the history associated with designating medical practitioners ‘Doctors’?
What is the meaning of Doctor?
Derived from the Latin “docere,” meaning to teach, the title “Doctor” was historically used for eminent scholars in fields such as divinity, law, and medicine, dating back to the Middle Ages. It was primarily reserved for those holding doctoral degrees.
Evolution of the “Doctor” Title:
- Pre-19th Century: The term “Doctor” was used for those with doctoral degrees in specific fields like law and medicine.
- 19th Century: The PhD became widespread, symbolizing academic achievement. However, the title “Doctor” was also adopted by unqualified practitioners, leading to public distrust.
- Lawyers and Doctors: Lawyers historically did not use the title “Doctor,” though the Juris Doctor (JD) degree became more common in the 20th century.
- Medical Usage: The title “Doctor” began being used for physicians without doctoral degrees. By the mid-18th century, it was commonly associated with medical practitioners.
Legal and Professional Use:
- UK Recognition (1838): The Royal College of Physicians recognized the title for diploma holders, but this was later revoked in response to the Medical Act of 1858.
- US Context: Regulation in the U.S. began in the late 19th century to prevent misuse of the title by unqualified individuals. By the mid-20th century, the title was associated with both medical doctors and PhD holders, though debates continued over its use by non-medical professionals, such as lawyers with JD degrees.
Who is called a doctor in India?
- Medical practitioner: The practitioner must be registered with the National Medical Commission (NMC) (formerly the Medical Council of India) or the respective State Medical Councils to legally practice medicine and use the title. This entitlement is based on the National Medical Commission Act, 2019, which governs modern medicine (allopathy) practitioners.
- Dentists: Holders of BDS (Bachelor of Dental Surgery) or higher qualifications in dentistry are entitled to use the title “Doctor”. Dentists must be registered with the Dental Council of India (DCI) to legally practice and use the “Dr.” prefix. This is regulated by the Dentists Act, of 1948.
- Veterinarians: Veterinarians with degrees such as BVSc & AH (Bachelor of Veterinary Science and Animal Husbandry) are allowed to use the “Dr.” prefix. They are regulated by the Veterinary Council of India under the Indian Veterinary Council Act, 1984.
- Ayurveda, Homeopathy, Unani, and Siddha Doctors (AYUSH): Practitioners of alternative medicine systems such as Ayurveda (BAMS – Bachelor of Ayurvedic Medicine and Surgery), Homeopathy (BHMS – Bachelor of Homeopathic Medicine and Surgery), Unani (BUMS – Bachelor of Unani Medicine and Surgery), and Siddha are allowed to use the “Dr.” prefix. These professionals are regulated by the respective councils, such as the Central Council of Indian Medicine (CCIM) and the Central Council of Homeopathy (CCH) under the Indian Medicine Central Council Act, 1970, and the Homeopathy Central Council Act, 1973.
- PhD Holders: Individuals holding a Doctor of Philosophy (PhD) or other doctoral degrees in academic disciplines are legally allowed to use the “Dr.” prefix, though this applies to their academic and research roles and not to medical practice. The University Grants Commission (UGC) Act governs the recognition of PhD degrees in India.
What are various Judicial rulings and governmental clarifications about Physiotherapists using the `Dr’ Prefix in India?
- Supreme Court of India on the Title of “Dr.” The Supreme Court has ruled that physiotherapists cannot be classified as medical doctors and should not be permitted to use the “Dr.” prefix in a manner that misleads the public. The court clarified that the prefix is traditionally reserved for allopathic doctors or those practising other recognized systems of medicine (like Ayurveda, Homeopathy, and Unani) under the Indian Medical Council Act, 1956. Physiotherapists, being rehabilitation professionals, do not fall under this category.
- Tamil Nadu High Court Rulings (2009-2011) The Tamil Nadu High Court has addressed multiple cases regarding the use of the “Dr.” prefix by physiotherapists. In 2009 and again in 2010, the court ruled that physiotherapists could not use the title “Dr.” in any official or public capacity unless they held a recognised medical degree such as MBBS. The court stated that using the title could mislead patients into believing that physiotherapists had the authority to diagnose and prescribe medicine, which they do not. There have been various court rulings in India regarding this issue, with some courts ruling that physiotherapists can use the “Dr.” prefix as long as they clearly indicate their profession (e.g., Dr. [Name], Physiotherapist or Dr. [Name], PT), to avoid misleading patients. However, physiotherapists are not authorised to use the “Dr.” title in a way that suggests they are medical doctors. They must make it clear that their doctorate is in physiotherapy or a related healthcare profession.
- State Government Clarifications: The state government of Tamil Nadu have issued clarifications that physiotherapists are not allowed to use the “Dr.” prefix without a clear indication that they are physiotherapists. For instance, in Tamil Nadu, the government’s directive in 2009 explicitly forbade physiotherapists from using the title unless they made their specific field of practice clear.
- Indian Association of Physiotherapists’ Defence: In response to opposition from the Indian Medical Association (IMA) and other medical bodies, the Indian Association of Physiotherapists (IAP) has argued that physiotherapists undergo rigorous medical education and should be allowed to use the “Dr.” prefix. However, this stance has been met with resistance from medical councils and government bodies, leading to continued legal and regulatory challenges.
What policy do other countries follow in allowing physiotherapists to use the `Dr’ prefix?
- United States: In the U.S., many physiotherapists hold a Doctor of Physical Therapy (DPT) degree, a professional doctoral-level qualification. DPT graduates are allowed to use the “Dr.” prefix, but it is important that they clearly specify their field (e.g., “Dr. [Name], Physical Therapist”) to avoid confusion with medical doctors (MDs). American Physical Therapy Association (APTA) guidelines encourage the use of the “Dr.” prefix by DPTs as long as their profession is made clear. This helps distinguish their qualification while maintaining transparency in their interactions with patients.
- Canada: In Canada, physiotherapists who have earned a Doctor of Physical Therapy (DPT) or equivalent degree can also use the “Dr.” prefix, provided that they clearly identify themselves as physiotherapists. The practice is regulated by provincial healthcare authorities, and the use of the title is allowed in most provinces under the same condition of clarity in professional identity. Some provinces, like Ontario, require physiotherapists to explicitly state their role to avoid misleading patients about their medical qualifications.
- Australia: In Australia, physiotherapists are generally not allowed to use the “Dr.” prefix unless they hold a PhD or another doctorate-level qualification. Physiotherapists with a PhD in the field can use the title “Doctor” but must make it clear that their doctorate is in physiotherapy, not medicine. The Australian Health Practitioner Regulation Agency (AHPRA) regulates this to prevent misrepresentation. The use of “Dr.” is not common for physiotherapists in clinical practice in Australia unless they have a PhD.
- United Kingdom: In the UK, physiotherapists typically do not use the “Dr.” prefix unless they have earned a doctoral degree, such as a PhD. Even with a PhD, the title must be used with a clear indication of their profession (e.g., “Dr. [Name], Physiotherapist”). UK regulations are generally conservative, and the title “Dr.” is reserved for medical doctors or PhD holders, with strict rules on how the title can be used to avoid confusion.
- South Africa: In South Africa, physiotherapists can use the “Dr.” prefix if they hold a PhD or a Doctorate of Physiotherapy (DPT). Like other countries, they must clarify their profession to avoid confusion with medical doctors.
- New Zealand: In New Zealand, physiotherapists with a Doctor of Physiotherapy (DPT) or PhD are permitted to use the “Dr.” title, provided they make it clear that they are not medical doctors. They are required to add their professional designation after their name (e.g., Dr. [Name], Physiotherapist) to maintain transparency.
- European Countries: In Germany and many other European countries, physiotherapists do not typically use the “Dr.” prefix unless they have completed a PhD. The title “Dr.” is reserved for those with a recognised doctoral-level qualification, and physiotherapists without such a qualification are not allowed to use the title in clinical practice. In Sweden and Norway, similar restrictions apply, and the title “Dr.” is typically reserved for medical professionals or those with a PhD.
For more details, read the following blog titled: Conclusion: The Future of Physiotherapy in India: Autonomy, Challenges, and Patient-Cantered Care under the NCAHP Act 2021