Use of Dr is perhaps even more confusing in Germany than UK

Editor—Loudon and Crisp described the confusion surrounding the use of the title of Dr.¹,² To confuse the issue more, I will describe what happens in Germany. Here the differentiation between the titles of Dr and Mr or Mrs is quite clear. Contrary to the United Kingdom, where the title tells us something about the working field of the physician, the German differentiation is fully based on having earned an academic MD title (German term: Dr med.) or not. Therefore, German doctors are desperately trying to earn an MD title to be called Dr by the patients, as being called just Mr or Mrs is a clear sign of inferiority. People who are Mr or Mrs usually do not reach the position of a head of department.

After having passed the preliminary medical exams, German medical students are allowed to start with their MD thesis. As the research interests and abilities vary from student to student, but each individual tries to earn an MD title, the quality of German MD theses varies widely.

Furthermore, as in Germany someone with a PhD is also called Dr (of natural sciences, for example), patients may confuse the profession of a person called Dr completely—for example, when encountering a doctor in chemistry but expecting a physician.

The disaster is compounded by the title of professor. This can be only be achieved after having completed a second thesis, called habilitation, which is comparable to a high quality PhD thesis, usually covering at least the authorship in 20 peer reviewed research papers. Having received the habilitation, your job title is initially that of a private lecturer, and after about four years of continuous research you are entitled to be called an associated professor. There are about 10 000 to 20 000 medical professors in Germany. Most of them are head of departments in peripheral hospitals and have stopped doing research.

Thus the British system is not as absurd as it seems if you compare it with that in other countries.