with an earned doctoral degree may use the title "doctor" in conjunction with professional practice. some professionals earn degrees with the title of doctor but which are considered, despite their name, to be at bachelor's-level, e.g. dds, md, jd. in ontario, registered naturopathic doctors may only use the title "doctor" in written format if they also use the phrase, "naturopathic doctor" immediately following their name, while a 2006 amendment that would allow practitioners of traditional chinese medicine to use the title has not, as of 1 august 2016, entered into force. as of 2022, in alberta, doctors of acupuncture may use the doctor title. quebec the usage of the french docteur and docteure, and their abbreviated forms dr, dre, dr and dre, is controlled by the code des professions. as a pre-nominal title it can be used without any further explication by physicians, veterinarians, and dentists. it can also be used prenominally, when accompanied by the name of the profession immediately after the name, by professionals who require a doctorate for their professional licence, such as psychology, and chiropractic, e.g. dr x, psychologue or dr y, chiropraticien. academic doctors, where the doctorate is not required to practice, bear the title only after their name; this is not abbreviated, e.g. m. z, docteur en philosophie not m. z, phd united states in the united states, the use of the title "doctor" is dependent upon the setting. the title is commonly used socially by physicians and those holding doctoral degrees; however, there was formerly a division between letitia baldrige and miss manners on its social usage by those who are not physicians. baldrige saw this usage as acceptable, while in contrast, miss manners wrote that "only people of the medical profession correctly use the title of doctor socially," but supports those who wish to use it in social contexts in the spirit of addressing people according to their wishes. miss manners has since softened her approach, noting in her the washington post column that there are two approaches: "having been earned, it should be used" and "that level of education being assumed, it need not be expressly mentioned"; while she maintains that everyone should be addressed according to their wishes, she no longer states that only medical professionals use the title correctly but instead acknowledges that the title has been earned by those with phds. the emily post institute similarly advises that "socially as well as professionally, medical doctors, dentists, and other professionals are addressed by, and introduced with, their titles. people who have earned a ph.d. or any other academic, nonmedical doctoral degree have the choice of whether to use "dr." both professionally and socially." other advice columns have also noted that "it has become common to see someone with a ph.d. addressed on the envelope as dr., and as a consequence, deviation from convention has become acceptable." the 2017 book etiquette rules! gives identical forms for addressing a "doctor of medicine (md), dental surgery (dds), veterinary medicine (dvm), etc.", and the holder of a phd, advising in both cases the use of initials after the name for formal correspondence and dr. before the name for social correspondence. although the usage of the title by ph.d. graduates has become common, its use socially by holders of professional doctorates (other than those noted) is neither explicitly endorsed nor explicitly discouraged by writers on etiquette. miss manners has, however, stated that a physician who has had their license revoked should be addressed by their former preferred honorific (i.e. not according to their md degree). it is unusual for those who hold honorary doctorates to use the title "doctor". publications from the office of the president of the united states of america also refer to phd holders as dr. soandso, and jill biden, who holds an edd, used the style "dr. jill biden" as second lady and has continued to do so as first lady. for addresses (defined as "the conventional forms of address as determined by social and official custom"), nasa uses "dr. (full name)" in addresses for phd holders while for physicians it uses "(full name), md", although both are addressed as "dr. (surname)" in the salutation (which is described as "informal"). the national institutes of health similarly use "dr. (surname)" in salutations for people with an md, phd or dds. they advise using full name followed by degrees in addresses, explicitly stating not to use the title "dr.", although an example in the following paragraph does use the title rather than giving degrees. most newspapers in the us follow the ap stylebook and reserve the title for physicians in their house styles; notable exceptions include the new york times, which follows the preference of the individual when referring to phd holders (although the title is not used for those with honorary doctorates), and the wall street journal, which similarly prefers "dr." for phd holders and physicians (if this is the person's choice) while stating explicitly that the title is not used for lawyers with jds or people with honorary doctorates. until 1989, the washington post used the title for "practitioners of the healing arts (including chiropractors and osteopaths) but not for holders of phds or honorary degrees", after which it dropped its use entirely. some sources state that ap style allows the use of dr. for holders of non-medical doctoral degrees as long as their speciality is given. the expansion of professional doctorates in clinical fields in the late 20th and early 21st centuries has led to disputes between physicians and other medical professions over who can use the title in a clinical context. this has been interpreted by some as part of larger battles within medicine, such as who gets to treat patients first and who has prescribing authority. the american medical association calls for non-physicians (those not holding an md or do) who use the title "doctor" and are in direct contact with patients to clarify that they are not physicians and to "define the nature of their doctorate degree", while the american osteopathic association opposes the use of the title by non-physicians in clinical settings absolutely as (in their view) "such use deceives the public". contrary to this, the emergency nurses association has adopted as a position statement that "1. nurses are entitled to have their educational degrees recognized and acknowledged in the same manner as other professions. 2. the proper title protection and use of accurate credentials is appropriate in the clinical setting. 3. when being addressed or introduced as doctor in the clinical environment, it is responsible practice for all healthcare providers to clarify their professional role. 4. patients, families and the general public have a right and expectation to be informed regarding the credentials of their caregivers, including the use of the title "doctor"." the american medical association launched a campaign in 2011 for states to adopt "truth in advertising" legislation. as a result, many states now have laws in place that protect the title of doctor when offering medical services. in some jurisdictions, the use of the title in health care is limited to those who have both a doctorate and are licensed to practice medicine, and there is a requirement that the field of the doctorate be disclosed. some other jurisdictions require the practitioner to hold a doctorate and to disclose the field, but make no stipulations as to licensing. some states require name badges to be worn in medical facilities giving first name, licensure status, and staff position, although these laws may not explicitly address the use of the title "doctor". although lawyers in the united states do not customarily use the title, the law degree in that country is the juris doctor, a professional doctorate. some jd holders in the united states use the title of doctor in professional situations, although ethics board decisions have varied on whether this is permissible or might mislead the public into believing the lawyer was medically qualified or had a phd. it is also sometimes used by jd holders in academic situations. in 2011, mother jones published an article claiming that michele bachmann was misrepresenting her qualifications by using the "bogus" title dr. based on her jd the article was later amended to note that the use of the title by lawyers "is a (begrudgingly) accepted practice in some states and not in others", although they maintained that it was rarely used as it "suggests that you're a medical doctor or a ph.d.—and therefore conveys a false level of expertise". ecclesiastical seminaries and entitled churches award their own doctorates in the united states, e.g. the doctor of religious science (dr. sc. rel.), the doctor of divinity (dd), the doctor of biblical studies (dbs) or the doctor of metaphysics (dr. mph.). these titles are most commonly awarded to meritorious clerics for their outstanding work or another achievement in the field of religious and biblical studies. american professional doctorates are not generally considered doctoral level degrees internationally, instead being classified as bachelor's or master's level. the isced mapping for these degrees, developed collaboratively between the us and unesco, places them at master's level. as a result, holders of md, jd, pharmd, etc. may not be permitted to use the title of doctor in countries such as germany where this is strictly controlled. europe in the european union, the title of doctor refers primarily to holders of post-graduate research doctorates, such as the phd. in many european languages the term doctor is distinct from a medical practitioner, which can be referred to as e.g. läkare in swedish, arzt in german, dokter or arts in dutch, or lääkäri in finnish. standardisation of degrees into the three cycles of bachelor's–master's–doctorate across the european higher education area (ehea) is being carried out through the bologna process, although not all ehea member states have fully conformed to the 1999 bologna declaration in favour of their own historic customs. with respect to the title "doctor", the bologna process makes no prescriptions regarding the names of degrees nor the titles they may confer. however, under the lisbon recognition convention, recognition of a foreign degree allows "the use of an academic title, subject to the laws and regulations of the country in which recognition is sought". according to the explanatory report, this means that: "the competent authorities of the parties may grant the right to use the title in the exact form in which it was awarded in the party concerned or in any other form. they may alternatively grant the right to use the corresponding title of the country in which recognition is sought." austria in austria, the degree "doktor" is granted to holders of research degrees (isced 8) with a denoting latin particle being added (dr. techn., dr. phil., dr. rer. nat., dr.iur., dr.theol. etc.). newer study programmes award a phd, but they exist alongside since many prefer obtaining a "dr." to a "phd". they take 3–4 years full-time and are organised in doctoral schools. in addition, the academic degree "doktor" (isced 7) is granted to physicians (dr. med. univ.) and dentists (dr. med. dent.), who since 2002 do not possess doctorate degrees (isced 8) anymore, but master's level 6 year-training (360 ects), much similar to an american md or dds. every student is awarded this degree upon graduation; writing a "diplomarbeit" (thesis, 50-100 p) is mandatory. a research doctorate (dr. scient. med. or phd) can be obtained after a three years full-time post-graduate study at a medical university. all doctors may be addressed as "doktor _____"; the title is usually contracted to "dr. _____", oftentimes they are just addressed as "herr/frau doktor" (mr./ms.), omitting the family name unless they are introduced to someone. contrary to popular belief, "dr." is not part of the name or a specific honour but a just degree like "bsc/ba", "mag." (ma/msc) or "dipl.-ing." (meng.) it is not mandatory to use it, although it may be added to official documents (e.g. driver's licence, passport), if desired finland in finland, the title of tohtori or doktor denotes holder of a research doctorate comparable to a phd. getting the doctorate requires advanced studies after the master's degree, writing a thesis, nowadays often a thesis by publication, and publicly defending the thesis. customary doctorates do not exist even in the field of medicine: physicians hold the degree of lääketieteen