lisensiaatti (licentiate of medicine), and are referred to simply as lääkäri (physician); "tohtori" would be rustic or old-fashioned. a research doctorate in medicine, lääketieteen tohtori, requires further research work and a separate doctoral thesis, and is not taken by all medical graduates. regardless, in finnish usage, the use of titles is uncommon and restricted to only the most formal of contexts. france in france, the title of docteur is only used generally for physicians (médecin) but can also be used by holders of research doctorates. medical professionals do not normally hold a doctorate, which in france always refers to a research doctorate, but a "state diploma of doctor of medicine" (diplôme d'état de docteur en médecine). the law in france allows the title of dr to be used professionally by holders of research doctorates, with the field of their speciality being mentioned after the name. the courts have ruled that stating the specialisation is not necessary except in circumstances specifically related to professional practice; at other times the title alone may be used. the courts have also determined that questioning the right of the holder of a research doctorate to use the title dr is a form of libel. the national union of hospital scientists (syndicat national des scientifiques hospitaliers) launched a campaign in 2015 to raise awareness of the right of scientists to use the title. germany in german language-speaking countries, the word doktor refers to a doctorate awardee in formal language (similar to a phd). it is distinct from arzt, since a doctoral degree is not a requirement for medical practitioners, though colloquial use of the word doktor for physician is common and ordinary people often incorrectly assume that only doktors may practice medicine. for this reason, 80% of all students in medicine write "doctoral" dissertations, often comparable to a master's thesis in science, alongside their undergraduate studies to obtain a dr. med. degree. the european research council decided in 2010 that those dr. med. doctorates do not meet the international standards of a phd research degree. in germany, the most common doctoral degrees are dr. med. (medicine), dr. med. dent. (dentistry), dr. med. vet. (veterinary medicine), dr. rer. nat. (natural sciences), dr. phil. (humanities), dr. iur. (law), dr. rer. pol. (economic and political sciences, also as dr. rer. oec. in switzerland), dr.-ing. (engineering), and dr. theol. (theology). all holders of doctoral degrees are appropriately addressed as "herr/frau dr. _____" in all social situations. in germany, double doctorates are indicated in the title by "dr. dr." or "ddr." and triple doctorates as "dr. dr. dr." or "dddr.". more doctorates are indicated by the addition of "mult.", such as "dr. mult.". honorary titles are shown with the addition of "h.c.", which stands for "honoris causa". example: "dr. h.c. mult.". some honorary titles are shown by addition of german equivalents of "h.c.", like "e.h.", "e.h.", or "eh.", which stand for "ehrenhalber" (honorary). example: "dr. e.h. mult.". all people holding a doctorate from an eu member state are, since 2001, entitled to use "doctor" or "dr." in all formal, legal and published communications without any further addenda. for academics with doctorates from non-eu member states, the qualification must be recognised formally ("validated") by the federal educational ministry in bonn. the recognition process can be done by the employer or employee and may be part of the official bureaucracy for confirming professional status and is dependent on individual bilateral agreements between germany and other countries and, since 2007, the lisbon recognition convention. an example of mutual recognition of doctor titles among eu countries is the "bonn agreement of november 14, 1994", signed between germany and spain (prior to the general recognition of eu doctorates). in 2008, the standing conference of the ministers of education and cultural affairs of the länder in the federal republic of germany extended their 2001 decision to recognise eu phds to cover phds that were awarded in australia, israel, japan, canada, and some american universities. it was announced in 2012 that this would be further extended to cover phds awarded in new zealand. phds that were awarded in the united states are recognized if the awarding institution is classified by the carnegie foundation for the advancement of teaching as a "research university (high research activity)" or as a "research university (very high research activity)." permission to use the title covers only scientific research degrees and does not extend to professional degrees such as the md or jd. greece in greece, doctor "διδάκτωρ" (didáktor) is indicated in the title as δρ and it is used for holders of doctoral degrees. other alternative names are also used, namely «δόκτωρ» and «δόκτορας», derived from the french "docteur". the term "ιατρός" (iatrós) indicates medical practitioners. hungary in hungary, graduates of six-year medical schools (dr. med.), five-year dentistry schools (dr. med. dent.), five-year law schools (dr. jur.) and five-year veterinary medical schools (dr. vet.) receive the title of a doctor at the end of their studies, after completing and successfully defending their thesis; their undergraduate studies must have lasted for a minimum of three years. completing a phd research programme (or dla in arts and music) also leads to the doctor title. since 2008, also those who graduated of five-year pharmacy schools have the right to use the title "dr" (dr. pharm.). a large part of hungarians with doctor titles received their titles for research in the old academic system before phd was introduced in hungary. since the introduction of phd title (1993), the dr. univ title (given before 1993). the csc candidate of science title was a scientific title in the old academic system and is now treated as an equivalent of phd. csc titles were awarded by the hungarian academy of sciences. the highest level doctoral degree in hungary is dsc doctor of sciences, awarded by the hungarian academy of sciences. it is also called doctor of the hungarian academy of sciences. the title of doctor used to become a part of the name and was added as such to personal identity documents. this practice is still common and graduates after receiving their diploma would usually change their personal documents in order to officially indicate the achievement. ireland usage in ireland is similar to that in the uk. the title of doctor is used for holders of doctoral degrees as well as for medical practitioners (except surgeons), dentists, and vets. the title is also used in ireland for catholic bishops, who are styled "the most reverend dr x, bishop of y" on envelopes. italy the first university of western civilization, the university of bologna, is located in italy, where until modern times the only degree granted was that of the doctorate, and all other italian universities followed that model. during the 20th century italian universities introduced more advanced research degrees, such as the phd, and now that it is part of the eu bologna process, a new three-year first degree, or "laurea" (equivalent to a ba of other countries, eqf & isced 2011 level 6), has been introduced. the old-style "laurea" is now known as "laurea magistrale/specialistica" (bologna process second cycle/eqf & isced 2011 level 7). for historical reasons, even to this day, the title of "dottore/dottoressa" (abbrev. both as dott/dott.ssa or as dr./dr.ssa ) is awarded even to those who have studied for a "laurea"(eqf & isced 2011 level 6). upper levels of degree are anyway shown in the title, as those who obtain a master's degree can be referred to as "dottore/dottoressa magistrale" (masterly doctor, eqf & isced 2011 level 7) while those who achieve the relatively new program of "dottorato di ricerca" (research doctorate, equivalent of a phd in english-speaking or doktor (dr.) in german-speaking countries, eqf & isced 2011 level 8), carry the title of "dottore/dottoressa di ricerca" (research doctor), which can be abbreviated as "dott. ric." or "ph.d." malta in malta, the title of doctor is used by academic doctors (with phds), medical practitioners, dentists and lawyers. its use by lawyers is due to the qualifying degree for practicing law having been the lld until reforms in 2014, and has been described as "historical baggage" by the dean of the university of malta's law school. lawyers do not generally use the title when practicing outside of malta. netherlands in the dutch language the word "dokter" refers to a physician, whereas "doctor" refers to the academic title. the doctor title is abbreviated as dr. placed before the holders name (note the lowercase). to enter a dutch doctoral defense, the candidate must hold a validated master's degree (a master's degree of an acknowledged university, or a master equivalent degree validated on a case-by-case basis by the dutch government). in some cases the candidate can be granted special dispensation if no master's degree is held. there is no specific notation of the discipline in which the doctorate is obtained. once the doctorate is obtained the preceding master's degree is generally no longer reported. exceptions only exist for the disciplines with specific master titles of engineering "ir." ("ingenieur", i.e. engineer) and law "mr." ("meester", i.e. master of law) where the title dr. is added to the original master title. for these disciplines, the original master's degree abbreviation is combined with the dr. abbreviation thus resulting in for example "dr. ir. familyman". the dr. title is always placed in front of the ir. title. in the case of a phd in law, the original mr. title is placed before the dr. title (mr. dr., see e.g. jan peter balkenende). for a person having a law master's degree, but holding a phd in another field than law the mr. title is placed after the dr. title (dr. mr.). no specific notation or title for the medical disciplines exists in the netherlands. although a physician is usually referred to as "dokter" (note the spelling difference) this does not necessarily imply the physician holds a doctoral degree; nor does it give the physician a title equivalent to that of phd. confusion can be caused by the original dutch master level title "drs." (for all non-engineering and non-law master's degrees). this abbreviation stands for the dutch title doctorandus latin for "he who should become a doctor" (female form is "doctoranda"). dutch drs. should not be confused with the plural 'doctorates': having multiple phds. once a doctorate is achieved the doctorandus is promoted to doctor, and no longer uses the drs. abbreviation. stacking of multiples titles of the same level, as seen in countries like for example germany (dr. dr. dr. musterfrau) is highly uncommon in the netherlands (although stacking of titles with different levels is common: prof. dr. ir. appelmans). those who have multiple doctor titles may use dr.mult. before their name, although this is rarely used. after obtaining a doctorate successfully, dutch doctors may bear either the title dr. (lower case) before, or the letter d (rarely in practice) behind their name, but not both simultaneously. in the netherlands, academic titles are used exclusively within academia. holding a doctorate has become a standard requirement for a university career. the doctor title has little to no meaning or implications for public life outside academia. it cannot be added to documentation (e.g. passport, drivers licence), and is used infrequently in daily practice. historically, the netherlands used their own academic degree nomenclature, but for many years now have recognised and implemented the bologna declaration. in everyday practice, the anglo saxon titles (e.g. phd) are frequently used. dutch academic titles and degrees are legally protected, and as of 2021 the traditional ’dr.’ and the phd are legally equivalent and can be used interchangeably. doctoral degrees (phd degrees) can only be granted by recognised (research) universities. illegal use is considered a misdemeanor and subject to legal prosecution. portugal in portugal, up to recent times after the completion of an undergraduate degree – except in architecture and engineering – a person was referred to as doutor (dr.) – male or doutora (dra.) – female. the architects and engineers were referred by their professional titles: arquitecto (arq.) and engenheiro (eng.). nurses are also referred to as "nurse", enfermeiro (male) or enfermeira (female), the title being enf. for both. nowadays portugal is a signatory to the bologna process and according to the current legislation the title of doctor (doutor, doutora) is reserved for graduate holders of an academic doctorate. professions