not to render unto the doctor of philosophy his 'doctor' title". the same writer noted in a letter to the journal of higher education in 1948 that alfred university had banned the use of the title for faculty (while retaining it for the president and deans) "in a strange move professedly designed to uphold and promote 'democracy' and 'americanism'". however, it was noted in 1959 that professors with phds were now generally addressed as "doctor", with the title of "professor" sometimes being substituted for those without doctorates, leading to a decline in the perceived value of that title. in the 1960s the inconsistent usage at american universities and colleges was mentioned in the new york times book review and the editor of science noted that: "in some universities, administrators call all ph.d.'s 'mister,' but students and colleagues call them 'doctor.' often, but not always, ph.d.'s are 'misters' socially. in industry and government, both socially and professionally, they are 'doctors,' as they are also in the pages of the new yorker, time, the saturday review, and the new york times." in 1965, the league of women voters designated medical doctors "dr." and phds "mr." at a hustings in princeton, leading to a letter of protest in science; it was reported that the league believed phds would be embarrassed by the title, and that etiquette writers differed in whether phds used the title. in 1970, reverse snobbism in the face of the rising number of "discount doctorates" was linked to professors at prestigious universities wanting to be called "mister". in the late 1960s the rising number of american law schools awarding juris doctor (jd) degrees led to debate over whether lawyers could ethically use the title "doctor". initial informal ethics opinions, based on the canons of professional ethics then in force, came down against this. these were then reinforced with a full ethics opinion that maintained the ban on using the title in legal practice as a form of self-laudation (except when dealing with countries where the use of "doctor" by lawyers was standard practice), but allowed the use of the title in academia "if the school of graduation thinks of the j.d. degree as a doctor's degree". these opinions led to further debate. the introduction of the new code of professional responsibility in 1969 seemed to settle the question – in states where this was adopted – in favour of allowing the use of the title. there was some dispute over whether only the phd-level doctor of juridical science should properly be seen as granting the title, but ethics opinions made it clear that the new code allowed jd-holders to be called "doctor", while reaffirming that the older canons did not. as not all state bars adopted the new code, and some omitted the clause permitting the use of the title, confusion over whether lawyers could ethically use the title "doctor" continued. the introduction of further professional doctorates in the us at isced level 7, the same as the md and jd, has led to continuing debate about the use of the title by holders of such degrees, particularly in medical contexts. in 2018, a decision by the globe and mail newspaper in canada to update its style guide so as to restrict the use of the title doctor to medics led to a backlash on twitter, particularly by women with phds, using the #immodestwomen hashtag. this was widely reported on internationally and led to the globe and mail reverting to its earlier style of using doctor for both physicians and phd holders. the canadian university of calgary also announced that it would adopt the use of doctor for those with doctoral degrees, breaking with the style recommended by the canadian press. doctor as a noun throughout much of the academic world, the term doctor refers to someone who has earned a doctoral degree (highest degree) from a university. this is normally the doctor of philosophy, abbreviated phd (sometimes ph.d. in north america) from the latin philosophiae doctor or dphil from its english name, or equivalent research doctorates at level 8 of the international standard classification of education 2011 classifications (isced 2011) or level 6 of the isced 1997 classifications. beyond academia (but specifically in the anglo-saxon world, italy, and france), doctor as a noun normally refers to a medical practitioner, who would usually hold a qualification at level 7 of isced 2011/level 5 of isced 1997 such as the british mbbs or the american md or do. forms of address when addressing several people, each of whom holds a doctoral title, one may use the plural contraction "drs" (or "drs." in american english) – or in some languages (for example, german) "dres." (from the latin doctores) may be used – for example, instead of dr. miller and dr. rubinstein: drs. miller and rubinstein. when referring to relatives with the same surname the form "the doctors smith" can be used. the abbreviation drs. can also refer to doctorandus, a dutch academic title that was replaced with the master title with the introduction of the master system. in english, dr is not usually combined with other titles, except for the reverend in "the revd dr" before the surname of a minister of religion, e.g., "the revd dr smith" or "the revd john smith, dd", and similarly "rabbi dr". in caribbean english, the usage "dr. the honourable" is common for politicians holding doctoral degrees. usage in many other languages is similar to english but some, notably german, allow for the stacking of titles. usage by medical practitioners in the uk and culturally-related countries in the united kingdom, india, pakistan, hong kong, trinidad and tobago, south africa, australia, new zealand, ghana, and other countries whose cultures were recently linked to the uk, the title dr is generally used both for those who hold doctoral degrees and for registered medical practitioners. history has dictated the use of the courtesy title dr by physicians and general practitioners. however, surgeons do not use the title of dr and, due to the origins of surgery with the barber surgeons, instead use mr, mrs, ms, miss, etc. this custom applies to surgeons of any grade who have passed the appropriate exams and is not the exclusive province of consultant-level surgeons. in recent times, other surgically orientated specialists, such as gynaecologists, have also adopted these prefixes. a surgeon who is also a professor is usually known as "professor" and, similarly, a surgeon who has been ennobled, knighted, created a baronet or appointed a dame uses the corresponding title (lord, sir, dame). physicians, on the other hand, when they pass their "mrcp(uk)" examinations, or equivalent, do not drop dr but retain it, even as consultants. the status and rank of consultant surgeons, addressed as "mister" or "ms.", and consultant physicians, addressed as "doctor", is equivalent. worldwide usage a doctor receiving her phd degree during a graduation ceremony. bangladesh in bangladesh, use of the title of doctor (dr.) is permitted for phd degree holders and registered medical practitioners. according to an amendment, universities are allowed to approve or reject any subject proposed for a thesis by a candidate for the degree of "doctor" in any subject. for registered medical practitioners, only mbbs and bds degree holders are allowed to use the title "dr." and be called "medical doctors". registered veterinary practitioners may use the title "dr." after earning the "doctor of veterinary medicine" (dvm) degree. however, registered homeopath practitioners also use the title "dr." even though, according to homeopathic practitioners ordinance 1983, they are only permitted to use "homeopath". currently, physiotherapy has no separate council and no authorized act at present permits the use of the prefix "dr." for physiotherapist. according to bangladesh unani & ayurvedic practitioners ordinance 1983, practitioners of the unani system are called "tabib" or "hakim" and are strictly prohibited from using the title "dr."; similarly, practitioners of ayurvedic system are called "vaid" or "kabiraj" and are also strictly prohibited from using "dr.". currently, medical practitioners having mbbs degree or dental surgeons having bds are legally permitted to use "dr." prefix. using "dr." for other medical practitioners remains controversial. hong kong hong kong follows british practice in calling physicians "doctor" even though many of them hold only a degree of bachelor of medicine and bachelor of surgery (mbbs or mbchb). an attempt by their professional body to prevent chiropractors from calling themselves "doctor" failed in the courts, in part because it was pointed out that practicing chiropractors may hold an academic doctorate in their discipline, and it would be anomalous to prevent them using the title when holders of doctorates in non-medical disciplines faced no such restriction. india in india, the title is used by qualified professional medical practitioners in the fields of allopathic medicine (mbbs), and dentistry(bds) as well as by other practitioners like siddha (bsms), yoga and naturopathy (bnys), ayurveda (bams), unani (bums) and homeopathy(bhms), veterinarians (bvsc) and holders of doctoral degrees, including phds and pharmacists with pharmds. physiotherapists (bpt) use 'doctor' as a suffix accompanied by the prefix pt. the usage by pharmacists is legally disputed, while the supreme court of india has ruled against the use of the title as a prefix by physiotherapists. indonesia the indonesian titles "dr." is used in front of the name of medical doctor who holds a specification as general practitioner, also when the doctor already holds his specialization to ___, such as "sp.tht" or "spesialis telinga, hidung, tenggorokan" (ent or ear, nose, and throat specialist). dr. is used in front of the name as the title "doktor" for doctorate title, the same level as phd title. pakistan in pakistan, the title of doctor (dr.) can be used by phd degree holders as well as medical, dental, optometry and veterinary doctors with mbbs, bds, od and dvm degrees respectively. usage by physiotherapists dpt degree respectively is disputed, with the pakistan medical and dental council saying they should not use the title, but the pharmacy council of pakistan (the regulatory body for pharmacists) and the higher education commission permitting and encouraging its use. philippines in the philippines, titles and names of occupations usually follow spanish naming conventions which utilize gender-specific terms. "doktór" is the masculine form, which retains the abbreviation dr.; the feminine form is "doktóra", and is abbreviated usually as "dra."; others, however, some being anglophones who wish to sound modern and westernised (or were raised in an almost exclusively english-speaking family environment), or some who advocate gender equality, would dispense with the distinction altogether. there does exist in filipino an equivalent, gender-neutral term for the professional that carries the more general notion of "healer", traditional (for example, an albuláryo) or otherwise: manggagámot. contracted "dr" or "dr.", it is also used as a designation for a person who has obtained a doctorate degree (e.g. phd, edd, dpa). sri lanka in sri lanka the title doctor "dr." is used for phd holders and medical practitioner such as physicians, surgeons, dentists and veterinarians. however, when addressing in native sinhalese a medical practitioner is addressed as "vaidya" (වෛද්ය) or "dosthara" (දොස්තර) while a phd holder is addressed as "aacharya" (ආචාර්ය). it is a common practice for married female medical practitioners to use the title "dr (mrs)" in a both professional and social capacity. thailand the usage of doctor (ดอกเตอร์) or dr (ดร.) has been borrowed from english. it can be seen as a title in academic circles and in the mass media. in contrast to other academic titles (professor, associate professor and assistant professor), the use of doctor as a title has not been recognized by the royal institute of thailand. therefore, this title, in theory, cannot be used officially. for example, in court of justice where strictly formal thai language is used, dr cannot be mentioned as a person's title. brazil the 'doctor' title is used by individuals holding a phd degree. 'doctor' is also used as a deferential title in brazilian portuguese. canada canada lies somewhere between british and american usage of the degree and terminology of "doctor". holders of research doctorates – phds and similar degrees – commonly use the title "doctor". a number of regulated healthcare professionals can also use the title "doctor"; in ontario these are limited by law to physicians, dentists, optometrists, chiropractors, doctorate-level psychologists and social workers. in alberta, registered nurses or nurse practitioners