such as physicians, attorneys, pharmacists, veterinarians, and few others are usually referred to by the title dr. (doutor) even if they have not been awarded a doctoral degree. however, custom gives the legislation little strength and most graduates use the dr. title in its abbreviated form, although use of the full doutor is normally restricted to those with doctorates. those who are both holders of an academic doctorate and professors at a college level are generally referred to as professor doutor. spain the social standing of doctors in spain is evidenced by the fact that only phd holders, grandees and dukes can take seat and cover their heads in the presence of the king. phd degrees are regulated by royal decree (rd 1393–2007), real decreto (in spanish). they are granted by the university on behalf of the king, and its diploma has the force of a public document. the ministry of science keeps a national database of doctoral theses called teseo. any person who uses the spanish title of doctor/doctora (or dr./dra.) without being included in this government database can be prosecuted for fraud. however, the spanish royal academy recognises that it is used colloquially to describe medics, even without doctoral degrees, as well as (in the feminine form, doctora, abbreviated dra.) the wives of doctors (i.e. holders of doctoral degrees) and medics, as well as "women who shine with wisdom and understanding". unlike other countries, until recently spain has registered a comparatively small number of doctor degree holders, but the tendency is changing. according to the spanish statistical office (ine), less than 5% of msc degree holders are admitted to phd programs. this reinforces the prestige that doctors have historically enjoyed in spain's society. united kingdom doctor is commonly used in the united kingdom as the title for a person who has received a doctoral degree or, as courtesy title, for a qualified medical practitioner or dentist who does not have a doctorate. there are no restrictions on the use of the title "doctor" in the united kingdom, except where, in commercial advertising, it might imply that the user holds a general medical qualification. the uk government allows medical doctors and holders of doctorates to have the title recorded on the observations page of their uk passport. the lack of legal restrictions was confirmed in parliament in 1996 by health minister gerald malone, who noted that the title doctor had never been restricted by law to either medical practitioners or those with doctoral degrees in the uk, although the titles "physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner and apothecary" were protected. according to the etiquette guide, debrett's, holders of doctoral degrees and medical doctors (but not surgeons) should be addressed as "doctor". for medical doctors, "doctor" is a professional title rather than an academic one: it is due to their being a medical practitioner rather than their having gained a doctoral degree. the quality assurance agency states that "the use of the title 'dr' by medical doctors is a historical abbreviation for the profession; it does not indicate a qualification at doctoral level". on guest lists and seating plans for formal events, holders of academic doctorates (but not medical doctors or other people using the title as a courtesy title) are listed either as "dr john smith" or "john smith, esq, phd", while untitled men (other than those holding doctorates) are shown as either "mr john smith" or "john smith, esq" (as appropriate to ensure the styling remains consistent). the title "dr" is also used on visiting cards. medical students in the uk normally complete a course of study leading to the degree of bachelor of medicine and bachelor of surgery (mbbs, bmbs or mbchb). the md degree is not a qualifying degree in the uk, but can be either a professional doctorate (at the same academic level as a phd), a doctorate by thesis, or a higher doctorate, depending on the university. to be eligible for an md degree in the uk one must already hold an entry level medical degree (for example, mbbs, mbchb, bmed, or a north american md degree) and usually must have had at least 5 years of postgraduate training and experience. trainee doctors are permitted to use the title doctor once they have started their post-graduation "foundation programme". debrett's states that medical doctors (except surgeons) should be addressed on envelopes as "dr (full name), (medical qualifications)", e.g. "dr john smith, md", "dr anne jones, mb bs, frcp", "dr david evans, mb chb", contrary to the normal rule of not mixing titles and post-nominals. surgeons (and dentists, if not holding a doctoral degree) should be "(full name), esq, (medical/dental qualifications)", e.g. "john smith, esq, ms, frcs", "david evans, esq., bds", but "dr anne jones, dds, fds rcs",. by contrast, those holding (non medical or dental) doctoral degrees, if not surgeons, should be "dr (full name)" without post-nominals on envelopes, e.g. "dr john smith". a & c black's titles and forms of address diverges from debrett's on how to address envelopes to medical doctors, omitting the pre-nominal title of dr (e.g. john smith, esq, md; john smith, md; john smith, mb) except in scotland and for general practitioners, where the post-nominals are instead usually omitted (e.g. dr john smith). black's also state that it is down to individual choice whether non-medical doctors are addressed on envelopes as "dr john smith" or "john smith, esq, phd" (or appropriate letters for the doctorate held), with the exception of doctors of divinity, who would be "the rev. j. smith, dd" on the envelope and "reverend sir" in a formal salutation (informally in the salutation "dear dr smith", and "dr smith" in speech). the custom of not referring to surgeons (members and fellows of the royal college of surgeons) as dr has been commented on in the british medical journal and may stem from the historical origins of the profession such as that some barbers also used to function as surgeons. in 2005, the then-president of the royal college of surgeons called upon surgeons to use the title of dr, saying that the use of mr or miss was confusing to patients. black's note that gynaecologists are addressed as surgeons in england and wales but as doctors elsewhere. in a similar manner to the medical mbbs, dentists qualify with a bachelor of dental surgery (bds) and vets with a bachelor of veterinary science (bvsc), bachelor of veterinary medicine (bvetmed) or bachelor of veterinary medicine and surgery (bvms). all of these are, like the mbbs, master's level qualifications that bear bachelor's designations for historical reasons. dentists have traditionally (as dental surgeons) been referred to in the same way as surgeons, but since 1995 the general dental council have permitted dentists to use the title "doctor", though many do not choose to do this, thereby stressing their surgeon status. however, debrett's continues to advises that dentists are normally addressed as surgeons and that the title "doctor" is usually only used for dentists who have a doctoral degree. on 5 march 2015 the council of the royal college of veterinary surgeons (rcvs) voted to permit its members to use the courtesy title of "doctor". guidance from the rcvs says the title should be used either with the description "veterinary surgeon" or the postnominals "mrcvs" to ensure there is no confusion with doctors of human medicine or holders of doctoral degrees. optometrists are not permitted to use the title "doctor" based on their initial qualification (boptom or bsc (optom)). optometrists can earn phds or doctor of optometry degrees (in the uk a phd-level qualification for qualified optometrists with experience in practice). ophthalmologists are fully qualified medical doctors. however, ophthalmology is considered a branch of surgery, thus ophthalmologists, like other surgeons in the uk, do not use the title "doctor". the general chiropractic council permits registered chiropractors to use the title "doctor", although it advises chiropractors to avoid using the title in advertising or, if they do, to spell out that they are "doctors of chiropractic". the committee of advertising practice advises, however, that "references to 'dc' or 'doctor of chiropractic' are unlikely to dispel that misleading impression , when used in conjunction with unqualified references to the prefix 'dr'", saying that the use of the title by chiropractors may be acceptable in advertising if "clearly and prominently qualified with additional text which makes clear it is a courtesy title and that the practitioner does not hold a general medical qualification". the advertising standards authority has ruled that practitioners of traditional chinese medicine should not use the title doctor in adverts unless they hold a general medical qualification and are registered with the general medical council. it similarly advises that osteopaths should not use the title unless holding a general medical qualification. there have also been rulings that an advert for an osteomyologist which referred to him as a doctor was misleading, as was an advert which used the title "dr" and the post-nominals "phd" on the basis of a phd from an unaccredited university. holders of honorary doctorates in the uk have the right, in most cases, to use the title of doctor, although holders are encouraged to refrain from doing so. black's says that "the same rules apply as to other holders", although notes that the post-nominals would not normally be used. in some circumstances, "doctor" may be used on its own as a form of address rather than as a title before a name. this is limited to when the person is being addressed by their job title and so is only used for medical doctors. wales wales follows uk usage in english. in welsh, the holder of a doctoral degree is doethur while a medical doctor is doctor or meddyg. the title "y doethur" is used by those holding doctorates, e.g. "y doethur brinley jones", "y doethur john elfed jones", which can be abbreviated "dr". medical doctors use, as in english, the title "doctor", also abbreviated "dr". former yugoslavia in countries that were formerly yugoslavian republics, such as bosnia and herzegovina, croatia, north macedonia, montenegro, serbia and slovenia the title formally belongs to holders of academic doctoral degree such as doctor of science (dr. sc.) or doctor of arts (dr. art.) degree. there is no "ph.d." in any of those countries, even though when holders are translating their dr. sc. degree to english, they nevertheless use "ph.d.", even though it should be "d.sc." or "sc.d.". informally, the title, in both its full and abbreviated form (i.e. "dr.") is used honorifically to address medical doctors even in more formal environment like in lectored media texts, however officially it is reserved only for the holders of academic degrees. formally the professional title for medical doctor is "lijekar" in bosnian and montenegrin, "liječnik" in croatian, "lekar/лекар" in macedonian and serbian and "zdravnik" in slovenian and they can hold different academic degrees, as well as additional honorific title of primarius that is given to distinguished specialists with exemplary reputation and achievements. australia with the introduction of national health practitioner registration legislation on 1 july 2010, the title "doctor" is not restricted in any australian state. the title "medical practitioner" is restricted for use by registered medical practitioners, while the title "doctor" is not restricted by law. despite this, the medical board of australia advises that practitioners who are not medical practitioners who choose to use the title 'doctor' (or 'dr') should clearly state their profession in advertisements, even if they hold a phd or another doctoral degree, e.g. 'dr smith (dentist)' or 'dr jones (chiropodist)'. the psychology board of australia prohibits psychologists from using the title, to avoid confusion with psychiatrists, unless they hold a doctoral degree, in which case they must make it clear that they are not a medical practitioner or psychiatrist, e.g. by putting '(psychologist)' after their name. the australian qualifications framework (aqf) defines doctoral degrees as being at level 10 of the framework; it specifies that: "individuals who have been awarded a doctoral degree at level 10 on the aqf are entitled to use the title 'doctor'. the title 'doctor' will not be used by those who hold an honorary award." the name 'doctor' is also used in the name of some extended master's degrees at level 9 (e.g. juris