Eliot C. Heher, MD
International travelers, particularly Americans, are sometimes surprised to learn that many physicians around the world don’t have an “M.D.” degree.
The reason for this is that upon graduation from medical school many physicians around the world receive an MBBS or MBChB–degrees bestowed under traditional British medical education. To complicate matters further, in the US and abroad a physician’s name is often followed by a number of other initials, such as FRCP (Lond), which denote membership in an honorary organization of physicians.
American Medical Degrees
First the basics. Most graduates of American medical schools receive the “M.D.” or Medical Doctor, degree. Of course graduates list the degree after their name, “Peter Rabbit, MD” and are referred to as doctors–“Dr. Rabbit”. The D.O., or Doctor of Osteopathy, is another medical degree that is awarded by 19 or so medical schools in the United States. Physicians with a D.O. degree are also referred to as doctors and are equally eligible with M.D.’s for medical licensure and practice (note that regardless of what degree a physician receives, he or she must receive and maintain a medical license from the State in which they practice, which requires extensive training after medical school).
The Ph.D. degree is a doctorate but is usually not associated with clinical practice or patient care. One very common exception is that of the Clinical Psychologist, who often have a Ph.D. or similar degree (unlike psychiatrists, who have an MD degree, Clinical Psychologists are typically not licensed to prescribe medications). Some physicians may possess both an MD and a Ph.D., though the Ph.D. is generally in an academic field involving research rather than patient care.
British Medical Degrees
In contast, most graduates of British medical schools (and schools in countries with an historical connection to the UK, such as Australia and New Zealand), do not receive an “MD” degree but receive a degree in each of three major areas of medical study: medicine, surgery, and obstetrics. To receive a degree the graduate must pass the qualifying examination in that area. And because in many cases these physicians-in-training have gone directly from high school into a six year program that combines college and medical school, the degrees awarded are bachelors degrees.
- The MB degree, which stands for bachelor of medicine, is awarded for passing the medicine exam examination, thereby qualifying as a medical doctor. This degree is really the equivalent to the MD in the United States–it’s the standard degree.
- The BS, ChB and Bch degrees (which are are equivalent to one another) stand for Bachelor of Surgery (Ch=Chirugie, which is latin for surgery). These degrees are awarded for passing the surgical portion of the exam.
- BAO, which stands for Bachelor of Obstetrics, is awarded for passing the Obstetrics portion of the exam and thus qualifying in obstetrics.
Thus physician graduates of the British system posses the “MB, [BS, ChB, or Bch], BAO” degree. They may present themselves as “Peter Rabbit, MBChBBAO”, or “Peter Rabbit, MBBSBAO”. In practice, the BAO portion is often dropped for convenience: “Peter Rabbit, MBBS”.
To make things even more complicated, keep in mind that on occasion the “MD” degree is awarded by medical schools in the British system, in place of the MB. To receive an MD rather than an MB, students must complete a thesis and receive some additional training (e.g., research training) over and above what is required for the MB. Senior, academic physicians are more likely to have an MD; community physicians will typically have the MB degree.
Osteopathic physicians with a DO also exist outside the United States. And, just as in the U.S., regardless of what degree they receive physicians outside the United States must be licensed to practice, and licensure often requires extensive training after graduation from medical school.
Alphabet Soup: The Colleges
Many physicians inside and outside the United States belong to an honorary professional organization called a College. Many physicians include initials after their name indicating their membership in a College. In the US, for example, many surgeons are fellows of the American College of Surgeons and place the abbreviation “FACS” after their name and degree: “Peter Rabbit, MD, FACS.” Medical doctors are often members (or sometimes fellows) of the American College of Physicians (MACP or FACP). Obstetrician/Gynecologists are often fellows of the American College of Obstetrics and Gynecology (“Peter Rabbit, MD, FACOG”). The Colleges vary somewhat in the requirements to become members and fellows.
The Royal Colleges
Similarly, physicians who practice in the UK or received professional training there may be members of a Royal College. The Royal College of Physicians and the Royal College of Surgeons, for example, are honorary, professional organizations for physicians with several locations within the United Kingdom: London, Edinburgh, Ireland, etc.
Medical doctors (e.g., internal medicine specialists and subspecialists like cardiologists and gastroenterologists) are eligible for the Royal College of Physicians. To become a Member of the Royal College of Physicians (abbreviated “MRCP”), physicians must pass a difficult exam. Only about 14% of candidates pass this exam the first time they take it, thus being a Member of the Royal College is quite an honor.
Distinguished Members of the Royal College may be invited to become Fellows–officially, Fellows of the Royal College of Physicians or FRCP, based on their accomplishments as physicians or researchers. Thus the designation “FRCP” is an honor beyond “MRCP”.
The designations are different for surgical doctors because only the Fellow designation exists. Surgical doctors become Fellows of the Royal College of Surgeons (FRCS) by passing a difficult exam (as medical doctors must to become Members of the RCP). Thus becoming a Fellow of the RCS is also quite an honor. Note that when a physician becomes a Fellow of the Royal College of Surgeons, he or she is no longer referred to as a Doctor. The physician in question is now referred to as “Mister”, which is considered a more honorable designation for a surgeon in the British system.
Members and Fellows of the Royal Colleges will sometimes indicate the name of the Royal College to which they belong by including it in brackets after the designation MRCP or FRCP. For example, John Doe, MBBS, MRCP (London) is a Member of the Royal College of Physicians in London.
In the British system, physicians who are appointed as Professors typically prefer to be called “Professor” rather than Doctor, because it is considered a higher honor.