In US fiction, it is very common to use the phrase “real doctor” (as in e.g. “Are you a real doctor?”) to refer specifically to MDs—something which is patently absurd. The word “doctor” is borrowed from Latin, where it signified a teacher (“docere”, “to teach”)—which is also the original use in the medieval academic world. It is, thus, clear that “doctor” is an academic title, and something that is awarded for academic ability. Notably, a doctorate is often a prerequisite for a professorship. (The modern focus on research, however, goes beyond what can be deduced from etymology and historical use.)
For simplicity, I speak only of “MD” (ignoring e.g. osteopaths) and “PhD”. For the latter, a wider range of doctorates and doctorate equivalents are possible, including those from different academic/university systems. (Germany, e.g., awards a wide range of doctorates that do not carry the specific label “PhD” or a German equivalent of that label. The difference is one of granularity of terminology—not the status of the doctorate. If anything, the German doctorates are the academically more challenging and rigorous.)
However, a bar has to be reached. The PhD reaches the bar (as do the German doctorates); the MD and the JD do not.
Since the time of original writing, the offering of non-PhD doctorates in the U.S., too, seems to have exploded. Which of these do or do not meet the bar, I leave unstated, for the time being. (However, I am often sceptical, as with the EdD, in general, and the EdD in “Educational Leadership”, in particular.)
For the purposes of this discussion, I will assume that an MD has not earned a proper PhD (or PhD equivalent). If he has, he might well have the right to call himself a real doctor—but not because of his MD.
If we now compare the two typical protagonists, the PhD and the MD, it should be quite clear that PhDs are the real doctors. Consider that:
A PhD is a sign of academic achievement, an ability to do research, to think critically, and requires a considerable act of creation of new knowledge. (At least in theory; the reality is sometimes different, in particular in the soft sciences.) An MD, OTOH, is mostly a sign of an ability to work hard, learn knowledge created by others, etc.
A telling joke:
A lecturer tells some students to learn the phone-book by heart.
The mathematicians are baffled: ‘By heart? You kidding?’
The physics-students ask: ‘Why?’
The engineers sigh: ‘Do we have to?’
The chemistry-students ask: ‘Till next Monday?’
The accounting-students (scribbling): ‘Till tomorrow?’
The laws-students answer: ‘We already have.’
The medicine-students ask: ‘Should we start on the Yellow Pages?’
(http://www.xs4all.nl/~jcdverha/scijokes/7_2.htmle)
In many other countries, e.g. Sweden and Germany, a physician does not need an MD to become licensed, but learns the corresponding material in what amounts to a master-level diploma—despite being similarly qualified as a US MD. (An exact comparison is virtually impossible, in light of the very different approaches.)
The corresponding British education is formally named a bachelor. (Whether it moves on the bachelor or master level, I have not investigated.)
However, “doctor” is often used as a so called courtesy title in such countries—even when there is not the slightest doubt that physicians are not doctors. In the U.S., absurdly, this mere courtesy title has been elevated to “real doctor”.
An MD is not a “terminal degree” in the US system; and MDs in other countries (where the MD is a real doctorate requiring a pre-qualification as e.g. a physician) are noticeably better qualified. US MDs would violate the law if they referred to themselves as “Doctors” (“Doktoren”) in Germany.
For further information, see e.g. Doctoratew, Doctor_of_Medicinew, Doktor_der_Medizin_(Berufsdoktorat)w:de.
Since the original writing, I have several times encountered the argument that an MD is better qualified than [some other degree holder], because of the extensive post-university (“post-graduate” would be confusing in this context) requirements, with internships, residency, and whatnot. This argument is specious, because different things are compared: The title of MD is awarded long before these additional requirements are fulfilled—and they might indeed remain unfulfilled by some MDs. To compare a physician five years into his career with e.g. a PhD fresh out of university is simply misleading. (Even then, however, the physician will not necessarily have gained the knowledge of scientific method and critical thinking that the PhD has). If we stack on five years onto the MDs, then we have to stack on five years onto the PhDs.
However, with hindsight, I am not certain that I target the right point: is the abuse tied to the MD or to the status as a physician? (And what exactly is the difference between the two? There does not seem to be a clear definition of “physician”, and it might or might not involve e.g. holding an MD, being appropriately licensed to practice medicine, and/or actually practising medicine.)
Why is the misconception that MDs would be the real doctors so common? I would speculate on two causes: Firstly, qualified professionals (including physicians) tend to earn noticeably more than teachers and researchers at universities and colleges (where most PhDs have been found, traditionally), giving them a higher status in the eyes of those focused on money. Secondly, most real-life and fictional encounters with doctors and “doctors” have been with MDs for the average US citizen—and since MDs are almost always referred to with the courtesy title “doctor”, rather than an accurate title like “MD” or “physician”, the public has come to misunderstand the meaning of “doctor”. (TV series playing in a hospital environment are noticeably more common than those playing in the math departments of universities.)
My advice: Try to always refer to physicians as “physicians”, dentists as “dentists”, etc. Should the need for a more generic term arise, use “MD” (although possibly not always applicable) rather than “doctor”—a US MD is no doctor in the sense it is used internationally, nor in academic circles within the US.
A potential historical reason for the misuse of “doctor” is that early universities had a limited number of faculties/fields/whatnot, e.g. theology, law, and medicine. According to some source that I encountered between the original writing (2009) and the writing of this note (2023), there was a prolonged time when “doctor” was reserved for those sufficiently progressed in these specific fields (i.e. those literally or metaphorically having a terminal degree and, possibly, literally teaching at a university; note that the road to a terminal degree was often far shorter in the past), while the corresponding level in newer faculties/fields/whatnot was “master” (or “magister”, or similar). When hierarchies were later merged or unified, two levels of higher degrees arose, the master as the lower, the doctor as the higher, where they had previously been equivalent.
(Note that I have not verified these claims.)
This could go a long way to explain the common misnaming, including the widespread use of the courtesy title “doctor” for physicians, e.g. in that the gap in level need not have been as large in earlier days as it is today, or that the courtesy title might once have been an accurate, non-courtesy title by the standards of the day. Indeed, if the division had been reversed (with master as the higher, doctor as the lower level), there would have been far less reason to complain. Such a reversal would also, arguably, have led to more logical names, as (at least by today’s standards) being a teacher of X is a lesser claim than being a master of X.
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