How the term MD is applied varies among countries — it is a first professional degree in some countries (e.g., USA, Canada), while in others it is a higher doctoral academic research degree resembling a PhD (e.g., the United Kingdom, Australia).[1] In the UK and many former British colonies, the equivalent of the American MD degree is the MBChB or MBBS (”Bachelor of Medicine and Bachelor of Surgery” - see Equivalent Degrees, below).
History of the medical degree
According to Sir John Bagot Glubb, Syed Farid Alatas, and S. M. Imamuddin, the first medical schools to issue academic degrees and diplomas were the teaching Bimaristan (Hospitals)of the medieval Islamic world. The first of these institutions was opened in Baghdad during the time of Harun al-Rashid. They then appeared in Egypt from 872 and then in Islamic Spain, Persia and the Maghreb thereafter. Physicians and surgeons at these hospital-universities gave lectures on Islamic medicine to medical students and then a medical diploma or degree was issued to students who were qualified to be practicing physicians.[2][3][4]According to Douglas Guthrie,[5] who bases his account on L Thorndike,[6] medical men were first called “Doctor” at the Medical School of Salerno. He states that the Emperor Frederick II decreed in 1221 that no one should practice medicine until he had been publicly examined and approved by the masters of Salerno. The course lasted 5 years, and to start one had to be 21 years old and show proof of legitimacy and of three years study of logic. The course was followed by a year of supervised practice. After the laureation ceremony the practitioners could call themselves “magister” or “doctor.”
Academic degrees for physicians by country
United States and Canada
The MB or Bachelor of Medicine was also the first type of medical degree to be granted in the United States and Canada. The first medical schools that granted the MB degree were Penn, Harvard, Toronto, Maryland, and Columbia. These first few North American medical schools that were established were (for the most part) founded by physicians and surgeons who had been trained in England and Scotland. University medical education in England culminated with the MB qualification, and in Scotland the MD, until from the mid-19th century the public bodies who regulated medical practice at the time required practitioners in Scotland as well as England to hold the two the dual Bachelor of Medicine and Bachelor of Surgery degrees (MB BS/MBChB/MB BChir/BM BCh etc). North American Medical schools switched to the tradition of the Ancient universities of Scotland and began granting the MD title rather than the MB mostly throughout the 1800s. The Columbia University College of Physicians and Surgeons in New York (which at the time was referred to as King’s College of Medicine) was the first American University to grant the MD degree instead of the MB.[7]Within the United States, MDs are awarded by LCME-accredited medical schools.[8][9][10]. The Liaison Committee on Medical Education is an independent body sponsored by the Association of American Medical Colleges and the American Medical Association, the AMA.
Admissions to medical schools in the United States is highly competitive, with 17,800 of the approximately 47,000 applicants matriculating to any medical school. Before graduating from a medical school and achieving the degree of Medical Doctor, students have to pass the United States Medical Licensing Examination (USMLE) Step 1 and to take (but not necessarily pass) both the Clinical Knowledge and Clinical Skills parts of Step 2. The MD degree is typically earned in four years. Following the awarding of the MD, physicians who wish to practice in the United States are required to complete at least one internship year (PGY-1) and pass the USMLE Step 3. In order to receive Board Eligible or Board Accredited status in a specialty of medicine such as general surgery or internal medicine, then undergo additional specialized training in the form of a residency. Those who wish to further specialize in areas such as cardiology or interventional radiology then complete a fellowship. Depending upon the physician’s chosen field, residencies and fellowships involve an additional three to eight years of training after obtaining the MD. This can be lengthened with additional research years, which can last one, two, or more years.
In Canada, the MD is the basic medical degree required to practice medicine. At McGill University in Montreal, M.D., C.M. (Medicinae Doctor et Chirurgiae Magister or a Doctor of Medicine and Master of Surgery sometimes also written MDCM) degrees are awarded.
Even though the MD is a first professional degree and not a doctorate of research (ie. PhD), many holders of the MD degree conduct clinical and basic scientific research and publish in peer-reviewed journals during training and after graduation. Medical Scientist Training Programs (MSTPs) are offered at many universities which are a combined medical degree and PhD. Some MDs choose a research career and receive funding from the NIH as well as other sources such as the Howard Hughes Medical Institute. A few even go on to become Nobel Laureates.[11]
United Kingdom, Ireland and some Commonwealth countries
In the United Kingdom and Ireland (and many Commonwealth countries) the MD is a postgraduate research degree in medicine. At some universities, this takes the form of a first doctorate, analogous to the PhD, awarded upon submission of a thesis and a successful viva. The thesis may consist of new research undertaken on a full- or part-time basis, with much less supervision (in the UK) than for a PhD, or a portfolio of previously-published work.[12]At some other universities (especially older institutions such as Oxford and Cambridge) the MD is a higher doctorate (similar to a DSc) awarded upon submission of a portfolio of published work representing a substantial contribution to medical research.[1].
In the case where the MD is awarded (either as a first or higher doctorate) for previously-published research, the candidate is usually required to be either a graduate or a full-time member of staff, of several years’ standing of the university in question.[13]
The University of Buckingham,[14] the only private university in Great Britain, has announced an Indian-style two year full-time taught course for a “Clinical MD” in internal medicine. This is designed for non-European Union graduates, who are no longer to be allowed to take accredited training posts in UK hospitals. This degree will be awarded first in 2010.
The entry-level professional degree in these countries for the practice of medicine is that of Bachelor of Medicine and Bachelor of Surgery (MBBS or MBChB). This degree typically requires between four and six years of study and clinical training, and is equivalent to the North American MD.
India, Pakistan and Argentina
In India, an MD is a higher postgraduate degree awarded by many medical colleges to medical graduates holding the MBBS degree {MBBS degree course has a duration of five and a half years}, after three years of study and passing an examination which includes both theory and practical, in a pre-clinical or clinical subject of a non-surgical nature. The original research element is not as prominent here, as this is primarily a clinical qualification resembling the professional doctorates of the USA. In surgery, orthopaedics and gynaecology the equivalent degree is Master of Surgery (MS). DNB(Diplomate of the National Board))is considered equivalent to MD and MS.This can be obtained by passing an exam conducted by national board of examinations after completing 3 years post MBBS training in hospitals recognised by the board.After obtaining the first post graduate degree, that is MD/MS/DNB, one can go for further specialisation in medical or surgical fields. This requires three years of hard training and study and then passing an examination, both theory and practical, and the degree awarded is DM (Doctorate in Medicine, superspeciality) eg DM in Cardiology, Neurology, Nephrology, Gastroenterology etc. For surgical subspecialities the degree awarded is MCh, eg MCh (Cardiac Surgery), MCh (Neurosurgery) etc.The DM or MCh degrees are equivalent to the Fellowship training in the US and are considered “post-doctoral” degrees in India, similar to the PhD.In Pakistan an MBBS is awarded as the basic medical qualification after completing five/six years of study. Tough entry tests are passed successfully before entering in to a medical college. Medical colleges and foreign medical qualifications are supervised by the Pakistan Medical and Dental Council (PMDC). Specialized degrees are awarded by the Pakistan College of Physicians and Surgeons.
In Argentine the medical degree Título de Médico[15] are equivalent to the North American M. D. Degree with 6 year of intensive theoric studies followed by three years of the Residencia as a Mayor Especialidad in a particular empiric field, compounded of internships, social services and sporadic research.
Equivalent degrees in other countries
- The Bachelor of Medicine and Bachelor of Surgery degrees (MB BS or MB ChB, and several variants) are equivalent to the North American MD degree.
- The American osteopathic medical degree (DO) has identical training requirements and practice rights as the MD degree.[16] (See Comparison of allopathic and osteopathic medicine.)
- In Germany medical students have to complete twelve semesters of study and pass two state examinations (the first one after two years) to become physicians. A research doctorate (PhD) can only be obtained at some universities after three to five years of additional studies and research. Physicians can obtain the degree “Dr. med., Doktor der Medizin” A candidate must submit a dissertation consisting of a suitable body of original academic research. A candidate also must defend this work before a panel of expert examiners appointed by the university. The dissertation has to be published.
- The Czech and Slovak title doktor medicíny, or MUDr. (Medicinae Universae doctor), are equivalent to the North American MD degree.
- The Poles, instead of the North American MD, use the title of lekarz medycyny (lek. med.; compare to lekarz weterynarii - a title obtained by graduates of the veterinary degree). What may be confusing for the British is that most of the Polish medical schools, which run English-taught units of the medical degree, translate this title as “MD” and not “MBBS”. However, the Polish School of Medicine (Polish Medical Faculty) at the University of Edinburgh, which operated from 1941 to 1949, awarded both British degrees of Bachelor of Medicine and Bachelor of Surgery (MB ChB) and a Polish Dyplom Lekarza on the same bilingual Latin-Polish certificate to 227 students. Of these, 19 progressed later to Doctor of Medicine (MD). [17] [18] [19]
- The Danish and Norwegian Candidatus medicinae or Candidata medicinae degrees (Cand.med.) are equivalent to the North American MD degree as determined by U.S. state medical boards.
- In Mexico as well as most Latin American countries, schools of medicine award the “Titulo de Medico Cirujano” degree after 6 years of study (some Mexican universities award the “Titulo” after 7 years of study). The Mexican “Titulo” is equivalent to the North American MD degree according to the ECFMG. The medical curriculum in Mexico follows the European model of medical education which includes 4 years of study covering the basic and clinical sciences, an undergraduate rotating internship year, and a year of social service providing primary care to an underserved population. Physicians holding the Mexican “Titulo” degree who practice medicine in the USA or Canada use the designation “MD” after their name.
- In the Netherlands finishing a medical university training does not automatically qualify to treat patients, or for that fact, to use the internationally recognised MD title. Finishing an university medical study results in a MSc or doctorandus title, locally noted as Drs. or drs. (e.g. drs. Jansen). A minimum of 2 years internship/ specialisation are required, the length in years varying with the discipline. Only after specialisation (e.g. GP medicine, cardiology), the MD title can be used. A PhD title can only be obtained after presenting a large body of original academic research, defending a resulting dissertation successfully before “a gathering of peers”, and a substantial number of peer-reviewed international publications. In the Dutch language, titles can be confusing; the Dutch “dokter” stands for a MD and literally means “physician”, while “doctor” signifies a PhD. The earlier mentioned abbreviation Drs. can also be obtained in other academic disciplines if completed succesfully, and is not medicine specific.[20] [21]
- IMGs (International medical graduate) or FMGs (Foreign Medical Graduates), who practice medicine in the United States may use the title MD. They can do so only if they have passed the United States Medical Licensing Examination (USMLE) exams, and satisfied any other legal requirements administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as specified under Public Law 94-484, as amended.
Other postgraduate clinical degrees
There is also a similar advanced professional degree to the postgraduate MD: the Master of Surgery (usually ChM or MS, but MCh in Ireland, Wales and at Oxford and MChir at Cambridge).In Ireland, where the basic medical qualification includes a degree in obstetrics, there is a similar higher degree of Master of the Art of Obstetrics (MAO).
