Doctor or Barber? Reviewing the use of gendered titles for UK surgeons

By Sophie Gatfield^a, Alexander Dodds^b and Andrea Sott^c

^aSpecialty Registrar in Trauma and Orthopaedics South West of England
^bConsultant Trauma and Orthopaedic Surgeon at Gloucestershire Hospitals NHS Foundation Trust, and Vice Chair BOA Orthopaedic Committee
^cConsultant Orthopaedic Surgeon at St Helier NHS Trust, Surgical Director for SWLEOC and BOA Trustee

In the UK and Ireland, most surgeons use the traditional titles of Miss or Mr professionally. On passing intercollegiate membership examinations to the Royal College of Surgeons (RCS), the young surgeon sheds their (often newly acquired) Dr title and will spend the rest of training and their consultant career within the ‘norm’ of this title. Many surgeons will continue to be addressed by patients and colleagues alike by their title and surname throughout their professional career.

In Australia, surgeons historically aligned with this convention. However, in recent years, more and more, qualified Australian surgeons are choosing to use Dr instead. This shift reflects changing professional norms, a desire for clarity in patient communication, and an effort to maintain consistency in medical titles. In 2021 The Royal Australasian College of Surgeons (RACS) took the step of formally phasing out gendered titles for surgeons, reverting to Dr as the default title¹. The tradition seems to remain steadfast in the UK, but as society progresses, roles become less gendered, non-doctor roles within surgical teams are prevalent and clarity for patients is paramount, perhaps now is the time to reconsider.

Historical background

The tradition stems from the medieval period, when surgery and medicine were considered separate professions. Physicians, who were university-educated and trained in medicine, were awarded the title of 'Doctor' as they held academic degrees in medicine. Surgeons, on the other hand, were not always formally educated in universities. Instead, they often trained as apprentices under the guidance of barber-surgeons—individuals who performed surgical procedures such as bloodletting, amputations, and wound care alongside hair-cutting services. Because they did not hold university degrees, they were not referred to as 'Doctor' but rather 'Mister' or 'Master'².

Only once previously does a genuine reconsideration of surgeon titles seem to have been made, in 2005. After public consultation on the role introduction of Surgical Care Practitioners, the then president of the RCS England, Hugh Phillips, discussed the importance of title. “All I am interested in is that people know who is treating them. It is terribly important to identify doctors, and one way of doing it is to call them doctors”³. The following year a national survey of ENT surgeons found an overall majority in support of sticking with tradition but also identified a statistically significant disparity between male and female respondents⁴.

The shift to Dr

Several arguments seem have been made to support the shift to Dr:

1. Clarity for patients – Many patients assume that all medical doctors, including surgeons, are referred to as Dr. The use of Mr/Mrs/Miss can be confusing, leading to misunderstandings about qualifications and expertise⁵. With increasing variety of roles in the medical workforce including surgical care practitioners, consultant nurses, physician’s associates and consultant podiatrists working in surgery, clarity for patients has never been more vital to emphasise.
2. International consistency – In most parts of the world, including the United States and Canada and most of Europe, surgeons retain the title Dr. A shift to Dr aligns the profession with global standards and simplifies professional interactions internationally. UK Surgeons with global recognition may choose to retain clarity of their global reputation by using the globally recognised title. According to GMC data, in 2023, over two thirds (68%) of joiners to the UK medical register were non UK graduates⁶. 19% of those in formal surgical training programmes are non UK graduates. As our workforce becomes increasingly globalised, there is sense in aligning with the global norm.
3. Gender neutrality – The traditional Mr or Miss distinction reinforces gendered language in a profession where equity needs to be prioritised. Using Dr ensures a neutral, inclusive approach. For female surgeons, the traditional ‘Miss + maiden name’ allows them to maintain a consistent professional identity. Or perhaps for some, a persistent reminder that generations of female surgeons remained unmarried as they took the ‘alternative’ path of having their own career. Furthermore, the conventional use of gendered titles forces those who do not wish to declare their gender to do so.
4. Professional recognition – Given that surgeons undergo extensive medical training and hold the same medical degrees as other doctors, some believe that retaining the ‘Dr’ title more accurately reflects their academic and professional credentials.

The Australian transition has been met with mixed reactions. Some surgeons and medical bodies support the shift, arguing that it modernizes the profession and removes unnecessary confusion. Others maintain that the historical title is a mark of distinction and should be preserved as a tradition unique to surgery.

Professional bodies, such as RACS, although using Dr as the default title, have not mandated the use of either in professional practice, leaving it to individual preference. This has resulted in a gradual, surgeon-led change rather than an enforced policy shift.

Conclusion

Professor Scarlett McNally challenges the surgical community as a whole to reconsider the use of anachronistic titles in surgery in her review of terminology used for postgraduate doctors (formally junior doctors). “Changing culture requires multiple small actions. The Kennedy Review into diversity in surgery showed that microaggressions and misidentification of people who do not fit the traditional image of a surgeon are rife. Now more than ever, we need to support every doctor to be their best.”⁷

The choice between Dr and Ms/Miss/Mr for all surgeons remains a matter of personal and professional preference. While tradition holds strong in the UK, the global move towards Dr reflects evolving medical practices, improved communication with patients, and a more globalised surgical workforce. Use of RCS census data or a BOA membership poll could be used to track surgeons opinions on titles and their evolution. As our profession continues to develop, we predict the use of Dr among UK surgeons will increase.

References

1. Royal Australasian College of Surgeons (2021). RACS phases out gendered titles for surgeons. Available from: www.surgeons.org/News/media-releases/RACS-phases-out-gendered-titles-for-surgeons.
2. Loudon I. Why are (male) surgeons still addressed as Mr? BMJ. 2000 Dec;321(7276):1589-91.
3. Dobson R. English surgeons may at last be about to become doctors. BMJ. 2005;330:1103.
4. Ibery N, Patel P, Robb P. Do surgeons wish to become doctors? J R Soc Med. 2006;99(4):197-9. 
5. Bismire H, Nunn S, Malpas CB, Bilszta JL. Doctor Who? Honorific titles and their influence on patients' perceptions of healthcare professionals. J R Soc Med. 2022 Mar;115(3):91-94.
6. GMC 2024, Workforce Report 2024. Available from: www.gmc-uk.org/-/media/documents/somep-workforce-report-2024-full-report_pdf-109169408.pdf.
7. McNally S. (2022). What should we call junior doctors? Available from: www.scarlettmcnally.co.uk/junior-doctors-report