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Everyone knows that a "medical doctor" is a
physician who has had years of training to understand the
diagnosis, treatment, and prevention of disease. The basic
training for a physician specialist includes four years of
premedical education in a college or university, four years
of medical school, and after receiving the M.D. degree, at
least three years of specialty training under supervision
(called a "residency"). Training in subspecialties can take
an additional one to three years.
The process most widely used by physicians to
tell whether and why you are sick is to ask you, and/or family
members, questions about your health and past medical history.
This process, "taking a history," is usually followed by an
appropriate physical examination of your body to determine
how well it is functioning and whether there are signs of
disease. Doctors also use a variety of tests such as lab tests,
x-rays, other imaging techniques, and additional procedures
to evaluate your health and identify any diseases or other
health problems that may be present. Some of these diagnostic
procedures (e.g., cardiac catheterization, CT scans, biopsy
of internal tissues) are very complicated. They require many
years of training in order to use them safely and accurately.
After the diagnostic process is completed, the
doctor will recommend treatment if it is needed. Treatment
may involve medication, surgery (there are many types of surgical
specialists), or other complex procedures.
Some specialists are primary care doctors, such
as family physicians, general internists, and general pediatricians.
Other specialists concentrate on certain body systems, specific
age groups, or complex scientific techniques developed to
diagnose or treat certain types of disorders. Specialties
in medicine developed because of the rapidly expanding body
of knowledge about health and illness and the constantly evolving
new treatment techniques for disease.
A subspecialist is a physician who has completed
training in a general medical specialty and then takes additional
training in a more specific area of that specialty called
a subspecialty. This training increases the depth of knowledge
and expertise of the specialist in that particular field.
For example, cardiology is a subspecialty of internal medicine
and pediatrics, pediatric surgery is a subspecialty of surgery,
and child and adolescent psychiatry is a subspecialty of psychiatry.
The training of a subspecialist within a specialty requires
an additional one or more years of full-time education.
Training of a Specialist: The training
of a specialist begins after the doctor has received the M.D.
degree from a medical school, in what is called a residency.
Resident physicians dedicate themselves for three to seven
years to full-time experience in hospital and/or ambulatory
care settings, caring for patients under the supervision of
experienced specialists. Educational conferences and research
experience are often part of that training. In years past,
the first year of post-medical school training was called
an internship, but is now called residency.
Licensure, the legal privilege to practice medicine,
is governed by state law and is not designed to recognize
the knowledge and skills of a trained specialist. A physician
is licensed to practice general medicine and surgery by a
state board of medical examiners after passing a state or
national licensure examination. Each state or territory has
its own procedures to license physicians, and sets the general
standards for all physicians in that state or territory.
Who credentials a Specialist and/or Subspecialist?
Specialty boards certify physicians as having met certain
published standards. There are 24 specialty boards that are
recognized by the American Board of Medical Specialties (ABMS)
and the American Medical Association (AMA). All of the specialties
and subspecialties recognized by the ABMS and the AMA are
listed in the brief descriptions that follow. Remember, a
subspecialist first must be trained and certified as a specialist.
In order to be certified as a medical specialist
by one of these recognized boards, a physician must complete
certain requirements. Generally, these include:
- Completion of a course
of study leading to the M.D. or D.O. (Doctor of Osteopathy)
degree from a recognized school of medicine.
- Completion of three to
seven years of full-time training in an accredited residency
program designed to train specialists in the field.
- Many specialty boards
require assessments and documentation of individual performance
from the residency training director, or from the chief
of service in the hospital where the specialist has practiced.
- All of the ABMS Member
Boards require that a person seeking certification have
an unrestricted license to practice medicine in order to
take the certification examination.
- Finally, each candidate
for certification must pass a written examination given
by the specialty board. Fifteen of the 24 specialty boards
also require an oral examination conducted by senior specialists
in that field. Candidates who have passed the exams and
other requirements are then given the status of "Diplomate"
and are certified as specialists. A similar process is followed
for specialists who want to become subspecialists.
All of the ABMS Member Boards now, or will soon,
issue only time-limited certificates which are valid for six
to ten years. In order to retain certification, diplomates
must become "recertified," and must periodically go through
an additional process involving continuing education in the
specialty, review of credentials and further examination.
Boards that may not yet require recertification have provided
voluntary recertification with similar requirements.
How to determine if a physician is a Certified
Specialist: Certified specialists are listed in The Official
ABMS Directory of Board Certified Medical Specialists published
by Marquis Who's Who. The ABMS Directory can be found in most
public libraries, hospital libraries, university libraries
and medical libraries, and is also available on CD-ROM. Alternatively,
you could ask for that information from your county medical
society, the American Board of Medical Specialties, or one
of the specialty boards (Click here
to view list of specialties).
The ABMS also arranges for the publication of
lists of certified specialists/subspecialists and operates
an 800 phone line (1-800-776-2378) to verify the certification
status of individual physicians. Additionally, information
about the ABMS organization and links to an electronic directory
of certified specialists can be accessed through the ABMS
website at www.abms.org.
Almost all board certified specialists are also
members of their medical specialty societies. These societies
are dedicated to furthering standards, practice, and professional
and public education within individual medical specialties.
Some, such as the American College of Surgeons and the American
College of Obstetricians and Gynecologists, require board
certification for full membership. A physician who has attained
full membership is called a "Fellow" of the society and is
entitled to use this designation in all formal communications,
such as certificates, publications, business cards, stationery
and signage. Thus, "John Doe, M.D., F.A.C.S. (Fellow of the
American College of Surgeons) is a board certified surgeon.
Similarly, F.A.A.D. (Fellow of the American Academy of Dermatology)
following the M.D. or D.O. in a physician's title would likely
indicate board certification in that specialty.
An ABMS Policy Statement: The Purpose of
Certification*
The intent of the certification process, as defined by the
member boards of the American Board of Medical Special-ties,
is to provide assurance to the public that a certified medical
specialist has successfully completed an approved educational
program and an evaluation, including an examination process
designed to assess the knowledge, experience and skills requisite
to the provision of high quality patient care in that specialty.
*Approved by the ABMS Assembly, 3/19/87.
This list was reprinted from the American
Board of Medical Specialties' brochure, "Which Medical Specialist
For You." You can visit their web site at www.abms.org.
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