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 which 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.
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.
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). 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:
1. Completion of a
course of study leading to the M.D. or D.O. (Doctor of Osteopathy) degree from
a recognized school of medicine.
2. Completion of three
to seven years of full-time training in an accredited residency program
designed to train specialists in the field.
3. 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.
4. 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.
5. 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.
Certified specialists are listed in The
Official ABMS Directory of Board Certified Medical Specialists published by
Marquis Who ís 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.
The ABMS also arranges for the publication of
lists of certified specialists/subspecialists and operates a toll free phone
line (1-866-ASK-ABMS) 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 Web site 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.
The intent of the certification process, as
defined by the member boards of the American Board of Medical Specialties, 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.
Accreditation:
A process of review and approval of medical
schools and graduate medical education training programs, residency programs,
conducted by credentialing bodies and certifying that the programs have
met certain standards. This process does not certify or accredit individuals.
The Liaison Committee on Medical Education
(LCME), a joint committee of the Association of American Medical Colleges
(AAMC) and the American Medical Association (AMA) conducts accreditation of
medical schools.
The Residency Review Committees (RRCs) of the
Accreditation Council of Graduate Medical Education (ACGME) are responsible for
accrediting residency programs. There are 26 RRCs and their members come from
relevant Member Boards of the ABMS, specialty societies and the AMA. The ACGME
oversees the activities of the RRCs and approves or disapproves their
recommendations.
Training:
Usually refers to a period of postgraduate
medical education during which a physician gains the experience necessary to
assume responsibility for the care of patients.
Internship:
The old term used to describe the first year
of postgraduate training following graduation from medical school. Physicians
participating in this training were formerly called interns but are now known
as Postgraduate Year 1 (PGY-1) residents and the year is called the PGY-1 year.
It is usually taken under the sponsorship of a single clinical department. See
Transitional Year PGY-1.
Residency:
A variable period of postgraduate education
and training (3- 7 years), based upon the specialty selected, in which a
physician participates with the expectation of becoming a specialist of medical
practice. These educational experiences occur in a variety of settings including
hospitals, clinics, offices and other relevant medical educational centers.
Transitional Year Residency:
A training program for physicians equivalent
to the PGY-1 residency training year, but organized and sponsored by several institutions
or clinical departments to provide training in multiple specialties of medicine
rather than in a single specialty.
Fellowship Training:
A period of training, usually 1-2 years,
which occurs after completion of a general or primary residency. Its goal is to
qualify a physician as a subspecialist in an area of medical practice such as
cardiology, hand surgery, etc.
Residency Matching:
The process by which most medical students
obtain an appointment for their postgraduate training. The matching process is
performed by independent agencies such as the National Resident Matching
Program (NRMP). The NRMP receives rank order preferences from students and
training institutions and "matches" them by computer according to the
highest ranked match. Residency information is available from medical schools,
training programs, The AMA Directory of Graduate Medical Education Programs,
hard copy and online, and the Fellowship and Residency Electronic Interactive
Data Access (FREIDA) service of the AMA.
Licensure (Medical):
Legal permission granted by a state or
territorial government to a physician to take personal, unsupervised
responsibility for the diagnosis and treatment of patients in the practice of
medicine. Most states and territories require that physicians complete at least
1 year, and several require 3 years, of graduate medical education to qualify
for licensure. In addition, applicants for licensure must pass an examination.
Qualifications for medical licensure in each jurisdiction are determined by
that jurisdiction. Federal, state and territorial governments do not license
physicians as specialists nor certify physicians as specialists.
Board Certification:
The
process of voluntary testing and evaluation of physicians who wish to become
board certified in a particular medical specialty. A physician may elect to
begin the certification process only after completion of an approved residency
training program.
Certification by a specialty board enables
the public to identify those practitioners who have met a standard of training
and experience set beyond the level required for licensure. Certifying boards,
unlike state licensing boards, are national in scope and independent.
Specialty Boards:
There
are 24 approved medical specialty boards that grant certification. These boards
form the umbrella organization, the American Board of Medical Specialties
(ABMS).
The specialty boards influence graduate
medical education since they set the criteria required of physicians seeking
admission to the certification examinations. Each board sets the minimum length
of time for education in an accredited residency and the content of the
certifying exam.
Candidate:
Individual
who is qualified to take a specialty board certification.
Diplomate:
Individual
who has met all specialty board requirements, including passing an examination,
and is board certified in a particular medical specialty.
Specialty Societies:
Membership
organizations of physicians involved in a given field of practice. Specialty
societies represent the interests of practitioners. In most specialty societies
it is necessary to be board certified to be eligible for membership.
Fellowship:
Physicians
attain Fellowship status in a specialty society when they demonstrate
outstanding achievement in their profession. Typical criteria for Fellowship in
a specialty society include years of membership, years as a practitioner in the
specialty and professional recognition by peers.