MD? PA? DO? Monthly makes sense of the titles to help you find the right health care professional.
Those in the medical field often have to cover a wide span of jobs and behind many professional titles come a number of degrees or certifications. To help you better
determine the right health professional for your needs, the following sheds some light on a few industry areas.
MEDICAL DOCTOR, MD
To earn the title of Medical Doctor (MD), a person must first earn an undergraduate degree, perhaps concentrating in an area of science to complete required prerequisites and obtain knowledge to pass the MCAT (Medical College Admission Test). Following admission to medical school, four years are spent in coursework and in close contact with a faculty member to ensure all requirements are met prior to an internship and residency.
The student must then pass the USMLE (US Medical Licensing Examination), parts one and two, and perform at least one year in an internship. To then practice, the candidate must pass the third part of the USMLE. Residency is the next step for the doctor who wishes to earn board certification in a certain area, such as general surgery or internal medicine. Depending on specialty chosen, a candidate may spend anywhere from three to eight years in residency. The first year of residency is called the internship and is generally spent rotating through a variety of practices or through areas within a certain chosen practice. If the physician wishes to specialize further, in fields such as cardiology or sports medicine, he or she will obtain a fellowship with a current physician practicing in that area.
Since needs change, as medicine evolves, family practice doctors and general internists also evolve. The typical path for a doctor in the past included medical school plus a one-year internship, to practice family medicine, and additional training in residency to specialize in a particular field. In regard to time and experience, doctors now often spend more time in residency, prior to practice, so that they may assess and treat a more complex array of conditions and injuries.
Family/general practitioners and internists are viewed as primary care, but internal medicine focuses on adults and requires physicians to gain specialization in knowledge of internal organs. Internists and family doctors see a range of patients and refer to specialists if a condition requires further assessment and complex treatment: ex. gastroenterologist for stomach and intestinal problems, cardiologist for heart and cardiovascular problems, ear/nose/throat physician for chronic sinus infections and serious or recurrent upper respiratory problems, a dermatologist for skin disorders or identification of skin changes, etc. Internists in a breast cancer program, for example, may focus on evaluating breast problems, managing cancer risk, and providing follow-up care for women with breast cancer.
Plastic surgeons are doctors who specialize in reducing scarring or disfigurement that may occur as a result of accidents, birth defects or treatment for diseases. This professional may also be able to perform cosmetic enhancements and procedures, such as breast augmentation, faces lifts, etc. A radiologist is a doctor specializing in interpreting X-rays and other types of imaging studies such as CT scans, MRI, etc.
Physicians of all specialties and practice are required to repeat medical board exams on a routine basis, every three to six years. They must obtain continuing medical education credits to maintain their medical license and pass their boards. This ensures that they stay up to date with the latest in findings on health and medicine in general and in their area of expertise.
The acronym F.A.C.S. refers to “Fellow of American College of Surgeons,” and F.A.C.G. to “Fellow of American College of Gastroenterology.” You can find definitions for acronyms at www.freedictionary.com.
OB/GYN
While some general practitioners offer obstetrical services to their patients, these generalists are not typically trained in surgical aspects of obstetrics or trained in gynecology and should not be confused with residency trained and boardcertified OB/GYNs. Also, while all gynecologists are trained obstetricians the reverse may not be true.
Obstetrics and Gynecology (OB/GYN or O&G) are the two surgical specialties dealing with the female reproductive organs and are often combined to form a single medical speciality and postgraduate training program. This training prepares practicing OB/GYN’s for surgical management and care for both pregnant and non-pregnant patients. In the U.S. OB/GYN specialists require four years of secondary education at an accredited college or university, followed by four years of medical school and four years in residency. Some OB/GYN surgeons choose to complete subspecialty training in programs (‘fellowships’) after completing residency training, but most choose to enter private or academic practice as general OB/GYNs.
Subspecialty training available to physicians in the US includes: Maternal-Fetal Medicine: obstetric subspecialty that focuses on medical and surgical management of high-risk pregnancies; Reproductive Endocrinology and Infertility: a gynecologic subspecialty focusing on medical and surgical evaluation of women with problems related to menstrual cycle and fertility; Gynecological Oncology: gynecologic subspecialty focusing on medical and surgical treatment of women with cancers of reproductive organs; Urogynecology and Pelvic Reconstructive Surgery: gynecologic subspecialty focusing on the diagnosis and surgical treatment of women with urinary incontinence and prolapse of the pelvic organs. Sometimes referred to (incorrectly) by laypersons as “Female Urology”; Advanced Laparoscopic Surgery; Family Planning – gynecologic subspecialty offering training in contraception and (sometimes) pregnancy termination; Pediatric & Adolescent Gynecology; Menopausal & Geriatric Gynecology.
DOCTOR OF OSTEOPATHIC MEDICINE, DO
Behind a doctor’s name you may find the letters MD for medical doctor or DO for Doctor of Osteopathic Medicine. Both are required to complete a similar path of schooling: four years undergraduate, concentrating in science; four years of medical school; graduate education through internships and residencies. The osteopath, however, focuses on a “whole body” approach to medicine, spending extra time learning the musculoskeletal system and how an injury or illness in one area of the body may affect another area.
They incorporate Osteopathic Manipulative Treatment (OMT) into their practice, along with all other medical knowledge. OMT involves the manipulation of bones, muscles, and tendons to improve blood flow and enhance, or stimulate the body’s own healing powers. DO’s may emphasize a more preventive philosophy regarding their medical care, focusing on healthy lifestyle habits. All D.O.’s, like MD’s, must perform an internship in family practice, ob-gyn, pediatrics, surgery, and internal medicine, in the event that they are going to practice as primary care physicians. Like medical doctors, specialization in other areas (ex. radiology, cardiology, pulmonology, surgery) takes another two to six years to complete prior to receiving a license to practice, depending, of course, on the specialty and its complexity.
Osteopaths should not be confused with Chiropractors, who practice manipulation of the spine, usually for conditions that seem resistant to practice or therapy from a traditional physician. Osteopaths are closer to a medical doctor, practicing in many of the same types of facilities and taking the same classes as medical doctor students, and are allowed to treat, diagnose and prescribe medication just as the MD does.
PHYSICIAN ASSISTANT, PA
To help address the rising need for assistance, due to a rising patient base, physicians may hire a physician assistant to basically help them in almost all areas of physician duties. A physician assistant (PA) may prescribe medication in all but three states in the U.S. They are allowed to do physical exams, treat and/or diagnose illness, and even order or interpret tests. They basically practice medicine under the license of a practicing physician, and may refer to this physician if the case he or she is working on is very complex or requires further consultation.
Training for the PA is typically a bachelor’s degree in a health-related field, plus a two-year program as a physician assistant. Many programs require that a PA candidate have at least four years of experience in a health-related field prior to admittance to the PA program, though programs vary from school to school. PAs may work in as many different areas as physicians do, but many work in general practice, internal medicine, pediatrics, or obstetrics/gynecology. During their rotations, during their two-year degree, they experience all areas of medicine.
EYE DOCTORS
Depending on the problem a person may have with his or her eyes, he or she may find an eye doctor with similar titles, but different responsibilities. The ophthalmologist, for example, is a medical doctor (MD) or doctor of osteopathy (DO) who has specialized in eye care. He or she has gone to medical school, had one year of internship, and then three or more years specializing in eye surgery and medical care for eyes.
These professionals are trained to diagnose vision problems or diseases of the eye, treat and/or medicate the condition, and perform surgery when necessary. This individual must be licensed by a state regulatory board. Most people will see an ophthalmologist if he or she has more symptomatic eye problems, such as a loss of vision, eye injury, or flashing lights/seeing spots, etc.
Most surgeries are performed by ophthalmologists so an eye care specialist may refer patients when a problem is more difficult. Lasik surgery, one type of corrective vision surgery, is performed by ophthalmologists. Today, professionals specializing in eye surgeries correct vision, remove cataracts, perform corneal implants and more.
An optometrist does not go to medical school, but has instead typically completed four years at an accredited school of optometry, in addition to an undergraduate degree. The optometrist is then awarded a doctorate of optometry (O.D.). Some optometrists also spend an additional year in an internship, specializing in a certain area of eye care.
The optometrist cannot perform eye surgery (except in the state of Oklahoma), but can diagnose problems such as glaucoma or retinal problems. They treat vision problems and are able to prescribe medication, perform eye examinations, and prescribe eyewear (ex. glasses, contact lenses). They have also become more likely to treat some of the same conditions that were previously left to the medical doctor, the ophthalmologist. However, this varies by state and by regulatory boards.
The optician is not a doctor, but is a licensed professional who works along with eye doctors. They are trained to make eyeglasses and sunglasses after the optometrist or ophthalmologist writes the prescription. The optician’s two-year technical degree provides training in the interpretation of eye care prescriptions. Opticians are also the professionals most people see if an adjustment to glasses or lenses must be made, or if a repair is needed.
An eye care team works together to provide full-service eye care. Most people should see an eye doctor on an annual basis, whether they have developed a need for eye care or for preventive health purposes. Family doctors may sometimes be the first contact in determining if an eye specialist is needed.
DENTAL PROFESSIONALS
A general dentist is who most people begin seeing at about the age of three. Even though baby teeth fall out, it is important to establish good dental habits early, to help maintain a healthy mouth and prevent dental health problems down the road. Ideally, most meet with a dentist every six months for a cleaning and to keep an eye on tooth and gum health.
A dental exam will typically include a cleaning by a hygienist, as well as occasional x-rays to check for cavities. The dentist will interpret the x-rays and perform an exam of teeth and gums to see if any problems are present. Depending on the issue, a dentist may have to schedule an appointment for a filling for cavities, or may need to refer to another dental specialist, if necessary. A general dentist is either a Doctor of Dental Surgery (DDS) or a Doctor of Dental Medicine (DMD). Universities vary regarding which degree they award, but DDS and DMD are essentially the same. Both complete four years of dental school, in addition to general undergraduate degrees. Specializing further requires post-graduate training and may include one of several areas: Orthodontist, Endodontist, Periodontist, Pedodontics, and Oral and Maxillofacial specialists.
An endodontist is a dentist who has taken two or more additional years of education, in addition to completing a four-year dental school. The additional education focuses on the performance of root canals. Endodontists are able to recognize dental problems that require a root canal and are trained in this procedure. Some dentists also perform root canals.
An orthodontist is a dentist with specialization in straightening teeth. Their goal is often dental re-alignment using braces, but they may also perform more complex work in modification or control of facial growth to help ensure correct jaw alignment and proper appearance. The gear used for more complex problems, such as these, may be called orthopedic devices for the dentofacial area. They include appliances such as headgear or plates that are typically used when a child is in his or her developing years.
Today, many dentists also straighten teeth using straightening trays, such as Invisalign®, for example. The dentist may take photos of a patient in his or her office and then send them to a lab where the images are used to create a series of customized trays. Dentists are also trained to whiten teeth using special topical agents and lights, such as ZOOM whitening technology.
A periodontist is a dentist with a specialty in treating the areas around the teeth (called the periodontum) – gums, bone structures, and ligaments that support them. The periodontist is referred to if a general dentist begins to see problems with gums or structures upon examination.
Some of the signs of periodontitis are: bleeding of the gums on an increasing or regular basis – such as when brushing teeth, flossing, or biting into foods; space around the gums called pockets – a sign of infection of the gums and something that most dentists/hygienists check on a routine basis, and if left untreated can turn into abscess; loosening of teeth – a sign of bone loss inflammation of gums, they need to remember that the same bacteria that infect the gums, when left untreated, may eventually spread to the bones surrounding teeth. The damage to bones and ligaments may result in the loosening and eventual loss of teeth. Because of this, the periodontist is also usually the specialist who performs dental implants to replace lost or damaged teeth.
NURSES & NURSE PRACTITIONERS, LPN, RN, BSN, MSN, FNP
Nurses may have a number of letters after their names. First, there is the LPN (Licensed Practical Nurse), a status which is achieved with a one-year associate’s degree from a community college or technical school and prepares the student to work in basic care of patients.
A registered nurse (RN) possesses a two-year degree, which prepares the nurse for more widespread services. A registered nurse is often an LPN’s supervisor. The Bachelor’s of Science in Nursing (BSN) is a four-year degree that trains a student in the full realm of nursing/science skills, but also focuses on management and leadership skills. A nurse may even earn a Master of Science in Nursing (MSN) if she or he wants to go further in education. Many management level jobs are awarded based on years of experience plus degree held. If a student does not have a desire to work towards management or a higher degree (such as a Nurse Practitioner degree), the RN degree may be the way to go.
Pay levels vary from state to state and region to region. Whichever level of nursing someone chooses, she or he is entering a very necessary field full of variety. Nurses are also in demand, perhaps more than ever before, in hospitals, clinics and in many rehabilitation settings. The demand is predicted to increase as the aged population increases. Nursing jobs are also among the most flexible, in terms of hours – people can pull long shifts and work few days, work regular full-time hours, or work part-time.
Nurse practitioners meet a number of the same needs as a physician or PA. Their schooling, however, revolves around nursing curriculums, while PA’s are based more on the medical doctor curriculums and focus on a broad array of health concerns related to medicine and surgery. Nurse practitioners will go through the two-year registered nurse program and then may practice for at least one year prior to being admitted to a nurse practitioner (NP) program.
The NP program is a two- or three-year program that awards a master’s degree that specializes in a certain area of medicine (such as emergency medicine, pediatrics, general health women’s health, etc.) Some universities have alternate entry programs that allow someone with an existing master’s degree in a health-related field to complete the RN to NP program in less time.
Like PA’s, NP’s can work with a practicing physician and order tests, interpret results, and even prescribe medications. They consult and refer patients to the physician as needed. Further programs exist for nurses as well – masters degrees can be obtained in anesthesiology for the title of nurse anesthetist.
PSYCHOLOGIST (PHD OR PSYD), PSYCHIATRIST (MD OR DO)
A psychologist is a non-medical professional specializing in the diagnosis and treatment of mental and emotional problems. He or she may provide psychological evaluation, assessment, testing, and treatment, but may not prescribe medications. There are various specialties within this field, from child psychology to aviation psychology.
Psychiatrists are licensed physicians who specialize in evaluation, diagnosis, and treatment of mental disorders. Their medical and psychiatric training prepares them to treat adults and children either individually, as part of and involving the family unit, and/or in group settings. Unlike psychologists, psychiatrists can prescribe medications.
In trying to keep up with a growing population with longer life expectancies, medical needs are increasing. The medical field will continue to specialize and, with research and expert minds, perhaps the increase in life span will become even more of a gift – with greater health.
