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.