Choosing A Doc: Know Your ABCs

The complex and confusing alphabet soup of degrees and titles doctors attach to their names presents a challenge for consumers. Here’s our guide to decoding them.

Illustration by James Worrell.

Finding the right doctor might seem a daunting task, but you have access to more information than you probably realize. The first step is to collect referrals—from someone you trust in the medical field, family, friends or resources like the NJM Top Doctors list. Once you have identified a few promising candidates, you can start digging deeper, and the Internet has made that task easier than ever.

Before delving in, call the doctor’s office and confirm that he or she is taking new patients. Next, see if the doctor meets the following three criteria recommended by the New Jersey Health Care Quality Institute, a nonprofit organization committed to improving patient safety and quality of care.

Is the doctor in network?
Some doctors are not in network for all plans provided by a given insurance company. Insurance companies sometimes list in-network doctors and hospitals online, but the best way to make sure a doctor is in network is to call the doctor’s office. However, some out-of-network doctors may work with patients to help them afford treatments.

Is the doctor board-certified?
Board certification means a doctor has been tested in knowledge, skills and experience in a specialty, such as pediatrics or obstetrics and gynecology, and is deemed qualified to provide quality care. “It’s above and beyond having your license,” says Lori Boukas, spokesperson for the American Board of Medical Specialties, the nonprofit organization that assists the 24 medical boards that certify MDs in the United States. (Doctors of osteopathy, or DOs, may be certified by the 18 boards regulated by the American Osteopathic Association. More about DOs in a moment.)

Most doctors seek board certification after obtaining their licenses. A doctor may seek multiple certifications from boards overseeing different specialties and subspecialties. Most certifications must be renewed every 6 to 10 years, and requires study, ongoing assessments, conferences and other training. “We always want to make sure doctors are keeping current with their training,” says Boukas.

Patients can check their doctor’s status at the ABMS website, certificationmatters.org.

For a variety of reasons some doctors might not be certified. They might not be able to pass the exams, says Boukas, or they might have stopped seeing patients to focus on teaching or conducting research.

Is the doctor licensed?
Another online source is the New Jersey Department of Law and Public Safety, Division of Consumer Affairs website, njconsumeraffairs.gov. In the blue list in the center column, click on “Physician, Podiatrist and Optometrist Profile,” then on the left side click on “Search for a Health Care Professional.” Select profile type from the pulldown and enter the doctor’s name below. A profile should appear that lists the doctor’s specialty, whether the doctor has a current license in that specialty and whether the doctor has made any malpractice payments in the past five years. The profile also includes information regarding the doctor’s education, hospital privileges and which languages the doctor speaks. Board certification is also listed. (Much of this information is available at njmonthly.com for this year’s Top Doctors.)

Once you have confirmed that the doctor is in network, board certified and licensed, you might want to find out more about the quality of care the doctor provides. Websites like healthgrades.com offer patient reviews for no charge; however, the New Jersey Health Care Quality Institute warns that these reviews do not reflect a professional evaluation, but the opinions of patients who took the time to write reviews.

Who’s that?
While receiving care, a patient might need to deal with medical professionals other than their primary-care doctor or specialist. Here is a list of caregivers a patient might encounter:

A resident is a medical school graduate who has earned the title doctor but is still acquiring the clinical experience necessary to be licensed to practice in a specialty, such as primary care or pediatrics, on his or her own.

First-year residents are sometimes referred to as interns; however, the American Medical Association no longer uses this term. (Residencies usually last three to eight years, depending on the chosen specialty.)

A fellow sometimes refers to a physician who may or may not have a license and has chosen to complete an additional one to three years of training in a subspecialty, such as gastroenterology (a subspecialty of internal medicine) or child and adolescent psychiatry. However, fellow may also refer to a licensed physician who has been accepted as part of a particular medical academy, college or society due to the physician’s clinical experience, board certification or other accomplishments. Fellows can be identified by their acronym. For example, doctors with the initials FAAFP are fellows of the American Academy of Family Physicians; an FAAP is a fellow of the American Academy of Pediatrics; FACOG, a fellow of the American College of Obstetrics and Gynecology; and FACS, a fellow of the American College of Surgeons. Doctors may be members of these organizations as well, but a member does not have the same standing or privileges as a fellow.

At a teaching hospital, the attending physician is usually a licensed doctor who is responsible for training residents and fellows. At a non-teaching hospital, the term may refer to the physician primarily responsible for a hospitalized patient’s care.

Physician assistants are licensed to examine patients, make preliminary diagnoses and provide basic treatment under the supervision of a licensed physician or surgeon.

Medical assistants perform administrative and clinical tasks, typically in a doctor’s office. They might help patients schedule appointments, prepare blood for laboratory tests or record a patient’s medical history during examinations.

A nurse practitioner is a registered nurse (RN) who has completed additional education, usually a master’s degree, and clinical training allowing them to perform physical exams, diagnose and treat common acute and chronic problems, and prescribe medication.

MD or DO?
Most patients are familiar with MDs, or doctors of allopathic medicine, but another type of doctor is growing in popularity with the public. Doctors of osteopathic medicine, or DOs, are licensed to practice any medical specialty, prescribe medication and perform surgery. “They can do everything an MD can do,” says Nicole Grady, media relations manager for the American Osteopathic Association.

Typically, both MDs and DOs have completed four years of college and four years of medical school, though of different types. (The School of Osteopathic Medicine at the University of Medicine and Dentistry of New Jersey in Stratford is the single osteopathic school in the state.) MDs and DOs must complete three to eight years of residency in a specialty before they may apply for a license. In New Jersey, MDs and DOs are both licensed by the New Jersey State Board of Medical Examiners, and they may specialize and subspecialize in any area of medicine. The differences are philosophical. Traditionally MDs are trained to rely on medication in treating organs or diseases. DOs tend to consider the patient as a whole and recognize the body’s ability to heal itself. “Our core values are in prevention and applying a holistic approach to medicine,” says Dr. George J. Scott, an osteopath and president of the New Jersey State Board of Medical Examiners. DOs are also trained to put an emphasis on a patient’s lifestyle, including eating habits and fitness.

Another difference is that DOs are trained to assess a patient’s musculoskeletal system—the bones and muscles—based on the belief that it reflects and influences the condition of all other body systems. DOs sometimes perform osteopathic manipulative therapy, which is a hands-on treatment meant to restore proper structure and, therefore, function. 

Most DOs in New Jersey are primary-care physicians, since many DOs pledge to practice in underserved areas, where people might not have access to a full-range of health care. “Many DOs fill critical needs,” says Scott, who is also the director of the family medicine residency program and assistant professor at the School of Osteopathic Medicine at UMDNJ. He acknowledges that in the past 20 years, some MDs have adopted certain osteopathic methods and principles.

Grady says patients sometimes don’t realize that DOs are actual doctors who have gone to medical school, and that osteopathic medicine is not a specialty. “DOs are not alternative-medicine providers,” she says. She also distinguishes them from chiropractors and naturopaths, who are not medical doctors.

The number of DOs practicing in the United States has almost doubled since 2000. New Jersey’s more than 3,300 active DOs represent about 5 percent of all DOs in the country. The numbers are expected to keep rising. “Patients are looking to build a relationship with their physicians—having someone to talk to about preventative care, lifestyle changes, what they can do to make themselves healthier,” says Grady.

Psychiatrist or Psychologist?
Both psychiatrists and psychologists are licensed to diagnose and treat patients with mental illness. They also may specialize to serve certain populations like children or the elderly.

Psychiatrists, however, have completed medical school and residency training. They are either MDs or DOs and can therefore prescribe medication as well as medical tests. “They are physicians who understand better the interplay between medical and emotional disorders,” says Dr. Edward A. Latimer, a psychiatrist in Montclair. They may also be board certified.

Psychiatrists generally handle more serious conditions like bipolar disorder and schizophrenia, which commonly require medication. Like psychologists, they often employ psychotherapy, sometimes referred to as “talk therapy.”

Psychologists earn doctorates in psychology (either a PhD., PsyD. or EdD.) and must complete a clinical internship. They may also be board certified. Psychologists usually have a strong background in research and rely on psychotherapy to help patients change their feelings, thoughts and behavior using techniques developed from research.

Orthopedist or Podiatrist?
Orthopedists, also known as orthopedic surgeons, are MDs or DOs who treat problems with the musculoskeletal system, which includes bones, joints, muscles, tendons and ligaments. “They take care of all types of musculoskeletal disorders and injuries, which include fracture care, muscle strains and tendonitis,” says Dr. Richard A. Rosa, an orthopedic surgeon in West Orange. Though the physician’s title is orthopedic surgeon, patients should not assume that surgery is the only method of treatment. “A large part of an orthopedic surgery practice is primary care,” says Rosa. Other methods of treatment include injections and anti-inflammatory medications.

While orthopedic surgeons may take care of any part of the body, podiatrists focus on the body below the knee. They often see patients complaining about foot and heel pain, and they tend to try to fix the problem without surgery, says Dr. James C. Ricketti, the president of the New Jersey Podiatric Medical Society. “We are more conservative than orthopedists,” he says.

Ricketti and other podiatrists are not MDs or DOs but doctors of podiatric medicine or DPMs. They attend podiatric medical programs that are usually part of a larger medical school. The first two years of a podiatrist’s medical education is similar to that of an MD or DO, says Ricketti, but podiatrists spend their third and fourth years focusing on their specialty in clinical rotations. They are required to complete a three- to five-year residency in surgery. Some podiatrists seek board certification in podiatric surgery or orthopedics and primary-care podiatry.

Rehabilitation Physician, Chiropractor or Physical Therapist?
Rehabilitation physicians, also known as physiatrists, are MDs or DOs who specialize in physical medicine and rehabilitation. They examine and diagnose patients whose limited physical function stems from injury, illness or a disabling condition. “A physiatrist is an excellent person to see for the aches and pains and the guidance on what to do about it,” says Dr. Ellen Novick, a physiatrist in Montclair. However, physiatrists do not perform the therapy themselves. They might prescribe medication or orthotics, or they might refer the patient to another physician or physical therapist. “They can help triage,” says Novick.

Neither chiropractors nor physical therapists are medical doctors, and they cannot prescribe pain medication. However, both must be licensed to treat patients.

Chiropractors most commonly treat patients with back and neck pain and headaches, and they are trained to diagnose injuries and disorders involving the muscles, ligaments and joints of the spine and extremities, according to the American Chiropractic Association.

Chiropractors can also assess other health issues. They might refer patients to a physician, says Moorestown chiropractor Michael Kirk, a vice president of the Association of New Jersey Chiropractors. “We are not only exploring the musculoskeletal system, we are exploring all the other systems of the body,” he says. Chiropractors must earn a doctor of chiropractic degree (or DC), which requires four years of postgraduate education, and complete an internship. A significant amount of their training focuses on clinical technique for manipulations and adjustments.

Physical therapists typically see patients who have been referred to them by a physician. They treat conditions that limit the body’s mobility and develop programs to improve a patient’s coordination, flexibility and strength. They often help people recover from injuries or strokes, or deal with diabetes and the problems of old age, according to the American Physical Therapy Association.

Physical therapists must have a master’s or doctorate in physical therapy (an MPT or DPT), which usually takes between two and three years. Some physical therapists specialize in a particular area of the body or in sports injuries or pre- and postnatal care. Physical therapists often show patients how to do exercises and continue treatment at home.

Ophthalmologist, Optometrist or Optician?
All three of these professions are related to eye care; however, there are stark differences in the training and expertise required.

Ophthalmologists are medical doctors. “An ophthalmologist is a specialist whose training enables them to take care of all aspects of eye disease and eye care, medically and surgically,” says Dr. Jonathan W. Ditkoff, an ophthalmologist in Bloomfield. They are licensed to prescribe eyeglasses and contact lenses. Some ophthalmologists focus on a subspecialty like glaucoma or cataract and refractive surgery. “That enables them to take care of more specific issues that occur in their realm,” says Ditkoff, who specializes in the cornea and external diseases of the eye.

An optometrist is not an MD or DO but an OD, or doctor of optometry. After earning an undergraduate degree, optometrists attend four years of optometry school. Their medical education includes clinical experience, and some seek additional training to specialize in areas like vision therapy and rehabilitation or ocular disease. Optometrists are licensed to perform eye exams and vision tests and prescribe eyeglasses and contact lenses and medications for certain eye ailments. “They are equipped to take care of most eye problems,” says Ditkoff, who works with two optometrists at his practice in Bloomfield. Ophthalmologists typically handle more serious conditions and conditions requiring surgery.

Opticians are technicians who work in stores that sell eyeglasses. “They are like the last step,” says Ditkoff. They fill prescriptions written by an ophthalmologist or optometrist and help people find the right kind of lenses and frames for them. They do not diagnose or treat eye diseases. In New Jersey, they must be licensed.
 


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