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Is There a Doctor in the House?

Here's a primer for deciphering all the newfangled medical credentials out there

THURSDAY, May 16 (HealthDayNews)-- It's a medical maze out there, as an increasingly complex health-care system becomes littered with such tricky terms as HMO, PPO and pharmaceutical formularies.

Now add this to the confusion: Going to the doctor doesn't necessarily mean seeing an M.D. anymore -- you might have an appointment with a D.O., a P.A. or an N.P.

Even doctors make things complicated. Take Dr. Arthur Silverman, for example. He's no mere M.D., according to his phone book advertisement. He's also lists FACP, FACR, INC., QME, IME and AME after his name.

"You almost have to be in the medical care system to get it," says Dr. Julie Abbott, medical editor for the Mayo Clinic Women's HealthSource. "It's very confusing for patients."

To help sort through the complexities, here's a primer on medical titles.

M.D.s are doctors of medicine, while D.O.s are doctors of osteopathy. Both are physicians. Their training typically includes an undergraduate degree and four years of medical school.

However, getting a license to practice requires even more training, called a residency. Although licensing laws vary from state to state, residencies are usually three to seven years.

A residency in internal medicine, family medicine or pediatrics usually takes three to four years. An obstetrician-gynecologist requires a four-year residency and a general surgeon five years.

Doctors can further specialize by doing a sub-specialty fellowship. For example, gastroenterology requires an additional one to three years of training.

Like M.D.s, doctors of osteopathy are qualified to practice medicine. They have a separate system of medical schools, and are more likely to become primary care providers rather than specialists, Abbott says. Of 1,000 residents at the Mayo Graduate School of Medicine, only a few are graduates of schools of osteopathy.

Whether or not there are differences in the care provided depends on whom you ask.

D.O.s often say their training is as rigorous as that of an M.D., but they encourage a more holistic approach and place more emphasis on the musculoskeletal system's role in health.

M.D.s tend to view a D.O. as a less prestigious degree, Abbott says, in part because it's typically harder to get into medical school. Many also take exception to the claim that D.O.s promote a more holistic, patient-centered approach.

"We'd all like to be holistic," she says.

However, those folks aren't the only ones you might see when you're sick these days.

A nurse practitioner, also known as an N.P., is a registered nurse who has typically received a college degree and a master's degree or additional training through a certificate-granting program. Nurse practitioners work under the supervision of a physician, but can do physical exams and health assessments, prescribe medicine and make referrals to specialists. It's increasingly common for nurse practitioners to be used as primary care providers, Abbott says.

Abbott said nurse practitioners can do an excellent job as primary care providers.

"Nurse practitioners are typically very empathic; they have more time than a physician," Abbott says. "They truly have a niche."

Then there are physicians assistants, known as P.A.s, who generally have a four-year university degree and have successfully completed a two-year physician's assistant certification program. Most also have backgrounds in health care. Traditionally, many have been military medics.

P.A.s can conduct physical exams, order and interpret tests, diagnose and treat common ailments and prescribe medicine. Rather than become primary care providers, they're usually found at a hospital, helping physicians with such technical tasks as holding and retracting surgical tools, putting in stitches or changing dressings.

"P.A.s are often used as an extension to the physician's role, rather than doing the same things as the physician like a nurse practitioner," Abbott says.

Last but not least, there are the medical upgrades.

Titles that start with a "F.A." mean a doctor is a member of a fellowship organization, which usually means they've continued to update their training. For example, an FACP is a Fellow of the American College of Physicians, while FACS is a Fellow of the American College of Surgeons.

"Fellowships are a good sign," says Dr. Stephen Barrett, founder of QuackWatch. "They generally represent people who have a significant amount of experience."

Of course, a doctor's official credentials aren't the only criteria you'll want to use when you're choosing a doctor, Barrett says.

"Having legitimate credentials doesn't guarantee someone has legitimate ideas," he says. "It's usually better to judge people by their behavior."

What To Do

To check up on your doctor's credentials, visit the American Medical Association's Doctor Finder.

You can also check out the American Board of Medical Specialty's Doctor Verification Service.

SOURCES: Julie Abbott, M.D., medical editor, Mayo Clinic Women's HealthSource, Rochester, Minn.; Stephen Barrett, M.D., founder, QuackWatch, Allentown, Pa.
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