Why are there so many of them?
You are having a problem with your foot, so you go to your doctor and they recommend that you go to a specialist. Should you see a podiatrist, an orthopedist or an orthopedic surgeon? This variety in specialization occurs throughout all areas of medicine. Understanding the differences between types of doctors can be extremely helpful in answering the question: Which one is the BEST one to help you?
In order to be accepted into medical school, you have to have at least a four-year college degree. Medical school takes another four years to complete. Typically, after medical school, doctors must complete a residency in a specialty of their choice. Depending on the type of residency, it can last anywhere from three to nine years. After residency, if a doctor wants to focus on a specific area of their specialty, or sub-specialize, then they must complete a fellowship, which is an additional two to four years of training. So, a freshly minted doctor has anywhere from 13 to 21 years of training.
You might notice that your doctor has an MD or DO after their name. Either one is qualified to take care of you. The main difference is the approach they use to do so. A MD is a doctor of medicine, whereas, a DO is a doctor of osteopathic medicine. MDs use a treatment method called allopathic, which is focused on treating disease symptoms by using remedies like drugs or surgeries. DOs method is osteopathic, which focuses on a “whole body” approach. This means they address medical concerns from medical and lifestyle standpoints. They are required to take additional classes, usually 300-500 hours, that focus on how your skeletal system interacts with the rest of your body when you are sick. The only time most people notice any difference in the care they receive is if their primary care physician (PCP) is a DO because often they will ask questions not only related to the disease process, but questions about your lifestyle and how this might affect your ability to become well.
A primary care physician is also known as an internal medicine doctor, general internist, generalist or internist. They are considered to be the general doctor for adults. This means they take patient histories, do physical exams, make diagnoses and prescribe medications. If something requires a more detailed care plan, they will refer you to a specialist that focuses on that item solely. Some internal medicine doctors specialize in sub-categories. When they do this, it means that they focus solely on that particular disease or body system. These type of internal medicine doctors are not considered to be primary care physicians. Pulmonologists are internal medicine doctors that take care of conditions that affect your lungs and how your breathing can affect your sleep, like it does if you have sleep apnea. Endocrinologist treat conditions related to your hormones and glands. Cardiologists focus on your heart and blood vessels. Gastroenterologists deal with your digestive system. Hepatologists care for conditions that affect your liver. Hematologist/Oncologists look after you if you have a blood disorder or cancer. Nephrologists take care of any kidney problems. Rheumatologists handle autoimmune disorders (diseases where your body’s immune system attacks itself). Allergist/Immunologists provide allergy testing and shots and treat conditions where your body’s immune system is under-functioning (these conditions are very rare). Infectious disease doctors deal with chronic and severe infections (ex. HIV/AIDS). Geriatrics is an internal medicine doctor that specializes in treating the elderly, usually people over the age of 80.
There are numerous areas that doctors can specialize in that are not related to being an internal medicine doctor. Hospitalists are doctors that work only in the hospital and are in charge of a patient’s care from the time they are admitted until they are discharged. This means they are coordinating care between the patient’s PCP and any specialists that are consulted. Dermatologists focus on skin conditions. Neurologists treat disorders related to your brain and nerves. Obstetricians/Gynecologists (OBGYN) concentrate on the female reproductive system, can take care of pregnant women and deliver babies. Some doctors practice both obstetrics (taking care of pregnant women) and gynecology (female reproductive issues); whereas, others only do gynecology, so it is important to clarify before you go, so you go to the right doctor depending on your need. Within OBGYN there are several specialties, such as maternal-fetal medicine (take care of patients with high risk pregnancies), reproductive endocrinology (assist with infertility issues), gynecologic oncology (deal with surgery for specific cancers, like breast, ovarian, endometrial and vulvar) and urogynecology (treat urinary conditions in women). Interventional Cardiologists perform procedures that are non-surgical (don’t need to cut you open) which are specifically related to a person’s heart or blood vessels. Interventional Radiologists are similar, except they use real time x-rays as a guide during procedures. Often the procedures they perform are related to blood vessels, kidneys and implanting certain medical devices. Anesthesiologists are the doctors that provide sedation for surgery and procedures. Psychiatrists treat you if you have a mental health issue. Subsets of psychiatrists focus solely on the geriatric (elderly) or pediatric (young) populations. Pediatricians are doctors that take care of children. Under pediatrics you can have the same specialties that adults have, such as neurology, cardiology, hematology/oncology, ophthalmology, anesthesiology and surgery. This means that these doctors have specialized in treating these areas for pediatric patients only. Family Practice doctors are trained in internal medicine, pediatrics and OB/GYN, which means they can be the primary care physician for adults and children and deliver babies. Emergency Medicine doctors are trained in stabilizing critically ill patients and providing treatment for a wide variety of conditions. Radiologists review and interpret imaging tests, such as x-rays, ultrasounds, CT scans, MRIs and PET scans. Radiation Oncologists are the doctors that provide the radiation treatment for certain types of cancers. Physical medicine and rehab doctors help to improve the function of your body if you have a chronic disability. Preventive medicine doctors deal with broad issues that affect many people, often they work in public health. Addiction medicine doctors help people overcome repetitive behaviors, such as drug/alcohol dependency or eating disorders. Hospice and Palliative doctors help manage pain and maintain a quality of life as a person nears death. Pathologists are doctors that examine biopsy specimens (small pieces of tissue that are viewed under microscopes). Medical geneticists focus on hereditary disorders and genetic counseling/screenings. Sleep medicine doctors evaluate you if you are having poor sleep. Sports medicine doctors deal with preventing and treating injuries that are related to sports and exercise. Electrophysiologists are cardiologists who have additional training in treating heart rhythm disorders.
Surgeons are doctors that specialize in performing different operations. General surgeons typically can perform a wide variety of surgeries that aren’t focused on a particular area of the body. Similar to internal medicine doctors, general surgeons can sub-specialize. A cardiothoracic surgeon operates only on your heart, lungs or chest; whereas, a vascular surgeon works on the blood vessels throughout your body. Cosmetic and reconstructive surgeons, also known as plastic surgeons, can do facial surgery, liposuction, breast surgery and some types of hand surgery. Colorectal surgeons used to be known as proctologist and operate on your colon. Surgical Oncologists remove tumors throughout your body. Transplant surgeons perform organ transplants. Trauma surgeons try to fix injuries that your body sustains, typically from objects that penetrate your body, but can be from blunt force injuries (internal damage without an obvious exterior wound). Surgical Endocrinologists deal with tumors or growths on the glands of your body.
There are several other types of surgeons that are not sub-specialties of general surgeons. Orthopedic Surgeons perform surgery on bones and joints. Within this type of surgery, many doctors specialize in certain areas, such as hands, shoulders, knees, hips, spines, sports medicine and orthopedic oncology. Neurosurgeons are doctors who operate on your brain and spinal cord. Bariatric surgeons perform surgery on your stomach or intestines to help you if you are extremely overweight. Urologists can address issues related to your kidneys, bladder and the male genitals. Otolaryngologists, are also known as ear, nose and throat (ENT) doctors, can do surgery on your sinuses, tonsils and vocal cords. Ophthalmologists see patients who are experiencing vision problems and can perform procedures to correct these. Oral surgeons are dentists who specialize in treating a wide range of conditions related to your mouth, teeth and gums. Microsurgeons perform reconstructive surgery under magnification using delicate instruments and exact techniques.
Non-Medical Doctor Specialties
There are healthcare providers that receive extensive training in certain areas, but aren’t medical doctors. You can see them for certain conditions related to their area of expertise, but they might not be able to treat every condition that falls under that area or have certain restrictions that medical doctors do not have. Psychologists and counselors are an example of this. Psychologists have a Ph.D. and counselors usually have a Master’s degree in social work, which means that they are unable to prescribe medications. So, when needed, they will work with a psychiatrist to provide this service to their patients. Podiatrists specialize in treating conditions related to feet and have the capability of prescribing certain medications and performing some surgeries. Optometrists can treat some eye conditions, but can’t perform surgery or prescribe certain medications.
With all of these different specialties, trying to understand what each one does can certainly be confusing. Hopefully, this list, while not completely inclusive, will give you a little more insight into who is providing care for you or a loved one. If you are ever unsure of why a doctor is consulted, don’t hesitate to ask. Since the human body is so complex, it is a good thing to have doctors who focus solely on a particular area. Although there are so many different types of doctors, each has their own place in taking of patients.