What makes a specialist so, well, special?
When you need a medical or surgical specialist – an ear, nose and throat doctor, for example, or a colorectal surgeon – there are basic
qualifications you should look for:
- Training and experience in the specialized
field of medicine specific to your condition are vital, of course.
- Having a
high volume pf patients and staying current with new developments in the
specialty also are important.
- Affiliation with a respected, highly ratedmedical center or health system likewise should be on the checklist.
Verifying specialty training
Yet, many people
don’t realize that a doctor may call himself or herself a specialist without
any specialized training, and that after four years in medical school and an MD
degree in hand, the newly minted doctor may hang up a shingle, for example, as
a dermatologist or an endocrinologist.
“A lot of doctors do that,” says Dr. Sheldon
Greenfield, a UC Irvine Health internal medicine specialist and the
co-director of the UC Irvine Health Policy Research Institute.
“That’s why checking on their specialty training
is important. They need to have the right training in the right place for the
right amount of time.”
Residencies vs. fellowships
What’s a residency? A fellowship? Dr. Mark
Langdorf, senior associate dean for medical education, explains:
- Residency. Most specialists have completed a residency,
which is the immediate period after graduation from four years of medical
school. During this time they focus on one organ system or medical specialty
for three to seven years. The vast majority of medical school graduates pursue
residency training, as at least one to two years of training are required in
most states to get an independent license to treat patients.
- Fellowship. A fellowship is an additional period of training
for one to three years, during which the specialist becomes even more focused
on a narrower scope of care. For example, an internal medicine doctor takes
three years of residency to train, and then the doctor can pursue a fellowship
in the subspecialty of cardiology for another three years.
At the end of either a residency or fellowship,
the doctor takes a comprehensive written and sometimes oral exam, administered
by a specialty board like the American Board of Internal Medicine.
The meaning of board certification
then the doctor is board-certified in that specialty or subspecialty, and this
board certification attests to the highest credential for a doctor in that
specialty. Doctors who are not board-certified have not been through the
rigorous training and testing of the board-certified specialist.
A given specialist might – and probably should – have some
combination of the three, if not all of them, says Greenfield.
Greenfield, whose research centers on educating patients to
get the most from their doctor visits, says that an ideal specialist will have
training at a university hospital, where fellowships often last three years and where specialists can stay sharp through
additional work as researchers and teachers.
Many specialists in a given field
have a particular expertise that’s even more specific, so patients should keep
that in mind as well.
“Is his or her expertise in exactly the right area that the
patient needs?” Greenfield says. “Do they need a general cardiologist, or one
who specializes in electrophysiology? Do you want someone who specializes in a
Questions to ask a
Here are some other questions Greenfield says a patient should
ask or research online when looking for a specialist:
- Is there any data on the doctor’s successes or
- What is the specialist’s weekly or monthly
patient volume? This is especially important for surgeons.
- Does the doctor have a reputation for explaining
- Does the specialist have a reputation for
weighing the patient’s life expectancy against the potential value of the
available procedures and treatments?
“Specialists keep up with the latest evidence within their
specialty area and think critically about the balance between what science says
and what a patient’s wishes are in finding the best plan of care moving
forward,” says Dr. Alpesh
Amin, a UC Irvine Health hospital and internal medicine specialist and
chair of the Department of Medicine.
“In some specialty areas, the specialist might be someone
who innovates and leads through innovation. In other specialties, one may have
an insight as to the right course the patient should follow. Both are thought
leaders, but one might do it through innovation and one might do it through insight
and awareness as to what the patient should do moving forward.”