Health: Understanding Our Doctors
Consumers are savvier than ever when it comes to making purchases, big or small. From Consumer Reports to Yelp and word-of-mouth, we have plenty of information at our fingertips. But choosing the ‘best’ doctor for our needs is not always as straightforward. As healthcare consumers, we need to educate ourselves about the training, experience and certifications of the people entrusted with our health.
We’ve all head the term ‘board certified,’ but what does it mean? And more important, does it matter? Unlike a medical license, which is issued by the state where the physician works and is a requirement, board certification is optional. It tells you that the physician has met certain rigorous educational and professional standards.
stamp of approval
According to ABMS, American Board of Medical Specialties, certification matters because it shows the doctor is committed to lifelong learning and staying abreast of the latest treatments and techniques. A number of medical research studies show a positive link between ABMS certification and quality of care. “ABMS board certification and ABMS maintenance of certification focus on physician professionalism, knowledge, and the skills important for improving patient care,” says Dr. Lois Margaret Nora, ABMS president and CEO. “Our program for Maintenance of Certification helps participating physicians remain current in an increasingly complex practice environment.”
Through its 24 medical specialty boards, the American Board of Medical Specialties (ABMS) certifies more than 80 percent of physicians in the United States. If a doctor is not board-certified, it could mean he or she did not complete the requisite training requirements with their specialty board, including passing the exam. Or, it could mean he or she completed training outside the U.S. or Canada or elected not to take an examination. While there are other certifying boards, Nora says ABMS is recognized as the standard in a review process that includes written and oral exams, case reviews, operative records and patient outcomes. To determine whether your physician is ABMS certified, go to certificationmatters.org.
[types of doctors]
When most people think of a doctor, they imagine a person in a white coat with a clipboard and M.D. behind their name. However, there are many types of doctors, including doctors of chiropractic, osteopathy, psychiatry and nursing, and these days we’re as likely to look for health solutions outside the traditional M.D. route as not.
M.D.s and D.O.s, both doctors
Those who hold doctor of medicine (M.D.) and doctor of osteopathy (D.O.) degrees are both considered physicians. Both complete a four-year medical program and a residency program that ranges from three to seven years, depending on the specialty. Following residency, some physicians also complete a one- to three-year fellowship to become highly specialized in a particular field.
But the differences between the two are not clear to everyone. According to Dr. Joseph A. Craft III, a cardiologist and leader of St. Louis Metropolitan Medical Society, both are fully qualified to provide surgical practices, medical treatments and procedures. The difference lies in their medical education: Osteopathic students also learn therapeutic techniques that emphasize prevention. Craft points out that M.D.s and D.O.s frequently train in the same residency and fellowship programs.
According to Craft, the best physicians are those engaged in teaching, research and/or their professional organizations. They are passionate about their field and committed to ongoing education. They often are ‘fellows,’ an honorary designation given to recognize ongoing individual service and contributions. A physician must be nominated and pass a rigorous evaluation to become a fellow.
Doctors of Chiropractic (D.C.), or chiropractors, use manual therapy to get to the root of a particular health problem, rather than treat individual symptoms, says Jennifer Reed, director of marketing and public relations at Logan University. Chiropractic students complete a minimum of 4,200 hours of classroom instruction, laboratory and clinical experience before earning a Doctor of Chiropractic degree. They must also pass a four-part exam to become state licensed. “Some chiropractors may decide to enhance their degree by obtaining a certification and diplomate credentials in a specialty area,” Reed says. “Postgraduate certification programs are available in radiology, rehabilitation, nutrition, pediatrics, orthopedics or neurology, among others.
DDS or DMD
The Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) degrees are the same, since both use identical curriculum and requirements. It is up to the university to determine which degree is awarded. All dentists complete a four-year dental program and take a rigorous national exam. Dental specialists, including orthodontists, periodontists and oral and maxillofacial surgeons, complete an additional two to three years of graduate dental training.
A Doctorate of Nursing Practice (DNP) degree prepares nurse leaders at the highest level of nursing practice to improve patient outcomes. Like nurse practitioners (N.P.) who have a master’s degree, those with a DNP are qualified to access and diagnose patients, plan and initiate therapeutic regimens, prescribe some medications, and collaborate with other providers, says Lisa Burnitt, DNP, assistant professor at Barnes-Jewish College Goldfarb School of Nursing. “In Missouri (the most restrictive state), we practice in collaboration with physicians. Nurse practitioners are certified nationally in a variety of specialties, including pediatrics, adult care, gerontology and women’s health.”
ophthalmologists & optometrists
Optometrists complete a four-year doctor of optometry (O.D.) program with an optional one-year residency for advanced clinical training. According to WebMD, optometrists are qualified to provide regular vision care, including screenings, eye condition diagnosis, treatment for common conditions like nearsightedness and astigmatism, and prescribe eye glasses and contact lenses. Ophthalmologists, on the other hand, are physicians who complete medical school and residency training. They provide total eye care, including surgical services.
psychologists & psychiatrists
Psychologists go through five to seven years of academic graduate study and hold either a Doctor of Philosophy (Ph.D.) or Doctor of Psychology (Psy.D.). Psychiatrists earn their M.D. and complete residency training. Unlike psychologists, they can prescribe medication. According to WebMD, “a common misconception about psychiatrists is that they treat only people with severe mental illness, like schizophrenia or bipolar disorder, diseases for which medication is the mainstay of treatment.”
[choosing the right doctors]
Whether you’re facing a serious health issue and need a specialist, or you simply need a new primary care physician, the decision is ultimately a personal one. Sure, credentials are important, but so is how a physician relates to you and how comfortable you are working with them.
a good fit
Ask around and make a list of potential names. “Word-of-mouth from a friend, neighbor or co-worker who has a good experience and long relationship with their physician is one of the best ways to find one. Another is to research providers from an insurance or hospital website or referral service,” says Dr. Jodie Rai, an OB/GYN at Women’s Healthcare Consultants of St. Louis. A primary care doctor can be a good resource, too, when looking for a specialist. Call the office since insurance plan listings are often incomplete, she adds.
Next, do your homework. Physician websites often provide valuable information, including their education, training, certifications and experience. Many physicians also have blogs and videos on their websites that may give you a feel for their personality. Online reviews can be helpful, but read them with a grain of salt. Reviews are not unbiased.
“It is a good idea to check that the doctor is board-certified or at least board-eligible,” recommends Rai. If you have a medical need that requires a sub-specialist, such as advanced diabetes or cancer, then check that the doctor is board-certified in that area. It also is helpful to look at education and years of experience. “For surgery, it is important to find someone who has done a high volume of the particular procedure you will need,” Rai says. Other factors include location and hospital affiliation, especially if you may need a hospital service like maternity or surgery.
The initial patient visit most likely will tell you if the physician is a good fit. Effective, two-way communication is key, says Dr. Michael Lim, SLUCare cardiologist. If you don’t feel comfortable talking with the doctor and asking questions, if he or she talks down to you or doesn’t take the time to explain your options clearly, that’s a deal-breaker he adds.
“Patients should be a part of the process and decision making, especially when talking about bigger procedures,” says Lim. “Patients have to believe the doctor knows them and understands them. Asking questions should be accepted and encouraged. Many times, there’s more than one way to treat a condition. I don’t tell patients what to do; I provide advice. I need them to understand what I’m saying and why.”
A second opinion won’t hurt, but it’s not always necessary. “Do you feel like the physician listened to you and has a good grasp of the diagnosis and treatment recommendations? If you like the physician and your gut says you can trust him or her, a second option may not be necessary,” Lim says.
breaking up is hard to do
The doctor-patient relationship is unique and personal, Rai adds. Even if you got referrals and did your homework, you might find that you don’t click with a physician in person. The best thing to do is move on, she says. “Doctors are used to patients transferring care, so they are expected to be professional in how it is handled. There is nothing to feel bad about,” she says.
Patients rarely have the luxury of researching the best physicians in emergency situations, but that does not mean they are at the mercy of the hospital and physicians assigned to them, Lim says. Assuming your life is not immediately on the line, Lim recommends asking questions and not consenting to any procedure you are uncomfortable with. “You might not be in a position to go home, but you have time to ask questions until you understand your options. You also can request a second opinion or to be transferred to another facility,” he says. “It’s your health and your body—you should be in charge of it.”
It’s the best-kept secret in medicine, according to Dr. Jodie Rai, an ob/gyn at Women’s Healthcare Consultants of St. Louis. Concierge medical practices are primary care practices in which patients pay an annual fee or retainer to have unparalleled access to their physician. With only a couple hundred patients, concierge doctors say they have more time to get to know the patient and provide preventive and holistic care.
Dr. Shari Cohen, a concierge physician in Creve Coeur, says the model is growing in popularity because it’s better for both patients and physicians. “All of my patients have my cell phone number and email address so they can speak to me whenever they need to,” she says. “When patients call the office, they always get someone on the phone and we try to get them in the same day for acute problems. We schedule longer visits, typically an hour for initial visits and 30 minutes for follow-up. Overall, it’s easier to take care of your health if you have access. Additionally, I don’t feel overburdened by the health care system.”
Critics say the model puts additional stress on the health care system, which is already stretched thin. Additionally, most people cannot afford to pay the annual fee, which ranges from $1,500 to $2,000 in St. Louis (in Cohen’s practice, the fee includes all visits. She does not bill insurance). But the benefits for patients are clear. Beyond increased access to the physician, Cohen says she is able to spend more time with patients talking about preventive care. For patients with chronic or multiple medical issues, she also can help coordinate care with specialists.
Cohen says concierge practices have been growing steadily in popularity in St. Louis and around the country.” Many primary care doctors who are not concierge have probably considered it,” says Cohen. “Primary care is feeling the greatest pressure with the insurance burden. It’s hard to take care of 20 to 30 patients per day, given the way healthcare is now. I feel like an old-time doctor. I’m back to really practicing medicine,” she says.