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What makes a specialist special?

June 18, 2015

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 UCI Health internal medicine specialist and the co-director of the UCI 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

If passed, 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 hyper-specific area?”

Questions to ask a specialist

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 failures?
  • What is the specialist’s weekly or monthly patient volume? This is especially important for surgeons.
  • Does the doctor have a reputation for explaining things well?
  • 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 UCI 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.”

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