October 19, 2012

Terms for Doctor Types and Practices

Writing about medical practices is fun, but far from easy. Presently, medical practice seems in a state of flux. There has always been some jealousy among doctors, but not like we are seeing today. Many medical organizations are feeling that they are superior to others and applying pressures to state legislatures to limit or prevent new ideas from gaining a solid foothold in the medical community.

It is also surprising that some states have provided opportunities for different ideas to flourish, and other states use various means to try to restrict or limit new ideas. Several states in the early days of concierge medicine worked hard to prevent it from getting started. Two states invoked insurance fraud and claimed the practices would avoid state policies of medicine without insurance and they succeeded for a couple of years until challenged in court.

Concierge medicine is growing and becoming a larger force yearly. When two or more doctors join together in a practice, they can often afford a nurse acting in several capacities. When I wrote this blog, I was not sure I would ever be involved with one. However, I am a volunteer peer mentor for type 2 diabetes patients with a concierge practice and know of four other peer mentors working with another practice. I have also added another physician practice that I now serve as a peer mentor for type 2 diabetes patients.

Telemedicine is another growing area that some practices are working hard to expand and again many state legislatures are being lobbied heavily to limit the scope of practice allowed. I have said this before, but it is worth repeating, the word reciprocity is not in the vocabulary of the medical associations. Any patient that has a regular doctor and travels to another state should have the right to confer with their doctor back home over the telephone, Internet, or other electronic media without worry about some doctor in that state complaining that he/she was denied access to treating the patient. Yet this is where it seems headed.

Yet telemedicine is growing. Even some private practices are utilizing telemedicine and using physician assistants, nurse practitioners, and nurses in areas low in doctors to do the examinations and then either passing this information onto their primary care doctors, or when none are available, writing the prescriptions electronically. Most are in states admittedly allowing this and encouraging this. Some universities are also following this practice and have centers organized to do this – Kansas and Tennessee are two such states.

Although individual practices are becoming harder to find, there are still a few in existence, but for how much longer is the question. Hospitals are slowly putting the stranglehold on private practices and becoming increasingly monopolistic in their operations. They either hire the doctors out of practices or buy out the practice and establish a clinic. Many are concerned about the ethics involved as in some areas of the country hospitals are establishing clinics and moving hospitals to new areas, thus abandoning the inner city areas where they have been. Under the current Affordable Care Act, will the physicians be able to survive financially? Only time will expose the answer.

A simplistic, but accurate description of the various forms of medical practices that a physician can opt for are:

1. Academician: He/she can become an academician and start teaching medical students.
2. Single specialty doctor: The doctor may decide to specialize in a certain field and then carry on practice in that field.
3. Multi-specialty: This happens when within the same company, several medical specialties are employed who are in charge of different fields.
4. Solo: The medical practice may decide to set up his/her own clinic, which is a common practice in dentists.
5. Industry: The physician may decide to work for the research based activities taking place in the industry and work for pharmacological companies, research labs, and equipment manufacturers.
6. Hospitalist: Employed and works for a hospital.

Some doctors may fit within two or more of the practices listed above or may have two or more specialties that he/she is qualified to practice.

I find the following statistics very interesting and will quote, “According to the Bureau of Labor statistics, there were nearly 700,000 doctors in the United States in 2008. There are many ways to break down the types of doctors who practice medicine in the country. Increasingly, more and more medical doctors are becoming specialists, and the number of specialists has grown rapidly in the last four decades. According to the American Board of Medical Specialties, there are now 24 different categories of specialists that branch off into a total of 147 and different doctors who can be board certified in their specialty. But to handle the doctors in the country in a more manageable number, there are 6 different medical doctors who see patients somewhere in the country every day.

1. Doctor of Medicine. This is an allopathic doctor, the one who earns an MD degree from medical school and represents about 70 percent of all medical school graduates. Many study specialties that concentrate on different areas of the body, such as cardiology, gastroenterology and pulmonology.
2. Doctor of Osteopathy. This is the second type of medical doctor who attends a medical school and becomes an osteopathic doctor. These doctors attend an osteopathic medical school, which is outnumbered by allopathic medical schools by about 12 to 1. There is virtually no difference any more in the training between the two disciplines, other than a technique called Osteopathic Manipulative Medicine. This involves manipulation of the joints and body parts to help in the diagnosis of injury or disease. Many medical doctors with a D.O. degree go on to general practices, in areas like family medicine.
3. Doctor of Dental Medicine. Most people are familiar with dentists, who attend 4 years of dental medical school and handle the medical care of the teeth and gums and have a DMD or in their title. There also are doctors of dental surgery who specialize in dental surgery and have a DDS in their title. Many dentists specialize further into areas such as endodontics, orthodontics and pediatric dentistry. This requires additional schooling.
4. Doctor of Chiropractic. These medical doctors go to 4 years of chiropractic medical college and specialize in joint pain anywhere in the body. They have a DCM in their title. Many chiropractic treatments involve the manipulation of the spine and chiropractic doctors work on the principle that misalignments trickle down to affect the nervous system.
5. Doctor of Optometry. This medical doctor attends four years of optometric medical college and has an OD in his or her title. They are the primary doctors for the diagnosis and treatment of eye diseases and conditions.
6. Doctor of Podiatric Medicine. This medical doctor undergoes 4 years of podiatric medical college and then a residency program of 2 to 4 years to be able to diagnose and treat diseases and injuries to the lower leg, including the foot and ankle. In 2008, there were 8 accredited podiatric medical colleges in the country, awarding a DPM to graduates.”

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