9.2 Physician Training and Specialties
Physician Education and Training
Physician training can vary, but it generally follows a similar path, which begins with a bachelor’s degree, then medical school, a qualifying exam, residency, and finally a licensing exam (Canadian Medical Association, 2022). The focus of residency will vary depending on the area of specialization. Residency can be a couple of years long, or possibly even seven years in some cases. For example, a residency in family medicine is shorter than one in neurosurgery (Canadian Medical Association, 2022).
When working in a hospital, you may see many different titles for physicians based on where they are in their training. There may also be medical students who are still in medical school and working with another physician (Albany Medical School, 2022). An intern is a physician who has completed medical school and is in their first year of residency. Residents are physicians who are still completing their residency and are working under a fully credentialed attending physician. An attending physician has completed their residency and is certified in their chosen specialty. They make the decisions when it comes to patient care and supervise the work of medical students, residents, and interns (Albany Medical School, 2022).
Physician Specialties
There are a number of different specialties that a physician can complete, and they may change specialties during their career. Some of the more common specialties are described below, along with reasons why a patient might be referred to them.
Anesthesiologists work mostly with patients undergoing surgery. They use their knowledge of pharmacy and physiology to ensure that patients remain unconscious or with no sensation during their surgical procedures (Canadian Medical Association, 2022). The name of this specialty includes the combining form esthesi/o, which means “sensation, so the literal translation would be “specialist in no sensation.” In Fig. 9.1, you can see an anesthesiologist at work protecting a patient’s airway during surgery.
Cardiologists are medical doctors who specialize in diagnosing and treating heart disease. They do not perform surgery but treat common cardiac issues such as arrhythmias, congestive heart failure, and other cardiac pathologies.
Cardiovascular surgeons perform surgical treatments for the heart and other thoracic organs. They do not provide ongoing care such as cardiologists do, but they complete the required patient assessments, surgical procedures, and immediate aftercare.
Clinical immunologists and allergists diagnose and treat diseases of the immune system. They may see patients with suspected or diagnosed allergies and other conditions related to the immune system.
Key Concept
The skin testing that is done for allergies is completed by a clinical immunologist or allergist in order to identify allergens. In skin testing, allergen extracts are injected into the epidermis, and the patient’s skin will react to any allergens within 30 minutes. Redness and swelling at the site of a particular allergen means that the patient is likely allergic to the substance that was introduced. It is possible to test for many allergens at the same time (Betts et al., 2013). Fig. 9.2 shows an example of a skin test that has been completed, but the patient has not (yet) reacted to the substances. In Fig. 9.3, the patient has reacted to some of the allergens, as shown by the redness and swelling at some of the sites.
Dermatologists have specialized training in treating diseases, disorders, and injuries related to the integumentary system and its accessory structures. They may assess and treat symptoms or pathologies such as dermatitis, growths, skin cancers, and rashes. There are also a number of subspecialties such as cosmetic dermatology, dermatopathology, and pediatric dermatology.
Emergency practitioners work in emergency departments to provide care to acutely ill or injured patients. Their patients can present with a variety of different pathologies and injuries (Canadian Medical Association, 2022).
Endocrinologists focus on the treatment of endocrine system disorders that affect hormone levels and may treat patients who have either high or low levels of certain hormones. The name of this specialty has the combining form endocrin/o, which means “endocrine glands.”
Key Concepts
A thyroid specialist is an endocrinologist whose subspecialty is the treatment of disorders of the thyroid gland such as hypothyroidism and hyperthyroidism.
A diabetes specialist is an endocrinologist whose subspecialty is the treatment of diabetes.
Family practitioners, which includes both family physicians and general practitioners, provide services to all patients regardless of age, sex, or health condition. They treat patients on an ongoing basis for any medical needs and perform any necessary physical assessments (Canadian Medical Association, 2022).
Gastroenterologists focus on the diagnosis and treatment of conditions affecting the digestive system. They may treat patients with an array of digestive pathologies that could include gastroesophageal reflux disease (GERD), Crohn’s disease, and ulcerative colitis.
Geriatricians treat older patients, often over 75 years of age, for any medical needs and assessments they may require (Canadian Medical Association, 2022). The name of this specialty has the combining form ger/o, which means “old age.”
Gynecologists focus on the diagnosis, treatment, management, and prevention of diseases and disorders of the female reproductive system. A patient may see this specialist if they have conditions such as pelvic inflammatory disease, endometriosis, or other pathologies that affect the female reproductive system. The name of this specialty has the combining form gynec/o, which means “woman” or “female.”
Hematologists are physicians who diagnose and treat blood disorders. They are very knowledgeable about different blood conditions and laboratory procedures. A patient could be referred to this physician if they have a blood disorder related to clotting, anemia, hemophilia, or other blood-related factors.
Infectious disease specialists have additional training in infectious diseases. A patient would be referred to them if they potentially have some form of infectious disease. This specialist can assist with the diagnosis, treatment, and ways of decreasing the spread of an illness.
Key Concepts
Nosocomial infections are infections that occur during a patient’s time in the hospital and are of concern to infectious disease specialists and other medical professionals. These infections can be caused by many different types of bacteria and antibiotic-resistant organisms. The term nosocomial has the combining form comi/o, which means “to care for,” and nos/o, which means “disease.”
Another concept that is important for all physicians and other medical professionals to be aware of are adverse conditions that result from treatment. The medical term for this is iatrogenic, from the combining form iatr/o, which means “treatment,” and the suffix –genic, which means “producing, originating, causing.” An iatrogenic condition could take the form of an adverse effect from a medication or other treatment that a patient may receive in the hospital.
Nephrologists are specialists in kidney diseases. They treat patients with kidney failure and other pathologies that relate to the kidneys.
Neurologists are medical doctors who complete specialized training in the prevention, diagnosis, and treatment of disorders and conditions related to the brain, spinal cord, nerves, and muscles. They may treat pathologies such as multiple sclerosis, epilepsy, tremors, cerebral palsy, Alzheimer’s disease, and Parkinson’s disease.
Neurosurgeons do not treat patients with neurological conditions long term, but instead perform surgical procedures on the brain or other parts of the nervous system. They provide surgical procedures for patients with tumours, growths, or trauma to the brain.
Obstetricians provide care to the mother and fetus through pregnancy and labour, and to the mother during the postpartum period. Obstetricians study both obstetrics and gynecology and are referred to as OB/GYNs, which means “obstetrics and gynecology.” Fig. 9.4 is an image of a baby being born, and you can see the obstetrician proving care to both the infant and mother. The combining form obstetr/o, which means “midwife,” is found in the medical term for this specialty.
Oncologists treat patients who have cancer and malignancies in any area of the body (Canadian Medical Association, 2022).
Ophthalmologists screen, diagnose, and manage the care of patients with optical, medical, and surgical diseases or disorders of the eye (Canadian Medical Association, 2022).
Otorhinolaryngologists (ENTs) specialize in the treatment of conditions in the ears, nose, and throat. They may see patients with hearing difficulties, difficulty swallowing, issues with balance, or tinnitus.
Orthopedists provide diagnosis, treatment, rehabilitation, and prevention of diseases of the bones, joints, ligaments, muscles, tendons, and nerves (Canadian Medical Association, 2022). The combining form orth/o in this medical term means “straight”; the reason is that orthopedists originally only provided care for children who had limbs that were not straight. The name of the specialty has not changed, but the scope of practice has increased.
Orthopedic surgeons are physicians who complete additional specialized training in the prevention, diagnosis, treatment, and surgery of disorders and diseases related to the musculoskeletal system. They may treat patients who have injuries to their musculoskeletal system from trauma or from complications of aging or repetitive use.
Pathologists are specialist physicians who study aspects of disease. They often work in the lab, studying samples from patients and working to assist in the diagnosis and prognosis of disease and illness.
Pediatricians provide ongoing care to children, as can be seen in Fig. 9.5, for any medical needs they may have. These doctors can provide both long-term and acute care, and children can be referred to them from family physicians if they require more specialized care (Canadian Medical Association, 2022). The combining form ped/o in this medical term means “child.”
Psychiatrists are specialist who provided treatment for diseases of the mind. They complete comprehensive assessments and diagnose and plan care for patients who are experiencing various forms of mental illness and emotional and behavioural disorders (Canadian Medical Association, 2022).
Pulmonologists, often also referred to as a respirologists, are concerned with the diagnosis and treatment of diseases related to the respiratory system. Respiratory medicine also requires in-depth knowledge of internal medicine. Patients may see this specialist if they have asthma, chronic obstructive pulmonary disease (COPD), emphysema, or other respiratory signs or symptoms.
Radiologists are specialists who use imaging techniques in the study, diagnosis, and treatment of disease. Their role is often as a consultant to other physicians for patients who require diagnostic imaging (Canadian Medical Association, 2022). A radiologist can be seen in Fig. 9.6 completing an assessment of an imaging scan in preparation for the scan to be sent to the patient’s primary physician. The combining form radi/o in this medical term means “X-ray.”
Radiation oncologists are physician specialists who provide care to patients with malignant tumours and other diseases requiring radiation treatment (Canadian Medical Association, 2022).
Rheumatologists are medical doctors who have specialized as internists in the subspecialty of rheumatology. They treat systemic diseases that affect the joints and muscles, including autoimmune disorders that affect multiple body systems, as well as rheumatoid arthritis, lupus, and psoriasis. The combining form rheumat/o in this medical term means “flow” or “fluid.”
Thoracic surgeons specialize in either thoracic surgery or cardiothoracic (heart and chest) surgery and care. A patient would require care from a thoracic surgeon if they need surgery that involves an opening into the chest or thoracic cavity.
Urologists are involved in the diagnosis and treatment of urinary and male genitourinary system conditions, disorders, and diseases such as prostate disease and renal and bladder dysfunctions. This physician does not only provide diagnosis and treatment, but also preforms surgical repair. Common patient conditions that they treat include kidney stones, kidney failure, benign prostatic hyperplasia, and bladder dysfunction. It is important to note that this specialist provides care and assessment for both male and female urinary systems.
Vascular surgeons treat diseases of the blood and lymphatic vessels. They repair and replace diseased or damaged vessels, remove plaque from vessels, insert venous catheters, and perform traditional surgery (Betts et al., 2013).
Exercise
Attribution
Unless otherwise indicated, material on this page has been adapted from the following resource:
Carter, K., & Rutherford, M. (2020). Building a medical terminology foundation. eCampusOntario. https://ecampusontario.pressbooks.pub/medicalterminology/ licensed under CC BY 4.0
References
Albany Medical College. (2022). Medical staff titles & terminology. https://www.amc.edu/PhysicianDirectory/pages/medical_staff_terminology.cfm#:~:text=An%20%E2%80%9Cintern%E2%80%9D%20is%20a%20physician,after%20graduating%20from%20Medical%20School.&text=A%20medical%20student%20is%20a,to%20earn%20a%20medical%20degree
Betts, J. G., Young, K. A., Wise, J. A., Johnson, E., Poe, B., Kruse, D. H., Korol, O., Johnson, J. E., Womble, M., & DeSaix, P. (2013). Anatomy and physiology. OpenStax. https://openstax.org/details/books/anatomy-and-physiology licensed under CC BY 4.0
Canadian Medical Association. (2022). Canadian physician specialties profile. https://www.cma.ca/canadian-physician-specialty-profiles
Image Credits (images are listed in order of appearance)
Physician anesthesiologists provide safe care in Afghanistan 141225-N-JY715-132 by Lt.Cmdr. Jesse Ehrenfeld, U.S. Navy, Public domain
Allergy skin testing by Wolfgang Ihloff, CC BY-SA 4.0
Allergies – When nature attacks by Nancy, CC BY-SA 2.0
The First Breath of Life by Farajiibrahim, CC BY-SA 4.0
Itzhak Levy 2 by דוברות מרכז שניידר לרפואת ילדים בישראל, CC BY-SA 4.0
Radiologist in San Diego CA 2010 by Zackstarr, CC BY-SA 3.0
