Continuing Ed for the Doc

So, what does it take to be a doctor?

Some of you may have noticed that I was out of the office more than usual the last couple of months. Unfortunately, I was not spending time by the pool or otherwise taking it easy. I was preparing for and taking my board exam.

Obtaining and maintaining board certification is a complicated process. I am Board Certified in Family Practice. To achieve this I had to complete an undergraduate degree, 4 years of medical school, and 3 years of residency (the first of which was the internship). In addition, I had to pass 3 national board exams during medical school and residency. Finally, upon completion of my residency training, I was allowed to sit for the boards in family practice. To maintain board certification status in family practice, I have to have an unrestricted medical license, complete 50 hours of continuing medical education credits annually, and retake (and pass) the exam at least every 7 years.

The American Board of Medical Specialties (ABMS) and the American Medical Association (AMA) recognize 24 specialty boards. Family practice, internal medicine, pediatrics, general surgery, ophthalmology and neurology are examples of recognized specialties. Subspecialists are physicians who have completed specialty training and then go on for further training. Cardiologists, gastroenterologists, and pulmonologists are internal medicine subspecialists. Plastic surgeons and colorectal surgeons are examples of surgical subspecialists.

To be certified as a medical specialist, a physician must complete medical school, 3 to 7 years of residency training, and then pass an exam given by their specialty board. All 24 of the boards currently require, or soon will require recertification every 6 to 10 years. Only 66% of active (practicing) physicians in this country are board certified.

As I mentioned early, I am board certified in family practice. Family practice has been recognized by the ABMS since 1969 as a medical specialty. Family practice was the first medical specialty to require board recertification (in 1974), and one of the first to require continuing medical education to maintain board certification. (The American Board of Internal Medicine, for example, has only been requiring recertification since 1990.)

That brings me to my next topic. What exactly is the difference between a family practitioner and an internist? Both are “specialists”, and have similar requirements for training and maintenance of board certification. What distinguishes the two?

Obviously, one main difference is that family practitioners are trained in pediatrics, and internists are not. But the real difference is in the focus of the training. Internists spend most of their training time and effort taking care of sicker adults in the hospital. In family practice we have a broader focus. We train alongside residents in OB/GYN, orthopedics, pediatrics, general surgery, neurology, psychiatry, and emergency medicine, among other specialties. Most family practice programs put a heavy emphasis on outpatient (office) management of illness, while internists usually spend much more time training in the hospital. In addition, we are taught to treat the patient in the context of their environment, including family relationships, work, and other activities.

For example, since I have had less training in managing hospitalized patients than many of my internist colleges, I tend to ask for more help from specialists for my hospitalized patients. On the other hand, in the office I have a broader knowledge base and can treat a wider variety of illnesses than most of my internist colleges. By the way, pediatrics training programs are similar to internal medicine training programs, except of course, they are focusing on kids.

I hope you found this brief explanation of the mechanics of medical education enlightening. Now just keep your fingers crossed that I passed that exam!