Ruben Miguel, M.D.

WHAT IS A RHEUMATOLOGIST?

Rheumatologists are specialists in the study and treatment of rheumatic connective tissue disease and other musculoskeletal medical conditions. Rheumatologists diagnose, treat and manage the many common and less common forms of arthritis such as moderate to severe osteoarthritis, rheumatoid arthritis, lupus, polymyositis and other connective tissue and autoimmune diseases. Their goal is to offer high-quality, patient focused specialty services to affected persons to increase quality of life by moderating the disease process. These goals are achieved through a combination of patient evaluation, education and treatment.

Rheumatologists must first complete seven or more years of medical school and postgraduate training and become board certified in Internal Medicine. Then, for an additional two to three years, they study conditions specific to the musculoskeletal system - arthritis, certain autoimmune diseases, pain disorders and osteoporosis.

what is an internist?

Doctors of internal medicine, often called "internists," focus on adult medicine. They care for their patients for life—from the teen years through old age. Internists have had special study and training that focuses on the prevention and treatment of adult diseases. At least three of their seven or more years of medical school and postgraduate training are dedicated to learning how to prevent, diagnose, and treat diseases that affect adults. Internists are sometimes referred to as the "doctor's doctor," because they are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems

What does it mean to be board certified?

Introduction

Everyone knows that a "medical doctor" is a physician who has had years of training to understand the diagnosis, treatment, and prevention of disease. The basic training of a physician specialist includes four years of premedical education in a college or university, four years of medical school, and after receiving the M.D. degree, at least three years of specialty training under supervision (called a residency). Training in certain subspecialties can take an additional two to three years.

The process most widely used by physicians to tell whether and why you are sick is to ask you, and/or your family members, questions about your health and your past medical history. This process, called taking a history, is usually followed by an appropriate examination of your body (a physical examination) to determine how well it is functioning and whether there are signs of disease. Doctors also use a variety of tests such as x-rays, other imaging techniques, and additional procedures to evaluate your health and identify any diseases or other health problems that may be present. Some of these diagnostic procedures (e.g., cardiac catheterization, CAT scans, biopsy of body tissues) are very complicated. They call for many years of training in order to use them safely and accurately.

After the diagnostic process is completed, the doctor will recommend what treatment is needed, if any. Treatment may involve surgery (there are many types of surgical specialists), medication, or other complex procedures.

The complexity of the body's structure and the way it functions calls for high levels of skill in understanding body systems and in knowing the effect that each system has on the whole, in health and in disease. That is why today, most physicians choose to specialize.

Specialists are physicians who have chosen a specific knowledge area of medicine and have completed a residency in that field. Specialization in medicine combined with continued medical education is necessary because of the rapidly expanding body of knowledge about health and illness and the constantly evolving techniques for the prevention, diagnosis, and treatment of disease. A subspecialist is a physician who has completed training in a general medical specialty and then takes additional training in a more specific sub-area of that specialty called a subspecialty. This training increases the depth of knowledge of the specialist in that particular field. For example, cardiology is a subspecialty of internal medicine, pediatric surgery is a subspecialty of surgery, and child and adolescent psychiatry is a subspecialty of psychiatry. The training of a subspecialist within a specialty requires an additional one or more years of full-time education.

Training of a Specialist
The training of a specialist begins after the doctor has received the M.D. degree from a medical school, in what is called a residency. Resident physicians dedicate themselves for three to seven years to full-time experience in a hospital or ambulatory care setting, caring for patients under the supervision of experienced teaching specialists. Educational conferences and research experience are also part of that training. A doctor in training to be a specialist is called a resident, although the first year of residency used to be called an internship.

In each state, the privilege to practice medicine is governed by state law and is not designed to recognize the knowledge and skills of a trained specialist. The physician is licensed to practice general medicine and surgery by a state board of medical examiners after passing a licensure examination. Each state has its own examining procedure to license physicians, and this board sets the general standards for all physicians.

Who Credentials a Specialist and/or Subspecialist?
Specialty boards certify physicians as having met certain published standards. There are 24 specialty boards that are recognized by the American Board of Medical Specialties (ABMS) and the American Medical Association (AMA). Remember, a subspecialist first must be trained and certified as a specialist.

In order to be certified as a medical specialist by one of these recognized boards, a physician must complete certain requirements. Generally, these include:

1. Completion of a course of study leading to the M.D. or D.O. (Doctor of Osteopathy) degree from a recognized school of medicine.

2. Completion of three to seven years of full-time training in an accredited residency program designed to train specialists in the field.

3. Some specialty boards require assessments of individual performance and competence from the residency training director, or from the chief of service in the hospital where the specialist has practiced.

4. Most specialty boards require that the person who seeks certification has an unrestricted license to practice medicine in order to take the certification examination.

5. Some boards require that the doctor has a period of experience in full-time practice in the specialty prior to examination for certification, usually two years following training.

6. Finally, each candidate for certification must pass a written examination given by the specialty board. Fifteen of the 24 specialty boards also require an oral examination conducted by senior specialists in that field. Candidates who have passed the exams and other requirements are then given the status of Diplomate and are certified as specialists. A similar process is followed for specialists who want to become subspecialists.

Some boards issue certificates for a limited period of time, usually seven to ten years. In order to retain certification, Diplomates of those boards must become recertified, and must periodically go through an additional process involving continuing education in the specialty, review of credentials and further examination. Some boards that may not require recertification have provided voluntary recertification with similar requirements.

The Purpose of Certification
The intent of the certification process, as defined by the member boards of the American Board of Medical Specialties, is to provide assurance to the public that a certified medical specialist has successfully completed an approved educational program and an evaluation, including an examination process designed to assess the knowledge, experience and skills requisite to the provision of high quality patient care in that specialty.

Reprinted with permission  from the American Board of Medical Specialties Public Education Program