What does ‘Doctor’ mean? Part 2

Editor’s Note: Part one of this colulmn ran in the March 28 edition of the Daily Mail,

By Dr. Jennifer Conley

A preceding column in this series introduced the confusion and lack of understanding about different types of doctors and how that title means many different things. This column describes in more detail the variety of degrees available in the healthcare industry that may use the title “doctor.”

Dentists have the degree of Doctor of Dental Surgery (D.D.S.) or Doctor of Dental Medicine (D.M.D.) Graduates of a three- or four-year dental school can begin working immediately as a general dentist or can continue with further training. General dentistry involves care and maintenance of teeth and treatment of basic dental problems such as cavities and extractions. Oral and maxillofacial surgeons have another four to six years of training beyond the general dentistry work. Other dental specialties, including endodontists, orthodontists and pediatric dentists have two to three years of additional training beyond general dentistry.

Optometrists have the degree of Doctor of Optometry (O.D.) General optometrists mostly work in vision testing and correction and screening for and managing eye diseases. Audiologists earn the degree of Doctor of Audiology (Aud.D.) These doctors test hearing function and treat deficiencies including fitting hearing aids. Pharmacists earn the degree of Doctor of Pharmacy (Pharm. D.) Pharmacists work in hospitals and outpatient pharmacies and are concerned primarily with medication administration. These doctors typically complete a four-year professional school and may then enter general practice or choose to pursue one to two years of additional training to specialize.

There are doctoral level degrees in therapies such as Doctor of Physical Therapy (D.P.T.), Doctor of Occupational Therapy (O.T.D.) and Doctor of Speech-Language Pathology (SLP.D.) These doctors focus on building or re-building abilities in individuals who have either lost or never had normal physical abilities. Behavioral therapies can be provided by Doctors of Social Work (D.S.W.) and Doctors of Psychology (Psy. D. or D.Psych.) These doctors work in hospital and clinical settings and are focused on mental health issues.

Chiropractors have the degree of Doctor of Chiropractic (D.C.). These doctors have had at least 90 hours of undergraduate classwork before entering chiropractic college. Chiropractic training is typically a four-year program and graduates may begin working as general chiropractors or have further training in a residency. Chiropractic is a form of alternative medicine concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system. Typical care from a general chiropractor includes imaging, examinations and adjustments.

Naturopathic physicians have a degree of Doctor of Naturopathy (N.D.). These alternative medicine doctors complete a four-year, graduate-level naturopathic medical school that covers basic sciences as well as holistic approaches to therapy. They emphasize disease prevention and wellness. They focus on nutrition, homeopathy, botanical medicine, psychology and counseling. There are 19 states that have licensure for naturopaths but Missouri does not.

Podiatrists have the degree of Doctor of Podiatric Medicine (D.P.M.). These doctors have completed four years of training in a podiatric medical school and three years of hospital residency training. They can then specialize further with residency or go directly into general podiatric practice. Podiatrists diagnose and treat conditions of the foot, ankle and lower leg and are able to perform surgeries.

Nurse practitioners have an advanced degree called Doctor of Nursing Practice (D.N.P.). It emphasizes clinical practice-oriented leadership training. It is especially useful for working in nurse leadership. Nurses can also pursue doctoral degrees of Doctor of Nursing (N.D.) focused on advanced specialist skills, and Doctor of Nursing Science (D.N. Sc.) and Doctor of Nursing Philosophy (Ph. D.) which are oriented to investigation and research. Nurse practitioners have a master’s degree in nursing (M.S.N.) at a minimum. The training typically requires about two years of course work for each degree level after the four-year B.S.N. and includes clinical training with nurse practitioners and physicians. Nurse practitioners work in collaboration with physicians. They are able to order tests and prescribe medications and can be trained in performing procedures. They can work in clinics and hospitals. Their practices are limited by state regulations and vary by state. Missouri currently requires that nurse practitioners work within boundaries of set distances from their collaborating physicians and have a certain percentage of their charts reviewed by the physician regularly. A physician may collaborate with up to three nurse practitioners at one time. Nurse practitioners work in different specialties and have had training specific to their specialty.

Physicians have two degree programs, Doctor of Medicine (M.D.) and Doctor of Osteopathy (D.O.). A graduate of one of these four-year programs cannot go immediately into general practice. These doctors must then have additional training in internships and residencies of at least three years. Specialty training takes longer, sometimes as much as seven years after medical school graduation. A state license cannot be obtained without at least a one-year internship. Unfortunately, there are now more medical school graduates than residency positions and a surplus of medical graduates has created the position of “assistant physician.” These doctors can be licensed to work with a physician under supervision while awaiting a residency position. Assistant physicians should not be confused with physician’s assistants (P.A.). Physician assistants have master’s degrees allowing them to work in collaborative practice arrangements with physicians but they are not physicians or doctors. Medical internships and residencies are intense and time-consuming. Upon completion of these programs graduates are prepared to assume management of complex medical problems and perform procedures within their field of training. There are numerous types of primary and specialty physicians.

Those letters after our names mean different things and are an important distinction between all those doctors.