II.

Health Care Professionals

Some 11.6 million people work in health care in the United States. They include about 778,000 physicians, 2.1 million registered nurses, and 160,000 dentists. Most of them work in health care services, which involve diagnosing and treating patients. Others work mainly in research, teaching, or administration of medical facilities.

A.

Physicians

Physicians diagnose diseases and injuries, administer treatment, and advise patients on good diet and other ways to stay healthy. The United States has two kinds of physicians, the Doctor of Medicine (MD) and the Doctor of Osteopathy (DO). Both use medicines, surgery, and other standard methods of treating disease. DOs place special emphasis on problems involving the musculoskeletal system, which includes muscles, ligaments, bones, and joints.

Patients receive medical care from primary care doctors and specialists. Primary care doctors include general practitioners, family physicians, general internists, and general pediatricians. Many women also use obstetricians-gynecologists as primary care doctors. Patients usually consult a primary care doctor when they first become ill or injured. Primary care physicians can treat most common disorders, and provide comprehensive, lifelong care for individuals and families.

But medical knowledge has advanced so far that no physician can master an entire field of medicine. Primary care doctors may refer patients with unusually complicated problems to specialists with advanced training in a particular disease or field of medicine. Specialists may even concentrate in one particular area, and become subspecialists. Each specialist in internal medicine, for instance, is an expert in diagnosis and nonsurgical treatment of adult diseases. But some internists take advanced training to become subspecialists in treating adolescents, heart disease, elderly people, cancer, or arthritis. For more information about the areas that specialists treat, see the table on Medical Specialties.

B.

Medical Education

Preparation for a career as a physician is long and demanding. It usually takes 11 years of study after high school to become a physician. The training typically includes four years of undergraduate or premedical study at a college or university; four years of medical school; and three years of advanced training in a residency. The exact length of study varies. Some colleges have a combined undergraduate and medical school program that lasts six years.

Premedical students usually major in science, or take some courses in biology, chemistry, biochemistry, mathematics, and physics. Medicine demands well-rounded individuals with knowledge of the humanities and social sciences, and courses in English, history, literature, art, music, sociology, and other fields are important. Many premedical students gain practical experience by taking summer jobs or volunteer positions in hospitals, clinics, or research laboratories.

Acceptance into a medical school requires excellent college grades, high scores on the Medical College Admission Test (MCAT), good letters of recommendation, and a personal interview with school officials. The United States has 144 medical schools. Of those, 125 award a Doctor of Medicine degree and 19 award a Doctor of Osteopathy. Students face very tough competition for admission to medical school. In 2000, more than 37,000 people applied for admission to medical school, but only 16,303 were accepted.

Education of a physician does not end with medical school graduation. New physicians must pass an examination for a state license to practice. Many then go into postgraduate education. MDs take a residency that lasts from one to seven years. DOs take an internship, which may be followed by a residency. During postgraduate education, physicians pursue advanced training and practical experience treating patients under the supervision of more experienced doctors. This postgraduate training usually takes place in a hospital or clinic.

To be recognized as a specialist in a particular field, a physician must pass a special examination and become board-certified. Physicians earn a certificate from the American Board of Medical Specialties, an organization in Atlanta, Georgia, that oversees the certification process.

Physicians who plan to go into research may obtain a doctoral degree in genetics, immunology, biochemistry, or another field. Some obtain still more training as postdoctoral fellows on the research teams of established scientists. Physicians who plan to specialize in public health may study for a master’s degree in that field.

After completing postgraduate education, physicians begin a lifetime of learning to keep current with new advances. They regularly read medical journals, take continuing education courses, and attend medical conferences.

C.

Other Health Professionals

Medicine is not restricted to physicians. A wide variety of health care practitioners work in this exciting field. By far the largest professional group is nurses. Registered nurses help physicians during examinations, treatment, and surgery. They observe, evaluate, and record patients’ symptoms, administer medications, and provide other care (see Nursing). Nurse practitioners perform basic duties once reserved for physicians, such as diagnosing and treating common illnesses and prescribing medication. Certified nurse-midwives care for mothers during pregnancy and deliver babies (see Midwifery). Nurse-anesthetists administer anesthesia to patients during surgery. Licensed practical nurses provide basic bedside care for sick patients under the supervision of registered nurses and physicians.

Physician assistants deliver basic health services under the general supervision of a physician. They examine patients, order X rays and laboratory tests, and prescribe drugs or other treatment. In some rural areas, physician assistants provide all basic health care for patients, consulting with a supervising physician by telephone or electronic mail.

Dentists diagnose, treat, and help prevent diseases of the teeth, gums, and other tissues in the mouth and jaws (see Dentistry). Most are general practitioners, but many specialize in a particular area of dental health. Orthodontists treat teeth that are poorly aligned; oral surgeons operate on the jaw and mouth; periodontists specialize in gum disease; pediatric dentists care for children; endodontists perform root canals; prosthodontists make and insert artificial teeth and dentures. Other dental professionals include dental hygienists who assist dentists in surgery, clean teeth, and provide fluoride treatments. They advise patients on proper oral hygiene techniques to prevent tooth and gum disease.

For more information about other health care practitioners, see the table on Allied Health Professionals.