“Well, there’s an MD in their title. Isn’t that enough?”
Simply put, no.
Physician training after earning an MD matters. In cases where a patient is seeking specialty care in a more niche field, subspecialized training matters a lot. Let’s dive into exactly why this is.
What is a sub-specialist physician?
A sub-specialist is a physician who has completed additional training beyond the general requirements of their specialty.
This additional training is typically a “fellowship,” which could be thought of as a very focused additional residency program. These programs are structured to give graduates special additional expertise within their chosen specialty – beyond the level of expertise that they can acquire during residency. Each fellowship usually takes one or more years to complete.
However, if they want to complete a fellowship, physicians must first complete a residency.
Confused? We don’t blame you. Here is a more complete chronology of the training of a sub-specialist to help clarify these terms and certifications.
What is the training process for a Medical Doctor?
A college student completes courses in sciences such as biology, chemistry, physics, mathematics, etc, which enables them to apply to medical school. In medical school, they learn the applications of basic sciences to the practice of medicine, how to diagnose and treat medical conditions, as well as the basics of patient care.
After they graduate from medical school, they are considered a physician, but must then choose a specialty such as family practice, internal medicine, general surgery, or radiology.
For our purposes, let’s dig deeper into radiology.
What does a radiologist do?
Radiologists are physicians who specialize in diagnostic medical imaging consultations and interpretations. To become a radiologist, a physician first completes an internship, typically lasting one year, that provides more in-depth general patient care, training, and experience.
They then undertake a four-year diagnostic radiology residency, during which they learn to:
- Supervise and interpret imaging examinations such as CT scans, MR scans, ultrasound scans, x-rays, nuclear medicine scans, mammography, and fluoroscopy
- Perform imaging-guided diagnostic and therapeutic surgical procedures like biopsies, angiograms, lumbar punctures, and drainages.
At this point, they are considered a radiologist, i.e. a specialist. Although they are typically then licensed to interpret medical imaging exams, they do not yet have the additional training and experience required to be considered a sub-specialist.
So… what is a sub-specialized radiologist?
In radiology, a sub-specialist is a physician who not only completed a diagnostic radiology residency – and who is therefore a radiologist – but who then also completed one or more fellowships in a sub-specialty of radiology.
An example of a sub-specialist radiologist is a “pediatric radiologist.” What is a pediatric radiologist? This is a physician who has completed not only a radiology residency but also a fellowship in pediatric radiology, which is the imaging of patients ranging in age from birth through approximately 18 years of age.
As another example, a radiologist who has additional fellowship training in the interpretation of head, neck and spine imaging is called a “neuroradiologist.”
A third example is a radiologist who has not only fellowship training in pediatric radiology and in neuroradiology, but who has also completed an additional fellowship specifically focused on pediatric neuroradiology, which is imaging of the head, neck and spine in patients ranging in age from birth through approximately 18 years of age. This sub-sub-specialist is called a “pediatric neuroradiologist.”
Why aren’t all images interpreted by a sub-specialized radiologist?
Modern healthcare benefits from the expertise of sub-specialists, but there are not enough sub-specialists to provide this level of expertise for most cases at most healthcare institutions. It takes so much extra time, for instance, to train a pediatric neuroradiologist that most infant and children’s head and neck imaging is interpreted by general radiologists, or radiologists with sub-specialty training only in general pediatric radiology, or in general neuroradiology – not in pediatric neuroradiology.
As a general principle, the more extensive and sub-specialized the training required to earn a set of credentials, the fewer providers there are with that set of credentials.
Due to the widespread undersupply of sub-specialists, most hospitals and imaging centers do not have a pediatric neuroradiologist available to interpret pediatric neuroimaging exams.
Moreover, and more generally, most patients do not have access to a nearby healthcare institution or imaging center where they can be assured that their exams will be interpreted by a radiologist with specific sub-specialty training in their area of need.
Furthermore, patients generally have no control over which radiologist interprets their imaging exam , nor what set of credentials the radiologist who reads their exam has. Usually, there is no mechanism in place for patients to request that a radiologist with sub-specialty training will be assigned to interpret and report the findings on their imaging exam. Yet, the report of the imaging exam that is generated becomes a permanent part of the patient’s medical record upon which the patient’s other physicians will continue to rely in the future for determining their diagnosis, treatment, and prognosis.
What does this mean for you as a patient (or parent)?
Suppose your child needs a CT or an MR of the brain or spine, and you want their exam to be interpreted by someone with the most training possible in the relevant sub-specialty. In other words, you want your child’s imaging to be interpreted and reported by a pediatric neuroradiologist.
Even if you request it, it is likely that your child’s imaging will not be interpreted or reported by a pediatric neuroradiologist, because there is likely not a pediatric neuroradiologist available at the imaging center or hospital where your child’s imaging will be performed.
Similarly, if your child has already had one or more imaging exams of the head, neck or spine, it is unlikely to have been interpreted and reported by a pediatric neuroradiologist.
Therefore, if you as a parent want to ensure that a pediatric neuroradiologist does interpret and report your child’s imaging, you will likely need to seek a second opinion.
However, it is not easy to find a pediatric neuroradiologist to provide a second opinion and thorough consultation – particularly if you want multiple exams interpreted in the overall context of your child’s medical history, and particularly if you want to be able to discuss the findings of the pediatric neuroradiologist directly with that sub-specialist.
How can we help?
MD For Patients was founded to help patients in exactly these types of difficult situations – in fact, it was the need to address these situations that led to the founding of this unique practice.
At MD For Patients, we do have a pediatric neuroradiologist who can interpret your child’s head, neck, and spine imaging in the broader context of their overall medical history, and then provide you with their opinions regarding the significance of any findings on the imaging. They will also discuss their opinions directly with you, while answering your questions about the imaging findings and educating you about the relevant terminology.
Our consultants can also communicate directly with your child’s pediatrician, or with other specialists involved in their care, in an effort to provide the most clear, efficient, and accurate communication possible.
For complex cases spanning multiple disciplines, MD For Patients can provide consultants from different specialties and sub-specialties. Using this multidisciplinary approach, our team can help strengthen and broaden your treating team. This can be very beneficial if you don’t have access to particular sub-specialists in your region, or through your current healthcare providers.
We know that dealing with complicated healthcare decisions can be anxiety-inducing, expensive, and exhausting. At MD For Patients, we aim to provide you with a clear and direct path to expert second opinions – including excellent service, but excluding red tape.
It’s our way of empowering patients to take better control of their healthcare.
Contact us today to schedule your consultation.
