Pregnancy : Doctor Specialties

Obstetric and gynecologic surgery refers to procedures that are performed to treat a variety of conditions affecting the female reproductive organs. The main structures of the reproductive system are the vagina, the uterus, the ovaries, and the fallopian tubes.

Harvard Medical School doctor addresses the question of whether a woman should see a gynecologist or an internist beyond her childbearing years.

HISTORY OF THE PROFESSION Nurse-midwifery dates back to 1925 in the United States. At that time, Mary Breckenridge developed the Frontier Nursing Service in Kentucky. The program used public health registered nurses, who had been educated in England, to staff nursing centers in the Appalachian mountains. The centers offered family health care services, as well as childbearing and delivery care, to residents in the area. The first nurse-midwifery education program in the U.S. began in 1932 at the Maternity Center Association of New York City. The program enrolled public health nurses, and awarded its graduates a certificate in nurse-midwifery. Today, all nurse-midwifery programs are in colleges and universities. Most nurse-midwives graduate at the Master's degree level. These programs must be accredited by the American College of Nurse-Midwives (ACNM) in order for graduates to take the National Certification Examination. There are 40 ACNM accredited nurse-midwifery programs in the U.S. Applicants for nurse-midwife programs usually must be registered nurses and have at least 1-2 years of nursing experience. As with the nursing profession in general, most certified nurse-midwives (CNMs) are women. However, in recent years more male nurses have chosen to become nurse-midwives. Nurse-midwives have improved primary health care services for women in rural and inner-city areas. The National Institute of Medicine has recommended that nurse-midwives be given more responsibility for delivering women's health care. Many studies over the past 20 - 30 years have shown that nurse-midwives can manage most perinatal (including prenatal, delivery, and postpartum) care, and most of the family planning and gynecological needs of women of all ages. Nurse-midwives work together with OB/GYN doctors. They either consult with or refer to other health care providers in cases that are outside of their experience (for example, high-risk pregnancies and pregnant women who also have a chronic disease. See also: Types of health care providers SCOPE OF PRACTICE The nurse-midwife is educated and trained to provide a broad range of health care services for women and newborns. CNM functions include diagnosis (taking a medical hystory, doing a physical assessment, ordering laboratory tests and procedures), managing therapy (outlining care, providing prescriptions, coordinating consultations and referrals), and activities that promote women's health and reduce health risks. Although most of the CNM practice focuses on childbearing, family planning, and gynecological care for well women, CNMs may also check and manage common illnesses in adults. All services are done together with the patient. As with the nurse practitioner profession (NP), CNMs are legally allowed to write prescriptions in some states but not in others. CNMs provide independent health care management, consultation or co-management, and referral services. PRACTICE SETTINGS Certified nurse-midwives work in a variety of settings, including private practices (either by themselves or together with a physician), health maintenance organizations (HMOs), hospitals, health departments, and birthing centers. CNMs often provide care to underserved populations in rural areas or inner-city settings. REGULATION OF THE PROFESSION As with many other professions, certified nurse-midwives are regulated at 2 different levels. Licensing occurs at the state level and falls under specific state laws. As with other advanced practice nurses (such as nurse practitioners), license requirements for CNMs can vary from state to state. The current trend is to require a master's degree and national certification. Certification is done through a national organization and all states have the same requirements for professional practi

The American Board of Obstetrics and Gynecology recognizes the subspecialty of Maternal and Fetal Health for Obstetricians/Gynecologists who pursue additional training in managing patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy, and cares for the mother and fetus.

A physician who specializes in the treatment of children from birth through adolescence. A pediatrician is a physician who has taken extra training in the development and diseases of infants, children, adolescents, and young adults through age 21. Parents are advised to begin the process of selecting a Parents rely on their pediatrician for support and advice as well as medical care. pediatrician about three months before their baby is due to be born. Most obstetricians will assist with the referral, and the American Academy of Pediatrics also offers a referral service. Other parents may also have recommendations and advice to offer. Because new parents will rely on their pediatrician for support and advice as well as medical care, it is important that they feel comfortable with the personality and style of the pediatrician they choose. Many parents interview more than one pediatrician before making the final selection. It is necessary to designate a pediatrician before the baby is born, so that he or she can examine the newborn in the hospital shortly after birth. Pediatricians receive extensive training that begins with four years of medical school. A three-year residency—special training in pediatrics—follows. (The resident works under the supervision of an experienced physician or team of physicians to acquire the knowledge and skills necessary to diagnose and treat childhood illnesses, diseases, and conditions.) Following the completion of the residency, the newly trained pediatrician is eligible to take the written examination offered by the American Board of Pediatrics. When the pediatrician passes the certification exam, he or she receives a certificate—which most will frame and display on the wall of their office—and earns the right to use the initials FAAP (Fellow of the American Academy of Pediatrics) after his or her name. Only pediatricians that have passed the certification examination can join the American Academy of Pediatrics. As of 1997, there were over 48,000 board-certified pediatricians who were members of the Academy. Some pediatricians then elect to pursue more study in a specific area of pediatrics—known as a subspecialty. Subspecialties include: adolescent medicine; allergy/immunology; ambulatory pediatrics; behavioral/developmental pediatrics; cardiology; child development; community pediatrics; critical care; dermatology; developmental biology; developmental disabilities; emergency medicine; endocrinology (glands and diabetes); gastroenterology; general academic pediatrics/epidemiology; genetics/dysmorphology (inherited diseases); hematology/oncology (blood disorders/childhood cancers); immunology; infectious disease; metabolism; neonatal/perinatal medicine; nephrology (kidneys); neurology (nervous system); nutrition; pathology; pharmacology/toxicology; public health/preventive medicine; pulmonology; radiology; rheumatology; and teratology. Parents may also need to call on a medical specialist—such as an ophthalmologist or surgeon—who has received special training in pediatrics. Pediatricians are called on to provide a variety of services to families, including diagnosing illness, prescribing treatment, counseling families, monitoring the growing child's physical, mental, and social development, and advising adolescents on a range of emotional and social issues. Pediatricians may also participate in research, advocacy for social and legislative changes to benefit all children, and in public education on issues like nutrition, injury and disease prevention, and in providing guidelines for safe participation in athletics.

Detailed information on pediatricians and what formal education is required

Detailed information on choosing a pediatrician

American pediatrician 1870–1960 A portrait of Owen Wilson. In the preface of "The Care and Feeding of Southern Babies," Wilson said that other similar works focused on childrearing in cooler climates, and therefore were inapplicable to infants in the southern United States. [Eskind Library, Vanderbilt University.] A native of Tennessee, Owen Wilson was a pioneer in pediatric medicine. Born on July 20, 1870, he entered Vanderbilt University in 1884, at the age of fourteen, and graduated with an engineering degree in 1889. He immediately enrolled in Vanderbilt University's Medical School, and graduated two years later. Wilson pursued additional training at New York Polyclinic Medical School and Hospital. After practicing with a prominent Nashville surgeon for several years, Wilson decided to specialize in children's diseases. He established a large pediatric practice in Nashville and served as Professor of Pediatrics at Vanderbilt University Medical School from 1909 through 1942. In 1926, Wilson published a book entitled The Care and Feeding of Southern Babies: A Guide for Mothers, Nurses, and Baby Welfare Workers in the South. Wilson believed that babies in the southern United States, because of climate and family food habits, required different feeding guidelines than those generally given in the early twentieth century. In his book, Wilson offered instruction on the care and feeding of children from birth until age three, and he included tables of height, weight, and child development , as well as some recipes. Only three hundred copies of this book were published. Wilson suffered from a fatal heart attack on May 10, 1960. SEE ALSO B EIKOST ; B REASTFEEDING ; I NFANT N UTRITION . Karen Bryla

Detailed information on questions to ask your child's physician about cancer

Nurses in public health settings work with community leaders, health and social-service agencies, high-risk groups, families, and individuals to identify and resolve unmet environmental, social, and health needs. Their role is to provide education about lifestyle and behavior choices that can help prevent illness and foster good health. public health nurses work in clinics, homes, schools, and other community locations. The Future of Public Health , published by the Institute of Medicine in 1988, initiated debate among public health nurse leaders and started a trend away from care of individuals in clinics toward an increased involvement with community groups such as healthy connections networks. This trend is expected to continue in the twenty-first century. J UDITH C AZZOLI ( SEE ALSO : Behavior, Health-Related ; Behavioral Change ; Future of Public Health ; Public Health Nursing )

Registered nurses, or RNs, are health care professionals who work as part of health care teams to promote health and prevent and treat disease. They are patient advocates and health care educators working to teach not only patients but also families and the community.

A nurse practitioner (NP) is a nurse with a graduate degree in advanced practice nursing.

HISTORY OF THE PROFESSION The first Physician Assistant (PA) training program was founded in 1965 at Duke University by Dr. Eugene Stead. Most programs require applicants to have at least 2 years of college experience. Applicants also need some experience within the health care setting, such as an emergency medical technician, ambulance attendant, health educator, licensed practical nurse or associate-degree nurse. However, because of the competitive environment, the average PA student has a bachelor's degree in some field and about 4 years of health-related experience. Educational programs for PAs are typically associated with colleges of medicine, and vary from 25 to 27 months in length. The first PA students were mostly military medics (or corpsmen) who were able to expand on the knowledge and experience they received in the military to move into a role in primary care. Over the years, male domination within the profession has consistently decreased, and about 58% of PAs today are women. The physician assistant role, legally associated with a supervising physician, has allowed PAs to perform tasks previously only performed by doctors: history taking, physical examination, diagnosis, and patient management. Numerous studies have noted the ability of PAs to provide high-quality health care - comparable to that of a doctor - for about 80% of the conditions seen in primary care settings. SCOPE OF PRACTICE The physician assistant is prepared, both academically and clinically, to provide health care services with the direction and responsible supervision of a doctor of medicine (MD) or osteopathy (DO. PA functions include performing diagnostic, therapeutic, preventive, and health maintenance services. PAs in all 50 states, Washington, D.C., and Guam have prescriptive practice privileges. They may not receive direct third-party (insurance) reimbursement for their services, but their services are billed for through their supervising doctor or employer. See also: Types of health care providers PRACTICE SETTINGS PAs practice in a variety of settings in nearly every medical and surgical specialty area. The majority (45) of them practice within primary care areas, with 28% in family practice. Other common practice areas are general surgery, surgical subspecialties, and emergency medicine. The remainder are involved in teaching, research, administration, or other nonclinical roles. PAs may practice in any setting in which a physician provides care, allowing the doctor to focus skills and knowledge in a more effective manner. PAs practice in both rural and inner city communities. About 30% of PAs practice in areas that have less than 50,000 people. Because of the ability and willingness of PAs to practice in rural areas, the distribution of health care providers throughout the general population has been enhanced. REGULATION OF PROFESSION Like many other professions, physician assistants are regulated at two different levels. Licensure takes place at the state level according to specific state laws. In contrast, certification is established through a national organization, with requirements for minimal practice standards being consistent across all states. Licensure: Laws specific to PA licensure may vary somewhat among the states. However, nearly all states require national certification prior to licensure. All state laws require PAs to have a supervising doctor. This physician does not necessarily have to be on site at the same location as the PA. Most states allow physician supervision to occur via telephone communication with periodic site visits. Supervising doctors typically review and sign all visits recorded in the patient's file by the PA. Certification: In the early stages of the profession, the AAPA (American Association of Physic

After a doctor completes medical school and is licensed to practice medicine, the physician may pursue a rigorous 3 year training program in Internal Medicine. After passing an examination and completing the requirements, the doctor is eligible to become Board Certified in Internal Medicine.

A laboratory technician is an individual who, under the direct supervision of a laboratory scientist, processes and prepares samples from humans, animals, food, water, soil, and air for examination and testing and who performs routine laboratory tests using written standard testing protocols. In some public health clinics, the laboratory technician is also responsible for collecting the specimens, preparing specimens for shipment to reference laboratories, and for preparing and distributing the reports of the test results. The laboratory technician may also be responsible for routine quality control procedures such as recording temperatures of refrigerators, freezers, and water baths. Additionally, the laboratory technician prepares reagents necessary for testing. K ATHLEEN L. M ECKSTROTH . ( SEE ALSO : Assurance of Laboratory Testing Quality ; Diagnostic Testing for Communicable Disease ; Laboratory Services ; Practice Standards ; Reference Laboratory )

The American Board of Medical Specialties recognizes Family Medicine as a distinct discipline requiring an additional three years of training for doctors who wish to become Board Certified in this field. Family Medicine doctors are usually primary care providers (PCPs) [formerly general practitioners, or GPs] for the entire family.

A Medical Geneticist is a doctor who completes a two- to four-year residency training program in medical genetics, and is expert in diagnosis and treatment recommendations for genetically linked diseases. There are four pathways to certification that the medical geneticist may pursue of which clinical cytogenetics is one.

Today's pharmacists counsel you on how to use your medicine correctly and help protect you against overdoses and dangerous drug interactions.

Pharmacists do much more than count tablets and pour liquids. Their main job is to focus on the medications you take and the effect they have.

In addition to dispensing prescription medications, many pharmacies serve as health consultation centers.

The anesthesiologist's role is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during, and after surgery.

Detailed information on the different types of anesthesia, including local anesthesia, regional anesthesia, spinal anesthetic, epidural anesthetic, and general anesthesia, and information on meeting your anesthesiologist before surgery

Details regional and general anesthesia and their role in surgery, encouraging patients to discuss surgical procedure and recovery with their doctor.

A nurse anesthetist prepares a child for surgery in the operating room. ( Science Source/Photo Researchers . Reproduced by permission.)