Health care has come so far from the days of doctors' house calls that no one bemoans their passing anymore. Now, those who long for the "good old days" hark back to the times when they went to the doctor's office and actually saw a doctor.

Whether at your internist's office, the imaging center, or the medical lab, you may go from sign-in to payment without seeing a medical doctor. Physician assistants and nurses, technologists and technicians, therapists and their assistants are more involved than ever in primary patient care.

This profusion of "non-physician" medical professionals is not only a consequence of managed health care. These professionals have long played a vital role in health care, from vision care to physical therapy. However, the need to provide more cost-effective care has prompted doctors to delegate more of their work to these lower-paid professionals--thus putting more patients in their care.

So, who are these people and how qualified are they to take care of you and your family?

Like your doctor, these workers are subject to legal and professional standards that safeguard quality of care. State laws define each profession's duties and authorities, and often require them to be supervised by a doctor. Also, states require most professionals who provide patient care to be licensed.

Licensing standards differ. However, they all require the person to complete an accredited degree program, pass a state or national exam, and renew the license regularly by fulfilling continuing education requirements and/or by taking an exam. Certification for these workers is available from professional agencies that set eligibility standards and administer national tests. States or employers may require certification, especially for workers who aren't licensed.

To help you put these professionals and their specialties into perspective and understand who's qualified to do what, we've created a guide to some of the most common titles in general and specialized practice.
      These professionals
      have long played a vital
      and respected role
      in health care.

      They are subject to
      legal and professional
      standards that safeguard
      the quality of care.

General medical practice
Physician assistants (PA) can perform most of the same services as a doctor including diagnosing and treating disease, ordering tests, prescribing medication, and performing minor surgery. PA training is similar to medical school, but lasts only 25 months with no residency or internship. To be licensed, PAs must pass a national certification exam, meet continuing education requirements every two years, and be recertified every six years.

Registered nurses (RN) carry out doctors' care plans by monitoring vital signs, administering medicine, dressing wounds, helping with minor surgery, and more. To be licensed, they must have either an A.S. or B.S. degree from a nursing school or a diploma from a hospital nursing program, and pass a national exam. Some states require continuing education for license renewal.

Nurse practitioners are licensed RNs with a master's degree and extensive work experience, including a preceptorship with a doctor. Working alone or on a medical team, they can direct care of common and chronic diseases and injuries. Most states allow them to write prescriptions. Nurse practitioners usually get certified in specialized fields such as pediatrics, nurse-midwifery, or geriatrics.

Licensed practical nurses (LPN) provide basic bedside care such as bathing, checking vital signs, and feeding; some states allow them to give medicine. LPNs must have a high school diploma, complete an LPN program with classroom and supervised clinical work, and pass a licensing exam.

Specialty medical practice
Medical laboratory--Clinical laboratory technologists and technicians staff the laboratories that test blood and tissue samples. Technicians must have at least an associate's degree. They include phlebotomists, who draw blood, and histology technicians, who prepare slides. Medical technicians are qualified to perform tests, and must have a bachelor's degree in medical technology. Not all states license these workers, but most labs require them to be professionally certified.

Respiratory therapy--Respiratory therapists care for people with respiratory problems, usually in hospitals. They must have either an associate's or bachelor's degree in respiratory therapy, and usually need to be certified or registered by the National Board for Respiratory Care in order to work. They are licensed in most states.

Radiology--Radiologists are licensed medical doctors qualified to diagnose and treat diseases using x-rays; some may be qualified to administer substances as part of treatment.

Radiologic technologists include radiographers who produce x-ray films; radiation therapy technologists who administer therapeutic radiation; sonographers who do ultrasounds; and nuclear medical technologists who prepare and administer radioactive substances and treatments. Programs for each profession grant either associate's or bachelor's degrees, and several agencies offer national exams for technologists who want to be registered. Not all states require these workers to be licensed. Nuclear medical technologists must meet federal standards for handling radioactive material.

Physical therapy--Physical therapists (PT) develop and manage treatment plans to improve mobility, relieve pain, or limit disability. To be licensed, PTs must have either a bachelor's or master's degree in physical therapy and pass the state exam; some states also have continuing education requirements. Physical therapy assistants, who have an associate's degree in PT, may not be licensed and are supervised by physical therapists.

Chiropractors diagnose and treat health problems related to the body's muscular, nervous, and skeletal systems without using drugs or surgery. Most states require licensees to complete at least two years of undergraduate study plus a four-year accredited chiropractic course, and to pass the National Board of Chiropractic Examiners' test.

Occupational therapy--Occupational therapists (OT) work with disabled patients to help them develop, recover, or maintain living and working skills. States that license OTs require them to have a bachelor's degree in OT and to pass the American Occupational Therapy Certification Board exam. Occupational therapy assistants, who do evaluation and treatment supervised by OTs, need an associate's OT degree and may have to be licensed.

Mental health--Clinical psychologists are social scientists qualified to provide counseling services. They cannot prescribe medication. They must be licensed and/or certified to practice. To be licensed, a clinical psychologist must have a doctorate (Ph.D. or Psy.D.), complete an internship and professional work experience, and pass a state exam. Some states require continuing education. The American Board of Professional Psychology does certification, which has similar requirements.

Mental health social workers (MHSW) provide psychotherapy or counseling at medical facilities and in private practice. They cannot write prescriptions. All states license MHSWs, who must have a master's degree in social work and supervised work experience. Some states and many medical insurance providers also require certification by the National Association of Social Workers.

Vision care--Ophthalmologists are licensed medical doctors who perform surgery and prescribe drugs, diagnose vision problems, prescribe glasses and vision therapy, and treat eye disease.

Optometrists, or doctors of optometry, provide the same primary care as ophthalmologists; they can't prescribe drugs or do surgery. To be licensed, they must have at least three years of undergraduate school and a degree from an accredited school of optometry, and pass the state exam.




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