The Physicians
- If you or a member of your family is admitted to the hospital, the admitting physician ultimately responsible for your care is known as the attending.
- In a teaching hospital the attendings are designated as full-time (meaning they are an employee of the hospital or affiliated medical school) or voluntary (meaning they are in private practice).
- Attending physicans may be internists, surgeons, gynecologists or pediatricians.
- Internists are fully trained in internal medicine and may have further training in a specialty such as cardiology or gastroenterology (although certain medical specialties such as neurology do not require a full internal medicine residency)
- Internal medicine specialists most often practice internal medicine along with their specialty
- In surgery it is a little different in that surgeons usually either practice general surgery or their specialty. Some of the surgical specialties such as cardiac surgery require a full general surgery residency. Others such as ENT or neurosurgery require fewer years of general surgery training but more years in their own specialty.
- The Departments of Gynecology and Pediatrics similarly have their “generalists” as well as specialists
What is an attending physician?
Attending physicians are senior medical staff that have official relationships of one kind or another with the hospital. They generally have one or more “privileges” at the hospital:
- Admitting Privileges allow an attending to care for a patient at a particular hospital;
- Doctors with Consulting Privileges may see, make recommendations or provide treatment to patients in a hospital at the request of an attending with full admitting privileges;
- Attending surgeons may also have Operating Privileges that allow them to admit patients and perform surgical procedures in the hospital’s operating rooms.
How many attendings will the hospital have?
The number of attendings at a hospital will vary depending on the size, specialty area (if any), and associated academic or research programs at the hospital.
Many doctors will have privileges at multiple hospitals. A doctor must apply for privileges at a particular hospital—the more prestigious the hospital, the more difficult it is to get attending or surgical privileges. In addition, hospitals are in the business of running at full capacity. This means that when certain specialties bring in more patients, the hospital incentivizes those areas by giving additional admitting privileges to doctors in that specialty.
Who else is on the medical staff?
Full-time staff physicians are all the doctors who work directly for the hospital. The attending staff are broken down according to their role in hospital: clinical or research. The clinical side deals with patients directly, while the research side focuses on work in the laboratory.
What is voluntary staff?
The voluntary staff consists of physicians in private practice who are responsible for their own salary and insurance coverage. They are really small business owners who can admit their own patients and oversee their care, while being part of a research or academic team.
You might find a large voluntary staff in small, community or suburban hospitals. In contrast, a large renowned hospital like the Mayo Clinic has no voluntary hospital staff, although other doctors may refer patients to them.
Are doctors at teaching hospitals physicians or professors?
Many attending physicians at a medical school affiliated hospital will also work as professors at that school. As in most university settings, these doctors can work their way up through teaching and research. Each step up means an increase in responsibility, pay and prestige. These physicians will teach both classroom and clinical, hands-on aspects of medicine.
Hospital Specialists
Any field of medicine requiring more training than the one year past medical school required for a license is a specialty. Although not perceived as such by some, the fields of internal medicine, family practice and pediatrics are specialties in their own right. Other specialties, such as cardiology or infectious disease, are sub-specialty areas within internal medicine.
Specialty and sub-specialty areas are governed by boards that administer assessments that doctors may choose to take in order to be recognized as a “board certified” in that area. Most medical sub-specialists tend to practice some general medicine in addition to their specialty. If a doctor isn’t board certified, it does not necessarily mean they are not experts at what they do; however, the certification does give people a better sense of confidence. These specialties are defined both by their areas of focus, and by their training and certification requirements:
| Internal Medicine | Internists require at least three years of post-medical school training: one year as an intern, and an additional one as a resident. This is the required prerequisite for most sub-specialty training.
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| Surgery | Surgeons who have trained for a full 5 years after medical school are known as general surgeons. Many general surgeons will choose a sub-specialty such as cardiothoracic, vascular or plastic surgery that may require many years more training. Board examinations are given in general surgery as well as surgical sub-specialty areas. In contrast to non-surgical sub-specialists, board certified surgical sub-specialists, with rare exception, only practice their sub-specialty and do not practice general surgery as well.
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| Psychiatry | Psychiatrists follow similar training to internists. After medical school, they undergo a one-year internship followed by three years of general psychiatry in a hospital setting. There are also subspecialties within psychiatry.
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| Obstetrics and Gynecology | Training for this specialty requires at least four years beyond medical school, and is distinguished from training for other specialties largely because of necessary time in both delivery and operating rooms.
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| Pediatrics | Pediatricians are also sometimes called internists for children, and typically do not have any adult medical training. Pediatric surgeons need to complete the general surgical residency of five years, plus two additional years before being able to conduct procedures on children.
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| Other Specialties | Other specialties such as neurology, neurosurgery, pathology and radiology have their own patterns of training. Some are longer and some shorter, but they all follow the same pattern of a more general residency followed by more specialized training under an experienced expert.
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