28 March, 2024

Medical Specialists: Who does what?

Introduction:
Over the last century, medicine has evolved into a sophisticated complex science requiring a set of specialized skills to decode and analyze all the available clinical data and deduce an expert conclusion. For this reason, the entire field of medicine is divided into various sub-specialities, with each expert gaining the required depth of knowledge and experience in a particular sub-field. While such division potentially leads to fragmentation of care, it is unavoidable if expertise is revered. An expert, by virtue of dedicated training and experience, can perform at a much higher level. While it addresses the need, it does introduce another confusing element: which specialist to approach for a particular ailment. Ideally, a patient should seek the guidance of a General Physician to start with and take it from there.

This article lists medical specialists you may encounter and their areas of expertise. As you go through the list, please pay attention to whether they are medical or surgical experts and their academic backgrounds. For your ease of reading, medical specialities are written in blue while surgical specialities are colour-coded green.

The typical duration of medical studies:
MBBS: 5.5 years (+ government-mandated rural service, if any)
MD/DNB: 3 years (+ government-mandated rural service, if any)
DM/DNB: 3 years (+ government-mandated rural service, if any)
MS/DNB: 3 years (+ government-mandated rural service, if any)
MCh/DNB: 3 years (+ government-mandated rural service, if any)
BDS: 4 years (+ government-mandated rural service, if any)

Additional training can range anywhere from 6 months to 2 years.

Here’s a basic flowchart of a few of the common medical specialities and their training:General Physician (or Medicine, Internal Medicine, Internist): (MBBS +/- MD)
A medical doctor who has basic knowledge of all body systems. These doctors typically are the first point of contact for any problem. They do initial evaluation and treatment and refer to specialists if necessary. By virtue of familiarity with all body systems, they are best suited to assimilate all the available information and deduce conclusions which at times become difficult for specialists who are focused on one particular body system.

General Surgeon: (MBBS +/- MS)
They are surgical counterparts of General Physicians. They have a broad understanding of most surgical needs and can perform basic surgeries involving various body parts. They refer patients to specialist surgeons as required.

Cardiologist: (MBBS + MD + DM)
Medical specialists for heart-related issues. Cardiologists not only provide medical treatment for established heart disease but also help with risk assessment for future cardiac issues. They also help manage risk factors like hypertension, diabetes, or high cholesterol levels. Cardiologists also provide long-term care to those who have undergone cardiac surgery in the past.

Interventional Cardiologist: (MBBS + MD + DM + Additional training)
Cardiologists with additional expertise in interventions like angiography and angioplasty. While general cardiology training involves some exposure to procedures like angioplasty, a few cardiologists undergo additional training to master the art of angioplasty and related procedures. They also perform other minimally invasive procedures like balloon valvuloplasty, transcatheter valve replacement (for example TAVR/TAVI), fixing blood vessels involving organs other than the heart etc.

Electrophysiologist (EP): (MBBS + MD + DM + Additional training)
Cardiologists who specialize in rhythm disorders. They also deal with pacemakers and defibrillators.

Cardio-thoracic Surgery (CTVS): (MBBS + MS + MCh)
Surgical specialists who treat the heart, lungs, and other organs of the chest. They perform open-heart bypass surgeries, valve replacements, lung surgeries, etc.

Vascular Surgery: (MBBS + MS + MCh)
Vascular surgeons are surgical specialists who deal with diseases of the blood vessels of the entire body except the Heart and the Brain. Few vascular surgeons perform catheter-based interventions, like Interventional Cardiologists, Interventional Neurologists, or Interventional Radiologists. 

Neurologist: (MBBS + MD)
Medical experts for brain and spinal cord. They deal with stroke (paralysis), epilepsy and other related issues. 

Interventional Neurologist: (MBBS + MD + Additional training)
Neurologists with additional expertise in performing catheter-based interventions (minimally invasive) of the brain, particularly during stroke (paralysis). 

Neurosurgery: (MBBS + MS + MCh)
Surgical experts for brain and spinal cord related issues. They perform traditional brain surgeries for issues like brain tumours, brain haemorrhage etc. They also operate on the spinal cord, although few neurosurgeons further specialize and restrict themselves to either the brain or the spine.

Gastroenterologist (GI): (MBBS + MD + DM)
Medical specialists who deal with issues related to the abdomen (such as the stomach, intestines, liver, pancreas, etc.). They perform endoscopy, colonoscopy, and related procedures. 

Surgical Gastroenterology (or Gastro-Intestinal Surgeon): (MBBS + MS + MCh)
Surgical specialists who perform surgery on abdominal organs. They also perform minimally invasive laparoscopic surgeries (a few laparoscopic surgeries are done by general surgeons). 

Nephrologist: (MBBS + MD + DM)
Medical specialists for kidney-related disorders. They also manage dialysis. A few nephrologists also manage patients post-kidney transplant.

Urologist: (MBBS + MS + MCh)
Surgical specialist for kidney-related disorders. They do surgeries on kidneys, urinary bladder etc. They also do minimally invasive procedures like cystoscopy, stone removal etc. A few Urologists perform kidney transplants as well. 

Pediatrics: (MBBS + MD)
General physician for kids (age less than 18 years) 
*Pediatric specialities are an established subset that many doctors choose to pursue. These experts can start their training as age-neutral specialists and then focus their work on kids, or start as pediatric doctors and gain further expertise in a particular field. For example, a pediatric cardiologist could be a general cardiologist who got further training to deal with kids-specific issues or a paediatrician who got further training as a cardiologist.

Endocrinologist: (MBBS + MD + DM)
Medical specialists who deal with hormones. They are experts on Diabetes, Thyroid disorders, gender-related hormones, weight disorders, and many more. They are also the medical specialist for bone health. Few endocrinologists perform procedures like thyroid biopsy etc. Few endocrinologists are experts in managing patients with cancer involving endocrine glands like thyroid, pituitary etc.

Rheumatologist: (MBBS + MD + DM)
Medical specialists who deal with immune system-related disorders. They treat joint issues like Rheumatoid Arthritis, skin diseases like Psoriasis, and general body diseases like Systemic Lupus Erythematosus. 

Radiologist: (MBBS + MD)
Experts who deal with X-rays, CT scans, MRIs etc. 

Interventional radiologist: (MBBS + MD + Additional training)
Radiologists with expertise in catheter-based interventions. They perform minimally invasive procedures involving blood vessels or perform biopsies on hard-to-reach areas of the body.

Oncologist: (MBBS + MD + DM)
Medical experts who deal with cancer. Oncologists prescribe and supervise chemotherapy. They are an essential part of the tumour board (including surgical oncologists and radio-oncologists, among others) that defines treatment strategies for individual cancer patients.

Hematologist: (MBBS + MD + DM)
Medical experts who deal with disorders of blood, including blood cancers and bone marrow transplants. Haematology and Oncology are commonly combined into a single speciality. 

Surgical Oncologist: (MBBS + MS + Additional training)
Surgical experts who perform cancer-related surgery. 

Pulmonologist: (MBBS + MD)
Medical specialists who deal with disorders of the lungs. They perform bronchoscopy.

Intensivist: (MBBS +/- MD + Additional training)
Medical specialists who address the critical care needs of patients in the Intensive Care Unit. 

Anesthesiologist: (MBBS + MD)
Medical specialists who deal with anaesthesia and pain management. 

Sleep Medicine: (MBBS + MD + Additional training)
Specialists from various branches who focus their work on sleep medicine. They can be pulmonologists, neurologists, or anesthesiologists. 

Dermatologist: (MBBS + MD)
Medical specialists for skin-related disorders. They also perform skin biopsies and minimally invasive treatment for certain skin lesions.

Psychiatrist: (MBBS + MD)
Medical specialists who deal with mental disorders. 

Psychologist: (Separate course)
Medical specialists who deal with behaviour and mood-related disorders. 

Orthopedics: (MBBS + MS)
Surgical specialists for bone-related issues. They deal with bone fractures, bone cancers, joint replacements etc. 

Obstetrics: (MBBS + MS)
Surgical specialists who deal with issues related to childbirth. 

Gynaecologist: (MBBS + MS)
Surgical specialists who deal with women’s health. Most commonly Obstetrics and Gynaecology are combined into a single specialty. There is no separate medical speciality for women’s health.

Ophthalmologist: (MBBS + MS)
Surgical specialists who deal with eye-related issues. There is no separate medical speciality for eye disorders.

Emergency Medicine: (MBBS ± MD/MS + Additional training)
Hybrid specialists who handle general emergencies in the Emergency room.

ENT (Ear Nose and Throat or Otorhinolaryngologist): (MBBS + MS)
Surgical specialist of ear, nose, and throat. They also perform cochlear implants for hearing impairment. There is no separate medical speciality for ENT.

Dentist: (BDS ± Additional training depending on expertise)
Teeth specialists. Few dentists take additional training to gain expertise in prosthodontics and oral surgery. 

I am certain I haven’t listed all the specialists one may encounter. If you see someone whose expertise is not listed above, please comment below, and I will include it. Thank you