New Docs on the Block

Family Health, Featured Article, Power to the Patient, Women's Health
on February 17, 2011
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These days, we have more choices than ever when it comes to health care. But with all those choices can come a challenge worth of a med school exam: How to know who does just what, and which expert you should see when? Clear up confusion with this list.

Integrative Doctor

Best for: Chronic health problems like diabetes, pain, autoimmune disorders, cancer, heart disease and preventive care

Training: Integrative doctors have either an MD or DO (osteopathic doctor) degree, plus special certification in integrative medicine. That means they’re trained in both conventional Western and alternative approaches to medical care.

The details: Found at integrative health centers at a growing number of major medical centers across the country, the integrative doc “takes into account the whole person–her mind, body and spirit,” says Dr. Tobi Fishel, director of psychological services at Vanderbilt University’s Center for Integrative Health. He may refer you to acupuncturists, dietitians and massage or yoga therapists, as well as conventional medical specialists. “The movement is booming now because there’s a lot of research that shows that many eastern modalities are helpful for living a fuller life,” Dr. Fishel says.

An integrative doc typically sees a patient as often as monthly over a long period of time to bring about broad lifestyle changes. That’s why they’re a good choice if you suffer from chronic health concerns. “Western medicine is very much geared to acute problems, to solving them with procedures and medications,” Dr. Fishel explains. “But if someone has chronic illness and/or pain, what we need to do is teach her how to learn to take care of herself in a different way.”

Of note: While care from an integrative MD is likely to be covered by insurance, some of the referrals they make—yoga therapy and acupuncture, for example—may not be.

Naturopathic Doctor

Aka: ND or NMD

Best for: Chronic complaints — digestive problems, hormonal issues, sleep disruption

Training: Fifteen states have licensing laws for naturopaths, requiring a degree from a four-year naturopathic medical school approved by the American Association of Naturopathic Physicians (AANP), and a licensing exam. Even if your state doesn’t require it, it’s a good idea to look for NDs who are graduates of one of these schools.

The details: Like integrative docs, naturopathic physicians take a whole-body approach to care.“People who want a preventive approach appreciate naturopathic care,” says Catherine Darley, ND, of Seattle, who specializes in sleep disorders. An ND may recommend acupuncture, herbal medicine, diet and other lifestyle changes. “We use the least-force intervention that will be effective for the condition being treated,” Dr. Darley says. “For example, if behavioral medicine will be effective to treat insomnia in a patient, I’ll try that first before prescribing pharmaceutical medications.”

Don’t see them for: Serious diseases (cancer, diabetes, etc.).

Of note: Insurance coverage for naturopathic care varies by state and plan to plan. Check with your insurance provider.

Osteopathic doctor

Aka: DO

Best for: Preventive care, injuries and common medical complaints

Training: Osteopathic physicians, like traditional MDs, complete four years of medical school and a residency, may become board-certified to practice a specialty of medicine, and are licensed at the state level. They receive additional training in the musculoskeletal system

The details: DOs are common in integrative healthcare environments, because they focus on the whole body and are often more likely to suggest alternative treatment approaches than MDs. For conditions like back pain or fibromyalgia, they may use a hands-on method called osteopathic manipulative treatment, or OMT—the primary thing that sets them apart from MDs. If you want the doctor to spend a little more time with you, a DO might be a better choice: Their visits tend to last a little longer since their approach is to consider the effect of an illness or complaint on the whole body as a network.

Of note: Costs and coverage are similar to those of MDs, though some plans will not cover DOs.

Physician’s Assistant

Aka: PA

Best for: Minor complaints like viral illnesses, sprains and strains, and allergic reactions

Training: PAs must become certified by taking a national exam after graduating from an accredited program. Many have health-care experience prior to beginning a PA educational program.

The details:A physician’s assistant works under supervision of a doctor (who may or may not be on site), and provides many of the tasks of basic medical care, including prescribing certain medications, administering exams, treating injuries, offering preventive care and ordering lab tests and x-rays. With changes related to health care reform, they are likely to become increasingly common.

Integrative nutritionist

Aka: Nutrition coach

Best for: People who know the basics of good nutrition, but need someone to help them make smarter everyday choices

Training: Training and experience can vary widely, as the terms “nutritionist” and “nutrition coach” are not regulated. Look for a professional who is a registered dietitian or holds a master’s degree or doctorate in nutrition.

The details: Like integrative doctors, integrative nutritionists take a holistic approach to an individual’s nutrition. Many are registered dietitians (RDs), but will focus more than a traditional RD might on helping you with adjust your relationship with food. An integrative nutritionist may accompany you to the grocery store and teach you how to cook healthier meals. For example, a patient with diabetes may first see an RD to learn the basics of a healthy diabetic diet, and then follow up with regular visits with a nutrition coach.

Of note: “Do not seek the advice of anyone who is selling any products” like herbs or supplements, says registered dietitian Dr. Mary Flynn, author of The Pink Ribbon Diet. “This should be a red flag that this person is not reputable and does not have the nutrition knowledge necessary to provide accurate nutrition information. Nutrition advice is always food based.”

Health coach

Aka: Wellness coach

Best for: Stress management, diet andfitness coaching

Training: Health and wellness coaches are not required to hold degrees from four-year medical schools, nor are they licensed at the state level. Until they are, it’s buyer beware. The Institute for Integrative Nutrition (integrativenutrition.org) has a reputable program, and top medical institutions like Duke University are launching programs as well.

The details: Health and wellness coaches offer some of the same holistic guidance that integrative doctors and nutritionists do, helping you implement healthy lifestyle changes including stress-management techniques and diet. As with nutritionists and other non-nationally regulated health care providers, careful research is key. Insurance will not cover a health coach’s services.

Of note: If you suffer from a chronic condition or have an acute medical concern, see a traditional or integrative MD before visiting a health coach—and be sure to tell your regular doctor about any coaching you receive.

Certified massage therapist

Aka: CMT

Best for: Stress relief, muscle soreness, back pain

Training: Training standards for massage therapy vary by state, but almost all require a license to practice. (Licensure usually requires the therapist to pass an exam.) Look for a therapist who has completed at least 500 hours of instruction or who is nationally certified by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB).

The details: A massage therapist uses touch and movement to manipulate the muscles of the body, increasing general wellness and combating a number of health complaints. Massage has been shown to relieve stress, tension, and pain. It can also lower blood pressure, boost the immune system, help with rehabilitation from sports injuries, and alleviate the side effects of cancer treatment.

Of note: Insurance is not likely to cover massage therapy, but some employers do offer it as a benefit.

Yoga therapist

Aka: CYT

Best for: Musculoskeletal issues like back, neck, and hip pain.

Training: There is currently no national, standardized course of training for yoga therapy, so it’s extra-important to find out how many hours of training they’ve had, whether they hold a membership in the International Association of Yoga Therapists (iayt.org)and get references.

The details: A yoga therapist uses the principles and physical postures of yoga to provide relief from various musculoskeletal issues. Think of them as physical therapists who use yoga poses and props rather than a traditional PT’s props and exercises.

Of note: Talk to your regular physician before seeking care from a yoga therapist, as some poses are not recommended if you have certain health conditions, like high blood pressure.

Nurse practitioner

Aka: NP

Best for: Basic medical care, including physical exams, routine screenings, diagnosing disease and prescribing medication, and ordering lab tests

Training: NPs are registered nurses with a master’s degree. Some NPs are nationally certified by the American Nurses’ Association or other nursing organizations, which requires passing an exam, typically in a specific area like pediatrics, acute care or women’s health.

The details: NPs sometimes serve as primary care providers in pediatric, geriatric and family care settings, either independently or under the supervision of an MD. The scope of their care—for example, the authority to write prescriptions—varies according to state laws.

Of note: Insurance will usually cover most, if not all, of their services.

Certified nurse midwife

Aka: CNM

Best for: Well-woman gynecological care for women of all ages — including routine screenings, exams, and reproductive counseling — in addition to maternity care

Training: CNMs are registered nurses who have had training in obstetrics.

The details: Certified nurse-midwives often work under the supervision of an obstetrician. Nurse-midwives practice in hospitals, clinics, and birthing centers, and may attend home births. You may receive care from one instead of, in tandem with, an OB-GYN.