1. The first requirement to practice medicine in the United States applies to all physicians: they must be licensed in one (or more) states. There are licensure requirements written into state law, that vary slightly from state to state. (For example, many states require one or more years of additional training after getting an M.D. or D.O. degree from an accredited Medical or Osteopathic School. This one year previously was called an "internship" although many institutions now describe the year as the "first year of residency." And, many states have requirements to pass an examination measuring competency before becoming licensed.) You can learn more about licensing at The Federation of State Medical Boards website. They have a listing of all the State Medical Boards, and their addresses, and occasionally their websites where you might be able to look up your physician's licensure status.

   There is also another website that links to physician credentials for most/all the states of the US, at the at DocFinder, where you can look up state licensed physicians. Unfortunately, some of their hyperlinks are not working when checked 17Jan2009.

2. In addition to being a licensed physician, many physicians obtain additional training (which is usually in a hospital), called a "residency." Typical subjects for residencies include pediatrics, internal medicine, and surgery. Although there is no formal requirement that physicians must possess to claim to be a specialist, most physicians who describe themselves as "specialists" have completed a residency training program.

3. After successful completion of a residency training program, and other requirements that vary from one specialty to another, a physician may choose to attempt to become "Board Certified." (Physicians who have completed all the eligibility requirements to take the Board exam in their specialty are sometimes called "Board-Eligible.") If a physician passes the Board exam in their specialty, they become Board Certified. That's where your pediatrician is up to, as described in your question.

   It should also be noted that there are two types of Specialty Boards: Boards that are part of the American Board of Medical Specialties, and over 125 so-called "self-designated" boards. Dr. Julia M. Reade, a physician who co-authored an article about doctors' credentials, states "There are some extremely reputable [self-designated] boards with very reputable people. Then there are these cranks who run these insane diploma mills" (quoted in Federation Bulletin, Vol 82, No 2, 1995, page 87). Unless the Board is part of the ABMS, let the patient beware!

4. Some physicians go on to take additional training besides the standard residency programs, and get several additional years of additional training in a "subspecialty" field (like pediatric endocrinology, which is a subspecialty of pediatrics). After successful completion of a subspecialty residency training program (which is frequently called a "fellowship"), the physician will be eligible to take the subspecialty exam, to become Board-Certified in the subspecialty itself. Generally speaking, a physician is not eligible to take the subspecialty Board exam unless they are already Board-Certified in the specialty.

5. There's another layer of credentials beyond those described above: Sometimes you will see physicians listing a set of letters beginning with the letter F or M (such as FAAP or FACE). These credentials are only attainable after becoming Board-Certified, and meeting other criteria developed by specialty organizations called "Colleges." The translations of these cryptic abbreviations is sometimes obvious, if you know that the letter

   F stands for the words Fellow of the,
   M stands for the words Master of the,
   A frequently stands for the words American, or Academy of
   R frequently stands for the word Royal, and
   C frequently stands for the words College of. But
   P may stand for the word Physicians, or Pediatrics, or Pathology!

   So, sometimes the abbreviations are very difficult to decipher without asking the physician; don't feel embarrassed to ask.

6. Finally, in the field of diabetes, there's an additional credential available: Certification as a C.D.E. (Certified Diabetes Educator). This credential is available for any health professional who meets the requirements developed by the National Certification Board for Diabetes Educators.

What does it all mean? Well, for the first thing, it's a way for us docs to ascertain the training of other docs (although obviously, a doctor with a terrible bedside manner might get through all the hurdles, while a very empathetic, caring, and knowledgeable physician might not take the many years' training needed to get all the credentials).

Next, it's a way for knowledgeable consumers to screen prospective candidates to be their physicians: if the doc has jumped through all the hoops, they presumably are better trained and probably more knowledgeable than doctors who haven't, and hence would be a place to start a search for a new physician. But it would take an office visit to see what the doc's personality is like, as none of the credentials indicate if the doc is nice or nasty. And credentialing does a poor job of indicating if the doc is up-to-date or not, although many of the credentialing organizations now require occasional reapplication to retain the credential.

Should you switch from your Board-Certified pediatrician who's not Board-Certified in pediatric endocrinology to a pediatric endocrinologist who has both credentials? Not if your child is doing well, and your child's physician deals with children with diabetes every day, and has the resources of a Diabetes Team to back her up. But if your child is not under control, and the doctor only rarely sees kids with Type 1 diabetes, looking around for another doctor is a possibility to consider.

-- WWQ

P.S.: Yes, there's a fee to be paid for every step along the way!

The American Association of Clinical Endocrinologists

You can search the AACE Physician Finder for a nearby endocrinologist. (You may search by City, State, Country, and Subspecialty)

American Medical Association

DoctorFinder lists most physicians in the US, whether members of the AMA or not. You can look by name, or by specialty. (You do need to know which state or ZIP code that the doctor is in; unfortunately, they do not have the ability to look throughout the entire United States at once.)

American Board of Medical Specialties

if you are looking to see if a physician is Board-Certified, and you already know the doctor's specialty, you can look up specialists at:

• American Board of Internal Medicine ("http://www.abim.org/")

  Verification of credentials is to be found at the homepage.

• American Board of Pediatrics ("http://www.abp.org/")

  Verification of credentials is to be found at: https://www.abp.org/NewVerification/faces/VerificationSearch.jsp

• American Board of Family Practice ("http://www.abfp.org/")

  Verification of credentials is to be found at: https://www.theabfm.org/diplomate/verify.aspx. But it's almost useless, as an exact match is needed for name, date of birth, and last 4 digits of the physician's Social Security number!