specialist

What is a specialist?

A specialist is a medical provider who has received training and potentially licensure in a special area of practice and who treats particularized health needs. Some classifications differentiate between medical specialists – such as pediatricians, endocrinologists, and psychiatrists – and surgical specialists such as neurosurgeons and orthopedic surgeons,¹ but they are all specialists.

The American Board of Medical Specialties lists three dozen different types of specialists, many of which have multiple subspecialties. For example, the internal medicine specialty has 21 subspecialties, including gastroenterology, nephrology, and medical oncology.²

In addition to physicians, other medical providers – such as nurse practitioners (NPs) and physician assistants (PAs) – can be specialists.³

What’s the difference between primary care providers and specialists?

While we often think in terms of the distinction between a primary care provider (PCP) and a specialist, doctors who serve as PCPs can be specialists in their own right. Those specialties for a PCP can include internal medicine, pediatrics (or internal medicine-pediatrics), family medicine, and obstetrics/gynecology.⁴

If a doctor serves as a patient’s PCP, they may have their own specialty (pediatrics, family medicine, OB/GYN, etc.) but can also refer patients to other specialists as needed. These referrals are required by some health plans, including many HMOs (health maintenance organizations) and POS (point of service) plans. If a health plan requires referrals to see a specialist, a plan enrollee will need to designate a PCP in order to receive covered care under the plan either from the PCP, or from a specialist after receiving a referral from the PCP.

The process of becoming a doctor in the U.S. involves medical school and then a residency program in the person’s chosen specialty.⁵ This could be a specialty that will allow the person to become a PCP, or it might be a specialty that will require referrals from PCPs, depending on a patient’s health plan.

If a patient has a health plan that doesn’t require referrals – such as a PPO or Original Medicare⁶ – they might not have a PCP, since a PCP may not be required, and might only see a specialist such as a dermatologist or ophthalmologist.