How are doctors trained and certified to treat cancer patients?
When choosing a doctor for your cancer care, you may find it helpful to know some of the terms used to describe a doctor’s training and credentials. Most physicians who treat people with cancer are medical doctors (they have an M.D. degree) or osteopathic doctors (they have a D.O. degree). The basic training for both types of physicians includes 4 years of premedical education at a college or university, 4 years of medical school to earn an M.D. or D.O. degree, and postgraduate medical education through internships and residences. This training usually lasts 3 to 7 years. Physicians must pass an exam to become licensed (legally permitted) to practice medicine in their state. Each state or territory has its own procedures and general standards for licensing physicians.
Specialists are physicians who have completed their residency training in a specific area, such as internal medicine. Independent specialty boards certify physicians after they have fulfilled certain requirements. These requirements include meeting specific education and training criteria, being licensed to practice medicine, and passing an examination given by the specialty board. Doctors who have met all of the requirements are given the status of “Diplomate” and are board certified as specialists. Doctors who are board eligible have obtained the required education and training but have not completed the specialty board examination.
After being trained and certified as a specialist, a physician may choose to become a subspecialist. A subspecialist has at least 1 additional year of full-time education in a particular area of a specialty. This training is designed to increase the physician’s expertise in a specific field. Specialists can be board certified in their subspecialty as well.
The following are some specialties and subspecialties that pertain to cancer treatment:
The American Board of Medical Specialties® (ABMS) is a not-for-profit organization that assists medical specialty boards with the development and use of standards for evaluation and certification of physicians. Information about other specialties that treat cancer is available from the ABMS website.
Almost all board-certified specialists are members of their medical specialty society. Physicians can attain Fellowship status in a specialty society, such as the American College of Surgeons (ACS), if they demonstrate outstanding achievement in their profession. Criteria for Fellowship status may include the number of years of membership in the specialty society, years practicing in the specialty, and professional recognition by peers.
How can I find a doctor who specializes in cancer care?
One way to find a doctor who specializes in cancer care is to ask for a referral from your primary care physician. You may know a specialist yourself, or through the experience of a family member, coworker, or friend.
The following resources may also be able to provide you with names of doctors who specialize in treating specific diseases or conditions. However, these resources may not have information about the quality of care that the doctors provide.
If you are a member of a health insurance plan, your choice may be limited to doctors who participate in your plan. Your insurance company can provide you with a list of participating primary care doctors and specialists. It is important to ask whether the doctor you are considering is accepting new patients through your health plan. You also have the option of seeing a doctor outside your health plan and paying the costs yourself. If you have the option to change health insurance plans, you may first wish to consider which doctor or doctors you would like to use, and then choose a plan that includes your chosen physician(s).
If you are using a federal or state health insurance program such as Medicare or Medicaid, you may want to ask whether the doctor you are considering is accepting patients who use these programs.
You will have many factors to consider when choosing a doctor. To make an informed decision, you may wish to speak with several doctors before choosing one. When you meet with each doctor, you might want to consider the following:
If you are choosing a surgeon, you may wish to ask additional questions about the surgeon’s background and experience with specific procedures. These questions may include:
It is important for you to feel comfortable with the specialist that you choose because you will be working closely with that person to make decisions about your cancer treatment. Trust your own observations and feelings when deciding on a doctor for your medical care.
How can I get another doctor’s opinion about the diagnosis and treatment plan?
After your doctor gives you advice about the diagnosis and treatment plan, you may want to get another doctor’s opinion before you begin treatment. This is known as getting a second opinion. You can do this by asking another specialist to review all of the materials related to your case. The doctor who gives the second opinion can confirm or suggest modifications to your doctor’s proposed treatment plan, provide reassurance that you have explored all of your options, and answer any questions you may have.
Getting a second opinion is done frequently, and most physicians welcome another doctor’s views. In fact, your doctor may be able to recommend a specialist for this consultation. However, some people find it uncomfortable to request a second opinion. When discussing this issue with your doctor, it may be helpful to express satisfaction with your doctor’s decision and care and to mention that you want your decision about treatment to be as thoroughly informed as possible. You may also wish to bring a family member along for support when asking for a second opinion. It is best to involve your doctor in the process of getting a second opinion, because your doctor will need to make your medical records (such as your test results and x-rays) available to the specialist who is giving the second opinion.
Some health care plans require a second opinion, particularly if a doctor recommends surgery. Other health care plans will pay for a second opinion if the patient requests it. If your plan does not cover a second opinion, you can still obtain one if you are willing to cover the cost.
If your doctor is unable to recommend a specialist for a second opinion, or if you prefer to choose one on your own, the following resources can help:
How can U.S. residents find treatment facilities?
Choosing a treatment facility is another important consideration for getting the best medical care possible. Although you may not be able to choose which hospital treats you in an emergency, you can choose a facility for scheduled and ongoing care. If you have already found a doctor for your cancer treatment, you may need to choose a facility based on where your doctor practices. Your doctor may be able to recommend a facility that provides quality care to meet your needs. You may wish to ask the following questions when considering a treatment facility:
If you are a member of a health insurance plan, your choice of treatment facilities may be limited to those that participate in your plan. Your insurance company can provide you with a list of approved facilities. Although the costs of cancer treatment can be very high, you do have the option of paying out-of-pocket if you want to use a treatment facility that is not covered by your insurance plan. If you are considering paying for treatment yourself, you may wish to discuss the possible costs with your doctor beforehand. You may also want to speak with the person who does the billing for the treatment facility. Nurses and social workers may also be able to provide you with more information about coverage, eligibility, and insurance issues.
The following resources may help you find a hospital or treatment facility for your care:
The Joint Commission offers an online Quality Check® service that patients can use to determine whether a specific facility has been accredited by the Joint Commission and to view the organization’s performance reports.
How can people who live outside the United States find treatment facilities in or near their countries?
If you live outside the United States, facilities that offer cancer treatment may be located in or near your country. Cancer information services are available in many countries to provide information and answer questions about cancer; they may also be able to help you find a cancer treatment facility close to where you live. A list of these cancer information services is available on the website of the International Cancer Information Service Group, an independent international organization of cancer information services. A list may also be requested by writing to the NCI Public Inquiries Office at:
Cancer Information Service
Suite 300
6116 Executive Boulevard
Bethesda, MD 20892–8322
USA
The Union for International Cancer Control (UICC) is another resource for people living outside the United States who want to find a cancer treatment facility. The UICC consists of international cancer-related organizations devoted to the worldwide fight against cancer. UICC membership includes research facilities and treatment centers and, in some countries, ministries of health. Other members include volunteer cancer leagues, associations, and societies. These organizations serve as resources for the public and may have helpful information about cancer and treatment facilities. To find a resource in or near your country, contact the UICC at:
Union for International Cancer Control (UICC)
62 route de Frontenex
1207 Geneva
Switzerland
+ 41 22 809 1811
http://www.uicc.org
How can people who live outside the United States get a second opinion or have cancer treatment in the United States?
Some people living outside the United States may wish to obtain a second opinion or have their cancer treatment in this country. Many facilities in the United States offer these services to international cancer patients. These facilities may also provide support services, such as language interpretation, assistance with travel, and guidance in finding accommodations near the treatment facility for patients and their families.
If you live outside the United States and would like to obtain cancer treatment in this country, you should contact cancer treatment facilities directly to find out whether they have an international patient office. The NCI-Designated Cancer Centers Find a Cancer Center page offers contact information for NCI-designated cancer centers throughout the United States.
Citizens of other countries who are planning to travel to the United States for cancer treatment generally must first obtain a nonimmigrant visa for medical treatment from the U.S. Embassy or Consulate in their home country. Visa applicants must demonstrate that the purpose of their trip is to enter the United States for medical treatment; that they plan to remain for a specific, limited period; that they have funds to cover expenses in the United States; that they have a residence and social and economic ties outside the United States; and that they intend to return to their home country.
To determine the specific fees and documentation required for the nonimmigrant visa and to learn more about the application process, contact the U.S. Embassy or Consulate in your home country. A list of links to the websites of U.S. Embassies and Consulates worldwide can be found on the U.S. Department of State’s website.
More information about nonimmigrant visa services is available on the U.S. Department of State's Temporary Visitors to the U.S. page.