Alphabet Soup

What does “MD” mean to you after someone’s name?

To many, in conjures an image of a trusty elder statesman of medicine, a healer, a researcher, a teacher and therapist of all things related to diseases of the human body.

It comes from the Latin, Medicinæ Doctor, meaning “Teacher of Medicine.” In the US, it is the first professional degree for physicians while in other countries, such as Germany or England, it is a higher doctoral research degree resembling the PhD (Philosophiæ Doctor, meaning "teacher of philosophy").

For reasons that are unclear to me, physicians also occasionally include other letters beyond the “MD” in their name. These add little to the MD descriptor, other than to define a professional society with whom the doctor associates themselves. For instance, I am a Fellow or the American College of Cardiology, and have “FACC” sometimes appear on my stationary. I never write this designator when signing my name, but I know my referring colleagues in medicine want to know I’m one of the gang, so it appears there. It also implies that I pay my dues to the American College of Cardiology which also serves as our political and advocacy branch of our subspecialty.

I find patients rarely understand what these letters mean, for there are many such designations. FACS means a Fellow in the American College of Surgeons, a surgical professional group, and FACP means Fellow of the American College of Physicians, a professional group of internists, for instance. Some people, like cardiologists who have first been internists before becoming a cardiologist, like to add both the FACP and FACC designator after their name. Providing, they’ve paid the fee and been vetted by the respective professional groups, no one seems to mind. A signature line becomes virtual alphabet soup as doctors sign their name “John R. Smith, MD, FACP, FACC.”

Big deal.

Regrettably, these initials are nothing more than a narcissistic exercise of self-aggrandizement, rather than meaningful milestone of additional education or skill. Further, in our zeal to differentiate ourselves from our less-specialized colleagues, they have promoted the fragmentation of our profession as a collective bargaining body in matters of public policy important to physicians collectively. The alphabet soup conveys no indication of additional qualification of the physician, only that they have paid for the privilege to add these to their names, have a valid license, and know a few colleagues in their same subspecialty club.

Importantly, these letters do not imply an individual is “board certified” by any one of the 24 Member Boards that make up the American Board of Medical Specialties. Within each specialty like Internal Medicine are often other subspecialties, like gastroenterology, rheumatology, cardiology or cardiac electrophysiology. In total, there are presently 145 specialties and subspecialties in which a doctor can become “board certified” and 145 ways we fragment our negotiating power on Capital Hill as each group fights for their own interests. It’s also 145 ways we confuse the public (and each other), 145 ways we lose our focus on the bigger picture of healthcare in America, and 145 ways that third parties can play us off one another as they forward their agendas over ours.

In effect, our sub-specialized egos and alphabet soup have neutered us as effective voices in healthcare reform.

Worse still, while “board certification” defines an important level of competence that should not be undervalued or disrespected in terms of the expertise required to achieve such certification, the term itself has been confused with the sponsoring professional society memberships' alphabet soup and has obscured our ability to protect this important credentialing designation.

More on this soon.

-Wes