Who is Treating my Child

When a child is admitted to a hospital, an avalanche of healthcare providers get involved. This creates considerable amount of confusion. Parents hear multiple references to “your child’s doctor“, presumably a single individual in-charge. At the same time, people identifying themselves as “Doctor X” turn out to be not that, and further inquiry reveals that they are consulting physicians, the admitting doctor, on-call doctor, or a resident.

The Attending

After a child is admitted to a hospital, they are assigned to a “prescriber” who is responsible for their overall care. In terms of training. that person is generally a physician or a nurse practitioner (NP). Other terms used for that person may be “the attending,” “psychiatrist,” or “primary doctor.” The term “attending” is probably the most reliable way to refer to the person-in-charge and will be used here as such.

A whole slew of healthcare providers may be working under the attending physician/NP with a direct role in diagnosing and treating a child. These include physician assistants, therapists, and psychiatrists-in-training (residents and fellows). How the responsibilities are distributed among these professionals vary from hospital to hospital, and it is always useful to inquire about the organizational structure.

Other commonly used terms:

Psychiatrist is a vague term which generally refers to a physician who had completed medical school and residency (specialty training) in general psychiatry. Many, but not all psychiatrists are “Board-certified psychiatrists” which means that they passed their “Boards” – an arduous test, after residency.

Child psychiatrists are physicians who completed residency training in general AND child/adolescent psychiatry. Again, they may or may not be “Board-certified.”

Unit Chief is a psychiatrist who treats patients but also is administratively in charge of an inpatient unit. A psychiatric unit may have several attendings, but only one unit chief.

The “admitting doctor/physician” is usually a different person who has shorter involvement at the point of hospital entry. The admitting doctors “hands off” the patient to the attending doctor in the hospital.

The attending physician may ask a consultant, e.g. a neurologist or a pediatrician, to weigh in on a complex case and make recommendations. Many hospitals employ nurse practitioners or physician assistance in this role.

The “covering doctor” (AKA doctor-on-call, medical officer, “night-float”) is responsible for urgent issues that may arise when the attending is not on duty, e.g. on weekends or overnight. The covering doctor may or may not be a psychiatrist, and they are generally unfamiliar with every particular patient. Many teaching hospitals have psychiatric trainees (residents and fellows) fill this role.

Minimum requirements for a physician to have a particular title:

Medical School

Licensed to practice medicine Residency Fellowship Board-certified, general psychiatry

Board-certified, child and adolescent psychiatry

Resident, incl. Chief Resident Yes varies by State current position
“Child Fellow” Yes Yes Yes current position
Psychiatrist Yes Yes Yes
Child psychiatrist Yes Yes Yes Yes
Board-certified psychiatrist Yes Yes Yes Yes Yes
Board-certified child psychiatrist Yes Yes Yes Yes Yes Yes

 Common titles of prescribers

MD, DO, and MBBS: These are physicians (not necessarily “psychiatrists” – see above) who completed a medical school and are licensed to practice medicine in the United States.

*  “MD” is the degree awarded by allopathic medical schools;

*  “DO” degrees are awarded by osteopathic medical schools;

* “MBBS” is a degree awarded by medical schools outside of the US.

NP is a nurse practitioner, or an advanced practice registered nurse(APRN), who are licensed to diagnose and treat patients with minimal or no supervision (depending on state).

PA is a physician assistant who practices medicine and surgery with some degree of supervision. In some hospitals, the term PA may refer to “psychiatric attendant” or psychiatric aide.

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