To help break this down, here's an overview of the distinctions between four commonly used — and misunderstood — health care titles.
The problem: You've got a sore throat and are considering seeing a primary care doctor who has a "D.O." after her name. Is this a legitimate credential?
A doctor of osteopathic medicine (D.O.) is a fully licensed medical doctor who must attend medical school and participate in residency programs, according to the American Osteopathic Association (AOA), which represents osteopathic doctors. D.O.s can practice in any medical specialty, prescribe medication and perform surgery. Osteopathic physicians are specially trained in the body's musculoskeletal system, preventive medicine and holistic patient care; they also recognize the body's ability to heal itself. D.O.s are most likely to be primary care specialists and can treat you from birth (as an obstetrician/gynecologist) through death (as a geriatrician), says the AOA.
A medical doctor is also a physician. Like osteopathic doctors, they examine patients, obtain medical histories, and order, perform and interpret diagnostic tests. M.D.s generally do not practice spinal manipulation unless they are D.O.s. M.D.s and D.O.s work in one or more specialties, including anesthesiology, family and general medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry and surgery.
Insurance: M.D.s, D.O.s and others with state licenses who are eligible are generally reimbursed.
Certified nutrition specialist versus registered dietitian
The problem: In some states, virtually anyone can declare themselves a nutritionist regardless of education or training. The terms nutritionist and registered dietitian are often incorrectly used interchangeably.
A certified nutrition specialist (CNS) is a nutrition practitioner or a person who uses nutrition therapy to address health needs, according to clinical nutritionist and CNS Corinne Bush. CNSs have an advanced degree (master's level or above) in nutrition or a related field from an accredited university. CNSs must pass the Certification Board for Nutrition Specialists (CBNS) examination on science-based nutrition therapy.
A registered dietitian (RD) is a nutritionist who has been credentialed by the Commission on Dietetic Registration of the Academy of Nutrition and Dietetics (AND), formerly known as the American Dietetic Association. RDs must have at least an undergraduate degree — usually in nutrition — and often work in community education or food service management settings, including nursing homes or hospitals. Most RDs go on to get advanced degrees, and some work in private practice, according to the AND. They must also complete continuing education requirements to maintain registration.
Insurance: Reimbursement varies widely depending on state regulations and specific plan restrictions for both CNSs and RDs. Medicare covers some services. Costs can vary widely for both, Bush said.
Be careful: Only CNSs and RDs are named in licensing laws. The AND has long pushed for nutrition licensure laws in all 50 states. The CBNS opposes this push, as it would effectively "outlaw many extremely well-qualified nutrition professionals, just when the public needs them most," said Bush, CBNS' legislative chairwoman. The AND, which changed its name to include the word "nutrition" and to emphasis its belief that RD's are the only qualified nutrition experts, says licensure laws are not intended to limit practice to a particular profession or provider; instead they "ensure that consumers can rely upon the competency of licensed practitioners."
Always look at credentials and remember that a CNS usually, but not always, has the most advanced science-based training.