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When attending a medical conference or visiting a hospital in the United States, both Americans and foreigners sometimes feel as if they are swimming in a bowl of alphabet soup. All of the healthcare professionals are wearing name tags, but the letters after their names are sometimes confusing: M.D., Ph.D., D.O., P.A., N.P., A.R.P.N., B.S.N., A.D.N., R.N., L.P.N, and L.V.N., to name just a few. It's no wonder that non-healthcare professionals feel like they are drowning in alphabet soup! What do all these letters mean?

M.D., or Medical Doctor, is probably the most familiar acronym. In the U.S., medical doctors must first earn a four-year undergraduate degree, either a Bachelor of Science (BS) or a Bachelor of Arts (BA), during which most aspiring physicians focus on science (e.g., they major in biology, chemistry or physiology). Then they attend medical school for another four years. Most physicians then complete their residency or specialty (three to seven years, depending on the specialty, e.g. internal medicine or surgery) and pass the state medical board examinations for the state in which they plan to practice medicine. After completing their residencies, some physicians choose to enter a fellowship to train for a sub-specialty such as endocrinology or cardiovascular surgery. Medical doctors who are also board certified in their chosen specialty often have the initials F.A.C.P. (Fellow, American College of Physicians) after their names too.

Ph.D. stands for Doctor of Philosophy, the traditional academic doctorate. Doctors of philosophy are qualified to teach at colleges or universities. They can only practice medicine if they have earned a joint M.D., Ph.D. degree, completed their residency and passed the state medical board examinations.

D.O., or Doctor of Osteopathy, is somewhat similar to a medical doctor. They must also earn a BS or BA, followed by successful completion of four years of osteopathic medical school, a residency and the state osteopathic board examinations. Their medical schools usually include training in physical manipulation techniques, somewhat similar to chiropractic techniques.

P.A., or Physician Assistant, is a relatively new position that came into being in the 1960's when there was a physician shortage in the U.S. Physician assistants must earn a BS or BA, followed by two to three years of additional coursework and training. After passing state examinations, they are licensed to practice medicine under the supervision of a physician. They can diagnose and treat patients, as well as prescribe medications.

N.P. stands for Nurse Practitioner and A.R.N.P. means Advanced Registered Nurse Practitioner. To earn these titles, nurses must complete a registered nursing degree as part of their BS, plus a master's degree, and pass the Family Nurse Practitioner National Certification Exam. Nurse practitioners can diagnose and treat patients, as well as prescribe medications. Most work in collaboration with physicians and are accredited by the American Academy of Nurse Practitioners.

B.S.N., or Bachelor of Science in Nursing, is awarded after four years of studying the science and principles of nursing, including coursework in not only bedside care, but also nursing science, research, leadership and nursing informatics. To receive a license and practice as a nurse, one must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) or for Practical Nurses (NCLEX-PN).

A.D.N., which stands for Associate's Degree in Nursing, is awarded after two-years of study. To receive a license and practice as a nurse, one must pass the NCLEX-RN or NCLEX-PN.

R.N., or Registered Nurse, is another familiar title. A registered nurse is someone who has completed either a diploma in nursing, a bachelor's degree in nursing (B.S.N.) or an associate's degree in nursing (A.D.N.), and who has passed the NCLEX-RN or NCLEX-PN.

L.P.N., Licensed Practical Nurse, and L.V.N., Licensed Vocational Nurse, are nurses that have completed only one year of coursework after high school. They are not Registered Nurses.

This is only the tip of the iceberg. There are multiple other acronyms for healthcare professionals. Hopefully this is a helpful guide to the most common abbreviations and will help you navigate through a hospital's alphabet soup.

Discussion questions

1. Please summarize the article. What is the main point of the article?
2. What does M.D. stand for, and what is required to practice medicine in the United States?
3. Which healthcare professionals can prescribe medications?
4. Which acronyms are related to nursing?
5. What is the difference between a nurse practitioner and a registered nurse?
6. Which of these healthcare professionals can one find in a Japanese hospital or clinic?
7. Which of these healthcare professionals do not exist in the Japanese healthcare system? Would the Japanese healthcare system benefit from their services?

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