What is a specialist physician for health insurance?

A doctor with advanced training in a specific field of medicine

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Derek SilvaSenior Editor & Personal Finance ExpertDerek is a former senior editor and personal finance expert at Policygenius, where he specialized in financial data, taxes, estate planning, and investing. Previously, he was a staff writer at SmartAsset.

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A specialist physician is a doctor who has completed advanced education and training in a specific field of medicine. Depending on your health insurance plan, you may need a referral from a primary care physician to see a specialist.

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As with primary care providers, your insurance may only cover certain specialists or require that you get laboratory work and testing, like an X-ray, from providers within your network. Your copay or coinsurance will likely be higher when you see specialists than when you see primary care physicians.

Common types of specialists

There are dozens of types of physicians. Who you should see depends on what you need. All physicians must complete advanced schooling, generally including a residency that provides three or more years of training in their specific field (after medical school). Below are some common physicians and their specialties.

Family physician

Family physicians accept patients of all ages and provide basic care. For example, they could help treat a cold. They can also diagnose bigger health issues and refer you to other specialists to help you further.


Pediatricians offer primary care to patients under the age of 18 (or sometimes 21). They provide basic care that young individuals need, like physicals and immunizations. They can also identify bigger health problems and refer you to another specialist. There are some pediatricians who specialise in other areas within the pediatric field.

Geriatric medicine specialists

Geriatric doctors care for the elderly. Some work in a hospital but others work in nursing homes and assisted-living communities. They may also make home visits.

(As you age, you may want to consider a living will to specify the kind of health care you want to receive if you can no longer care for yourself.)

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Obstetrician/Gynecologist (OB/GYN)

An OB/GYN specializes in women's reproductive health. This includes preventive care, such as pap smears, as well as care related to pregnancy. Subspecialties also exist to cover areas like menopause or infertility treatments.

(Learn more about choosing health insurance when you’re pregnant.)


Psychiatrists treat patients who need help with emotional, psychological, or behavioral problems. All psychiatrists can prescribe medication. Some psychiatrists focus on individuals of certain ages, like adolescent psychiatrists, or with certain conditions, like psychiatrists specializing in care for those with a drug addiction.

(Read about how to save on mental health treatment.)

Internal medicine physician

The field of internal medicine is very large and generally deals with the prevention, diagnosis, and treatment of diseases for adults. There are general internists who serve as primary care doctors, but there are also many subspecialties.

Here are some common internists and their specialties:

  • Cardiologist: diseases of the heart and blood

  • Endocrinologist: the endocrine system and glands, like the thyroid gland, that produce the hormones that regulate most of the body's functions

  • Gastroenterologist: the digestive system

  • Infectious disease physician: serious or hard-to-treat infections, like HIV

  • Nephrologist: diseases and treatments that affect the kidneys, including dialysis

  • Oncologist: diagnosing and treating cancers

  • Urologist: problems with the bladder or urinary tract, plus prostate exams and some infertility treatments


Dermatologists diagnose and treat medical conditions related to the skin, nails, and hair. Some perform surgeries in addition to prescribing medicine. The field of dermatology is very competitive, partially because their work deals so closely with people’s outward appearances. For example, a dermatologist may do procedures like laser hair removal or Botox.


Surgeons plan surgeries, perform the actual operations, and then provide follow-up care to patients. A surgeon may be a generalist and perform general surgery on the body, but they usually specialize. As an example, an ophthalmic surgeon specializes in matter of the eyes and vision.

Optometrist and ophthalmologist

Optometrists specialize in examining eyes and are the ones people usually see as their primary eye doctors. They can prescribe eyeglasses and contact lenses. Some also provide care or therapy to treat vision problems. For conditions they cannot treat, they may refer you to an ophthalmologist.

(Is vision insurance even worth it? Read more on what vision insurance covers.)

Ophthalmologists are more specialized and they are trained to treat diseases and disorders related to someone’s eyes. Common examples are cataracts and glaucoma. They can prescribe medication and perform eye surgery when it’s necessary, but they cannot provide vision correction the way an optometrist can.


These physicians focus on the ear, nose, and throat, which is why people commonly call them ENTs. Otolaryngology is a broad field so there are also specialists within it. Some things they may treat relate to allergies, sinus problems, or neck pains.


A pulmonologist is a doctor that treats the body’s the cardio-pulmonary system, which includes the heart, lungs, and other organs generally related to breathing. They may help with issues related to asthma, pulmonary disease, and lung cancer.


Neurologists specialize in treating the nervous system — the brain, spine, and nerves. They may treat patients who suffer from seizures, migraines, encephalitis, meningitis, autoimmune disorders, or neurodegenerative disorders like dementia, Alzheimer’s, and Lou Gehrig’s disease.


These doctors perform imaging tests, like X-rays and ultrasounds, to diagnose diseases. They may also specialize further in an area like radiation oncology, which treats cancers.

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