The Doctor's office is a shared office of five physicians with individual practices. the practices are independent of each other. The physicians provide coverage for each other. Each physician practice have their staff and differing office hours. We are working to bring visiting sub specialist to this arrangement on a weekly basis.

Simply put, doctors of internal medicine are Doctors for Adults. But you may see them referred to by several terms, including "internists," "general internists" and "doctors of internal medicine." But don't mistake them with "interns," who are doctors in their first year of residency training. Although internists may act as primary care physicians, they are not "family physicians," "family practitioners," or "general practitioners," whose training is not solely concentrated on adults and may include surgery, obstetrics and pediatrics.

Internists are equipped to deal with whatever problem a patient brings -- no matter how common or rare, or how simple or complex. They are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time. They also bring to patients an understanding of wellness (disease prevention and the promotion of health), women's health, substance abuse, mental health, as well as effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

In today's complex medical environment, internists take pride in caring for their patients for life -- in the office or clinic, during hospitalization and intensive care, and in nursing homes. When other medical specialists, such as surgeons or obstetricians, are involved, they coordinate their patient's care and manage difficult medical problems associated with that care.

As internists, gastroenterologists focus on adults. Their role is to prevent, diagnose and treat conditions and disorders of the GI tract in adult patients. But as broadly trained internists, they may also perform a general physical check-up. If a condition is found that falls within gastroenterology, they will provide the treatment. If it requires the services of another physician, they will refer you appropriately. Gastroenterologists may perform routine laboratory studies for patients undergoing a complete office examination.

Not everyone who suffers from digestive problems needs a gastroenterologist. Many digestive disturbances are diagnosed and managed well by general internists, surgeons and others. Their skills are most necessary when special knowledge in diagnosis and treatment is required.

Gastroenterologists do not perform surgery. They may, however, perform procedures such as liver biopsy and examinations of the esophagus, stomach, small and large bowel, through the use of special flexible medical instruments called endoscopes.

If surgery is required, they work with surgeons to select the best operation for a patient and provide medical care following surgery.

In most cases, you will still need a general internist or other primary care physician for medical care unrelated to the digestive tract, although some gastroenterologists maintain a general internal medicine practice as well as their subspecialty. If you have been referred by your primary care physician to a gastroenterologist, you will probably be referred back to your primary physician for follow-up care. If you require continuing care for GI-related conditions, your primary care physician and your gastroenterologist, working together, will recommend to you which physician you should see. Be sure to ask your gastroenterologist or referring physician if you have any questions about how your physicians are working together.

Physician assistants are health care professionals licensed to practice medicine with physician supervision. PAs employed by the federal government are credentialed to practice. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in virtually all states can write prescriptions. Within the physician-PA relationship, physician assistants exercise autonomy in medical decision making and provide a broad range of diagnostic and therapeutic services. A PA's practice may also include education, research, and administrative services.

PAs are trained in intensive education programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).

Because of the close working relationship the PAs have with physicians, PAs are educated in the medical model designed to complement physician training. Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and sit for a recertification every six years. Graduation from an accredited physician assistant program and passage of the national certifying exam are required for state licensure.

In the mid-1960s, physicians and educators recognized there was a shortage and uneven distribution of primary care physicians. To expand the delivery of quality medical care, Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PAs in 1965. He selected Navy corpsmen who received considerable medical training during their military service and during the war in Vietnam but who had no comparable civilian employment. He based the curriculum of the PA program in part on his knowledge of the fast-track training of doctors during World War II.

Physician assistant-certified. It means that the person who holds the title has met the defined course of study and has undergone testing by the National Commission on Certification of Physician Assistants (NCCPA). The NCCPA is an independent organization, and the commissioners represent a number of different medical professions. It is not a part of the PA professional organization, the American Academy of Physician Assistants (AAPA). To maintain that "C" after "PA", a physician assistant must log 100 hours of continuing medical education every two years and take the recertification exam every six years.