Finding a Travel Medicine Specialist

Finding a travel medicine physician isn’t difficult. About 500 U.S. and Canadian doctors now provide related services, either as part of their private practices or in travel medicine clinics. But finding a physician who knows exactly what precautions are necessary for specified destinations can be tricky. Since there is no board certification offered for travel medicine--and not likely to be any soon, given the field’s relatively small number of practitioners--any physician can offer most travel vaccines and consultations. But some do it much better than others, according to experts.

Soon, however, the search for a qualified travel medicine physician may become easier, thanks to the efforts of two professional organizations.

The International Society of Travel Medicine is working on practice guidelines, said Dr. Jay S. Keystone, society president and director of the tropical disease unit at Toronto Hospital in Canada, and hopes to issue them within six months.

In addition, the American Society of Tropical Medicine and Hygiene has developed an examination leading to a certificate in clinical tropical medicine and travelers’ health. A pilot exam was offered last winter and the first official exam will be offered in November.

Among topics covered on the exam are infectious diseases, diagnosis and treatment of travel related diseases and health issues such as control of tropical diseases.

Most physicians who are long-time travel medicine experts applaud the efforts. “The exam is badly needed,” said Dr. Leonard Marcus, a Newton, Mass., physician who provides travel medicine care. “It will bring credibility to the specialty.”

“The whole point of the exam is standardization of care, so people can trust the physician they see,” said Dr. Alan Spira, a Beverly Hills physician who focuses on travel medicine and has earned the certificate. “A lot of physicians who do travel medicine as a sideline for extra income are not truly qualified. They often give incorrect information and recommend unnecessary vaccines.”

Surveys suggest that is true. In a poll of 548 primary care physicians in Atlanta and San Diego, only one doctor gave correct information for all three sample itineraries to developing countries, according to researchers who reported the results last year at the International Society of Travel Medicine meeting. Forty percent of the doctors did not provide correct immunization advice for any of the three destinations.

Prerequisites for the exam offered by the American Society of Tropical Medicine and Hygiene, based in Northbrook, Ill., are stringent. Before taking the test, doctors must complete a course in tropical medicine at one of seven universities currently approved by the Society and participate in two months of overseas clinical work, said Judy DeAcetis, spokeswoman for the society. Until the number of approved universities increases, applicants for the next five years are allowed to substitute five years of practice experience and 30 hours of continuing medical education in travelers’ health and tropical medicine from other institutions, but must still have two months of overseas work experience.

Meanwhile, there is much a consumer can do to evaluate a physician offering travel medicine services, said Dr. Terri Rock, a Santa Monica family practice physician who often provides travel medicine services.

“Ask the doctor, ‘How long have you been doing travel medicine?’ ” she said. “You should be personally consulting with a doctor or a nurse practitioner trained in the area. Good travel medicine goes beyond shots, it includes consultations.”

Word of mouth is another avenue to finding a good travel medicine physician, Keystone said. A good guideline, he said, is to pick a physician whose practice includes at least 20% travel medicine patients.

“Ask the physician, ‘How do you keep up?’ ” Keystone said. If he or she participates in travel medicine meetings or reads travel medicine journals, those are good signs.

Ask, too, about the physician’s sources of travel medicine information, which is constantly changing as epidemics and other diseases subside and reemerge. Ideally, a physician should retrieve information from both books and computerized data bases. Among the organizations providing dependable travel medicine information are the World Health Organization, Centers for Disease Control and the U.S. Department of State.

The Healthy Traveler appears the second and fourth week of every month.