I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.

Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have to do to practice the kind of medicine it says out on the shingle in front of the office? In some cases, maybe less than you think. Time for the insider scoop on what, exactly, doctor qualifications mean. You want to be a doctor? These are the hoops.

Step 1: Go to medical school, and graduate. Here’s an old joke:

Q: What do you call the person who graduates last in the class at med school?

A: Doctor.

Anyone who graduates med school gets that title, “Dr.”, plus a two letter degree after their name (MD or DO in the USA.) Lots of other folks call themselves “Doctor”—podiatrists, dentists, chiropractors, and people with doctoral degrees in anything from archeology to zoology. So “Doctor”, itself, that doesn’t mean much, at least as a way of demonstrating that you’re qualified to practice medicine.

Step 2: Get accepted into, and then complete, a one-year internship in any medical field. This could be in general medicine, surgery, psychiatry, pediatrics, anything. Once you’ve completed this one year past medical school, you can take a board exam and apply for a medical license. Pass the board, get that license, and you can practice medicine and prescribe medications. Surgery? Sure, you bet. The licensing for physicians and surgeons is the same.

That’s right: a practicing doctor or surgeon only needs a one year internship past medical school to get a license. Now, these people may have trouble getting credentialed at a hospital, or getting malpractice insurance, but nothing legal is stopping them from plying their trade, prescribing medicine, or operating on grandma’s blocked salivary gland.

Step 3: Get accepted into, and complete, a residency program. Sometimes this is combined with that first intern year, or it might be a separate program. The length varies—general internal medicine and pediatrics takes three years; general surgery generally five; cardiothoracic heart surgery I think takes fifty years, or something like that. After completing residency, a doctor can now call themselves a member of a specific profession within medicine, like a pediatrician, psychiatrist, gynecologist, or family medicine physician.

Step 4: Take the specialty boards, pass them, and get a bunch more letters to hang on that shingle outside of the office. Now we’re talking qualified! By doing this, the physician can now claim to be “board certified.” In pediatrics, passing the boards allows you to call yourself a “Fellow of the American Academy of Pediatrics,” and put the abbreviation FAAP after your professional designation: Lawrence G. Kidfriendly, MD, FAAP. That’s a real, genuine, qualified pediatrician. It is a guarantee that he’s any good? Of course not. But he’s at least jumped through the hoops, gotten his training, and passed the boards. That does count for something.

In most cases, to call yourself “board certified” requires periodic re-certification. Most specialties require ongoing educational classes, re-taking board exams, and other steps to re-qualify every 7-10 years.

Should all physicians be board certified? There are some legitimate reasons why some good docs haven’t jumped through all of the hoops. Some are fresh out of residency and just haven’t had the time to get their passing scores. Some are of an older generation, when board exams weren’t  required. And some doctors find the expense and hassle of recertification to just not be worth it.

In other cases docs who aren’t fully boarded were just unable to pass the certifying exam. Remember, if they completed their residency, they can still call themselves a member of their medical specialty. Even if they didn’t finish residency, they can still legally practice medicine (and surgery) as long as they’ve got a license.

Is your doctor board-certified? He or she ought to be—or have a good excuse to have skipped or delayed this step. If you don’t know, ask.

This essay is cited in the KevinMD record on board certification.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.