Internal medicine physician in Latviawhere to get treatment, how to verify certification, what this doctor does

An internist is a doctor for adult internal disease. They work in outpatient clinics and in hospital, work up complex cases where symptoms cross several organ systems, and manage patients carrying several chronic conditions at once. They also decide whether a narrower specialist is needed.

• High blood pressure and heart failure
• Type 2 diabetes and metabolic disorders
• Liver, kidney and gastrointestinal disease
• Chronic airway disease, including COPD
• Anaemia, unexplained weakness or weight loss
• Prolonged fever with no clear cause

A family doctor is enough when there is one condition and treatment is working. An internist is needed when the diagnosis stays unclear after first-line tests, or when several chronic conditions and their medicines have to be reconciled.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• Residency in internal medicine. The RSU programme runs 5 years, 330 ECTS, tuition 5,800 EUR per year, led by Assoc. Prof. Inga Stuķēna. Programme page: RSU residency programme.
• Theory covers a problem lecture monthly and seminars three times a month, 33 seminars a year, with a written theory test after each rotation cycle.
• The state examination covers defence of a research paper plus the certification examination.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points, at least 60 per cent tied to the base specialty, plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• Languages. Consultations run in Latvian, many internists also work in Russian. Confirm English when booking.
• Experience. Clinic price lists often set out department head or dr. med. consultations separately, at a higher fee.
• Age groups. Internists see adults only. For children the equivalent specialty is paediatrics.
• Hospital or outpatient setting. If a run of tests is likely, a provider with laboratory and ultrasound on site saves visits.
• Second opinion. Patients may freely choose the doctor and institution. With a valid referral, a state-funded consultation can be taken at any provider delivering that service from state funds.

• Bring the referral, earlier test and imaging results, hospital discharge summaries, and a full list of medicines with doses.
• Book by phone or through the provider's online form. Turning up without an appointment is not allowed, even with a referral.
• In the public system the wait depends on the provider's queue. Private clinics usually offer a paid appointment within days.
• At the visit the doctor reviews the course of the illness, goes through every medicine taken, examines the patient, and orders blood tests, an ECG, ultrasound or another specialist opinion as needed.
• The referral also covers repeat visits within the same illness episode.

In the public system, with a referral, a specialist visit carries a 4.00 EUR patient co-payment. Ultrasound is 4.00 EUR and endoscopy 7.00 EUR. Co-payments in one calendar year are capped at 570.00 EUR. Without a referral the visit is a paid service at the provider's own rates.

• Internist or family doctor, first consultationPrice EUR: 60.00Provider: Veselības centrs 4
• Internist or family doctor, repeat consultationPrice EUR: 50.00Provider: Veselības centrs 4
• Internist or family doctor examination before a chest X-rayPrice EUR: 17.00Provider: Veselības centrs 4
• Remote repeat consultation for a prescription renewalPrice EUR: 25.00Provider: Veselības centrs 4
• Internist, pulmonologist or allergist, first consultationPrice EUR: 70.00Provider: ARS medicīnas klīnika
• Internist, pulmonologist or allergist, repeat consultationPrice EUR: 60.00Provider: ARS medicīnas klīnika
• Internist or private family doctor consultationPrice EUR: 58.00Provider: ARS medicīnas klīnika
• Patient co-payment for a specialist visitPrice EUR: 4.00Provider: NVD

The specialty body is the association "Latvijas Internistu biedrība" (Latvian Society of Internal Medicine, LIB), registration number 40008018142, registered address Hipokrāta iela 2, Rīga, LV-1079, phone +371 67042338, internistubiedriba.lv. It was founded on 17 March 1997. The society brings together Latvia's certified internists, runs seminars and conferences, and carries out certification and recertification in the specialty. Contacts: Inga Stuķēna and Anita Laizāne, email anitabirojs@inbox.lv.

The parent body is the Latvian Medical Association, founded in 1988, whose Certification Council issues certificates. The sector regulator is the Health Inspectorate.

If you have doubts about the quality of care, raise them first with the institution's management, which must operate a complaints and suggestions system. If that does not resolve it, a written submission goes to the Health Inspectorate no later than two years after the alleged infringement, and is reviewed within 30 days, extendable to four months in complex cases. The procedure and the required contents of the submission are set out on the Health Inspectorate site.