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A diplomate is a specialist who has passed the certifying exams as a measure of competency in that particular specialty. Only those who have trained in accredited institutions are allowed to take these exams.
A fellow is a member of a particular specialty society who have been recommended by peers. Not all members become fellows. Some elect not to join or some are not allowed to join because of some other reasons such as unethical practice of their specialty.
Also, a fellow of a specialty society is deemed as co-equal in rank with other fellows from specialty societies of other countries. For example, a fellow of the Philipine College of Surgeons may become a fellow of the American College of Surgeons if he wishes to because there is a reciprocity agreement between the 2 societies. This makes our local fellows world class.
Although academic proficiency in a particular specialty is fulfilled by being a diplomate. It is still advisable to get consultation with a fellow of a specialty society. A patient who has some grievance with a fellow of a specialty society can transmit a complaint to the society which governs that member. In short, the patent has more protection if one consults with a fellow. A patient who consults a fellow is assured that his doctor agrees with the set standards of practice advocated by his society.
To add, some hospitals do not accept physicians who are not diplomates or those who are not fellows of a particular society.
So if you are not sure of who to consult, make sure he or she is a fellow. These are the ones with the "F" after their name (e.g. FPCS, FPSGS, FPCP, FPOGS, FPPS, etc.)