Specialty (medicine)

A specialty (or speciality) in medicine is a branch of medical practice. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.[1]

History of medical specialization

To a certain extent, medical practitioners have always been specialized. According to Galen, specialization was common among Roman physicians. The particular system of modern medical specialities evolved gradually during the 19th century. Informal social recognition of medical specialization evolved before the formal legal system. The particular subdivision of the practice of medicine into various specialities varies from country to country, and is somewhat arbitrary.[2]

Classification of medical specialization

Medical specialties can be classified along several axes. These are:

Throughout history, the most important has been the division into surgical and internal medicine specialties. The surgical specialties are the specialties in which an important part of diagnosis and treatment is achieved through major surgical techniques. The internal medicine specialties are the specialties in which the main diagnosis and treatment is never major surgery. In some countries Anesthesiology is classified as a surgical discipline, since it is vital in the surgical process, though anesthesiologists never perform major surgery themselves.

Many specialties are organ-based. Many symptoms and diseases come from a particular organ. Others are based mainly around a set of techniques, such as radiology, which was originally based around X-rays.

The age range of patients seen by any given specialist can be quite variable. Paediatricians handle most complaints and diseases in children that do not require surgery, and there are several subspecialties (formally or informally) in paediatrics that mimic the organ-based specialties in adults. Paediatric surgery may or may not be a separate specialty that handles some kinds of surgical complaints in children.

A further subdivision is the diagnostic versus therapeutic specialties. While the diagnostic process is of great importance in all specialties, some specialists perform mainly or only diagnostic examinations, such as pathology, clinical neurophysiology, and radiology. This line is becoming somewhat blurred with interventional radiology, an evolving field that uses image expertise to perform minimally invasive procedures.

Specialties that are common worldwide

Specialty Can be subspecialty of Diagnostic (D) or therapeutic (T) specialty Surgical (S) or internal medicine specialty (I) Age range of patients Organ-based (O) or technique-based (T)
Allergy and immunology Paediatrics or Internal medicine Both I All O
Adolescent medicine Paediatrics Both I Paediatric T
Anaesthesiology None T Unknown All Both
Pathology None D Neither All T
Cardiology Internal medicine T I Adults O
Paediatric cardiology Paediatrics T I Paediatric O
Cardiothoracic surgery General surgery T S Adults O
Child and adolescent psychiatry and psychotherapy None T I Paediatric O
Clinical neurophysiology Neurology D I All Both
Dermato-Venereology None T I All O
Emergency medicine Anaesthetics Both I All Both
Endocrinology Internal medicine T I Adults O
Gastroenterology Internal medicine T I Adults O
General practice None Both Neither All Multidisciplinary
Geriatrics Internal medicine or family medicine T I Geriatric Multidisciplinary
Obstetrics and gynaecology None T S All O
Health informatics None Both Neither All Multidisciplinary
Hospice and palliative medicine Various Both Neither All Neither
Infectious disease Pediatrics or Internal medicine Both I All Neither
Internal medicine None T I Adults Neither
Interventional radiology Radiology Both Unknown All Multidisciplinary
Vascular medicine Internal medicine T I Adults O
Microbiology None D I All T
Nephrology Internal medicine T I Adults O
Neurology Internal medicine T I Adults O
Neurosurgery Surgery T S All O
Nuclear medicine None Both I All T
Occupational medicine None T I Adults Multidisciplinary
Ophthalmology None T S All O
Orthopaedics General surgery T S All O
Oral and maxillofacial surgery Surgery T S All O
Otorhinolaryngology None T S All O
Paediatrics None T I Paediatric Neither
Paediatric allergology Paediatrics T I Paediatric O
Paediatric endocrinology and diabetes Paediatrics T I Paediatric O
Paediatric gastroenterology, hepatology and nutrition Paediatrics T I Paediatric O
Paediatric haematology and oncology Paediatrics T I Paediatric O
Paediatric infectious diseases Paediatrics T I Paediatric O
Neonatology Paediatrics T I Neonatal Neither
Paediatric nephrology Paediatrics T I Paediatric O
Paediatric respiratory medicine Paediatrics T I Paediatric O
Paediatric rheumatology Paediatrics T I Paediatric O
Paediatric surgery General Surgery T S Paediatric O
Physical medicine and rehabilitation None T I Adults Multidisciplinary
Plastic, reconstructive and aesthetic surgery General surgery T S All O
Podiatric medicine Surgery T S All O
Pulmonology Internal medicine T I Adults O
Psychiatry Internal medicine T I Adults T
Public Health None Neither Neither All T
Radiology None Both I All T
Sports medicine Family medicine Both Neither All Multidisciplinary
Neuroradiology Radiology Both I All Both
Radiotherapy None T I Adults T
General surgery None T S Adults T
Urology General surgery T S All O
Vascular surgery General surgery T S All O

List of specialties recognized in the European Union and European Economic Area

The European Union publishes a list of specialties recognized in the European Union, and by extension, the European Economic Area.[3] Note that there is substantial overlap between some of the specialties and it is likely that for example "Clinical radiology" and "Radiology" refer to a large degree to the same pattern of practice across Europe.

List of North American medical specialties and others

In this table, as in many healthcare arenas, medical specialties are organized into the following groups:

Specialty Code Group Sub-specialties Focus
Allergy and immunology Allergic reactions, asthma, and the immune system
Anesthesia AN, PAN Surgery[4] Anesthesia
Cardiology Medicine Disease of the cardiovascular system
Cardiovascular surgery Surgery The operation of heart and major blood vessels of the chest.
Clinical laboratory sciences Diagnostic Application of diagnostic techniques in medical laboratories such as assays, microscope analysis.
Dermatology D, DS Medicine Dermatology, Mohs surgery Skin and its appendages (hair, nails, sweat glands etc.).
Dietetics RD[5] Food and nutrition
Emergency medicine EM Medicine
  • Disaster medicine
  • Emergency medical services
  • Hospice and palliative medicine
  • International Emergency Medicine and Global Health
  • Medical toxicology
  • Pediatric emergency medicine
  • Research
  • Simulation
  • Sports medicine
  • Toxicology
  • Ultrasound
  • Undersea and hyperbaric medicine
  • Wilderness medicine
 The initial management of emergent medical conditions, often in hospital emergency departments or the field.
Endocrinology Medicine The endocrine system (i.e., endocrine glands and hormones) and its diseases, including diabetes and thyroid diseases.
Family medicine FM Medicine
  • Adolescent medicine
  • Geriatric medicine
  • Hospice and palliative medicine
  • Sleep medicine
  • Sports medicine
 Continuing, comprehensive healthcare for the individual and family, integrating the biological, clinical and behavioral sciences to treat patients of all ages, sexes, organ systems, and diseases.
Forensic medicine Medicine
Gastroenterology GI Medicine The alimentary tract
General surgery GS Surgery
  • Colorectal surgery
  • Gastrointestinal surgery
  • Transplant surgery
  • Trauma surgery
Geriatrics IMG Medicine[4] Elderly patients
Gynecology Female reproductive health
Hepatology Medicine The liver and biliary tract, usually a part of gastroenterology.
Infectious disease ID Medicine Diseases caused by biological agents
Intensive care medicine Medicine Life support and management of critically ill patients, often in an ICU.
Medical research Anatomy, Biochemistry, Embryology, Genetics, Pharmacology, Toxicology
Nephrology Medicine Kidney diseases
Neurology N Medicine Diseases involving the central, peripheral, and autonomic nervous systems
Neurosurgery NS Surgery Disease of the central nervous system, peripheral nervous system, and spinal column.
Obstetrics and gynecology OB/GYN Surgery[4]
Oncology ON Medicine Cancer and other malignant diseases, often grouped with hematology.
Ophthalmology OPH Surgery Retina, Cornea Diseases of the visual pathways, including the eyes, brain, etc.
Oral and maxillofacial surgery Maxfacs, OMS Surgery
  • Oral and Craniofacial surgery (Head and neck)
  • Facial cosmetic surgery
  • Craniomaxillofacial trauma
 Disease of the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region.
Orthopedic surgery ORS Surgery Hand surgery, surgical sports medicine, adult reconstruction, spine surgery, foot and ankle, musculoskeletal oncology, orthopedic trauma surgery, pediatric orthopedic surgery Injury and disease of the musculoskeletal system.
Otorhinolaryngology, or ENT ORL, ENT Surgery Head and neck, facial cosmetic surgery, Neurotology, Laryngology Treatment of ear, nose, and throat disorders. The term head and neck surgery defines a closely related specialty that is concerned mainly with the surgical management of cancer of the same anatomical structures.
Palliative care PLM Medicine A relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
Pathology PTH Diagnostic Understanding disease through examination of molecules, cells, tissues and organs. The term encompasses both the medical specialty that uses tissues and body fluids to obtain clinically useful information and the related scientific study of disease processes.
Pediatrics PD Medicine Children. Like internal medicine, pediatrics has many sub-specialties for specific age ranges, organ systems, disease classes, and sites of care delivery. Most sub-specialties of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, pediatric oncology, pediatric ophthalmology, and neonatology. deals with the medical care of infants, children, and adolescents (from newborn to age 16-21, depending on the country).
Pediatric surgery Surgery Treats a wide variety of thoracic and abdominal (and sometimes urologic) diseases of childhood.
Physical medicine and rehabilitation Or Physiatry PM&R Medicine Concerned with functional improvement after injury, illness, or congenital disorders.
Plastic surgery PS Surgery
  • Cosmetic surgery
  • Burn
  • Microsurgery
  • Hand surgery
  • Craniofacial surgery
 Elective cosmetic surgery as well as reconstructive surgery after traumatic or operative mutilation.
Podiatry POD Surgery
  • Forefoot surgery
  • Midfoot surgery
  • Rearfoot surgery
  • Ankle surgery
  • Soft tissue leg surgery
 Elective podiatric surgery of the foot and ankle, lower limb diabetic wound and salvation, peripheral vascular disease limb preservation, lower limb mononeuropathy conditions. Reconstructive foot & ankle surgery.
Proctology PRO Medicine (or Colorectal Surgery) Treats disease in the rectum, anus, and colon.
Psychiatry P Medicine The bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
Pulmonology Medicine The lungs and respiratory system. Pulmonology is generally considered a branch of internal medicine, although it is closely related to intensive care medicine when dealing with patients requiring mechanical ventilation.
Radiology R, DR Diagnostic and Therapeutic
  • Interventional radiology is concerned with using expert imaging of the human body, usually via CT, ultrasound, fluoroscopy, or MRI to perform a breadth of intravascular procedures (angioplasty, arterial stenting, thrombolysis, uterine fibroid embolization), biopsies and minimally invasive oncologic procedures (radiofrequency and cryoablation of tumors & transarterial chemoembolization)
  • Nuclear medicine uses radioactive substances for in vivo and in vitro diagnosis either using imaging of the location of radioactive substances placed into a patient or using in vitro diagnostic tests utilizing radioactive substances.
 The use of expertise in radiation in the context of medical imaging for diagnosis or image guided minimally invasive therapy. X-rays, etc.
Rheumatology RHU Medicine Autoimmune and inflammatory diseases of the joints and other organ systems, such as arthritis and other rheumatic diseases.
Stomatology Dentistry Diseases of the mouth
Surgical oncology SO Surgery Curative and palliative surgical approaches to cancer treatment.
Thoracic surgery TS Surgery Surgery of the organs of the thoracic cavity: the heart, lungs, and great vessels.
Transplant surgery TTS Surgery Transplantation of organs from one body to another
Urgent Care Medicine UCM Medicine Immediate medical care offering outpatient care for the treatment of acute and chronic illness and injury
Urology U Surgery Urinary tracts of males and females, and the male reproductive system. It is often practiced together with andrology ("men's health").
Vascular surgery VS Surgery The peripheral blood vessels – those outside of the chest (usually operated on by cardiovascular surgeons) and outside of the central nervous system (treated by neurosurgery)

Physician compensation

The mean annual salary of a medical specialist is $175,011[6] in the US, and $272,000[6] for surgeons. However, because of commodity inflation, increasing negligent costs, steep price rise of rental, the annual salary range of a medical specialist varies and is not rising as fast as other professional pay. Often, especially in the United States, physicians practice in groups of specialists within a particular medical specialty. These practice groups are often formed to help reach economies of scales in rental, insurance and staff costs as well as other benefits of practicing with other professionals and are typically governed by various legal documents.[7]

The table below details the average range of salaries for physicians of selected specialties as of July 2010. Also given in the average number of hours worked per week for full-time physicians (numbers are from 2003).

Specialty Median salary (USD)[8] Average hours

work/week[9]

 Average salary/hour (USD)[10]
Anaesthesia 331,000 to $423,507 61
Dermatology 313,100 to $480,088 45.5 103
Emergency medicine 239,000 to $316,296 46 87
Cardiac Surgery 218,684 to $500,000 55
Family medicine 175,000 to $220,196 52.5 58
Internal medicine 184,200 to $231,691 57 58
Neurology 213,000 to $301,327 55.5 93
Obstetrics and Gynecology 251,500 to $326,924 61 83
Ophthalmology 150,000 to $351,000 47
Orthopedic surgery 397,879 to $600,000 58
Otolaryngology 191,000 to $393,000 53.5
Oral and Maxillofacial Surgery 260,000 to $440,210 53
Pediatrics 160,111 to $228,750 54 69
Podiatry 170,800 to $315,150 45 80
Psychiatry 173,800 to $248,198 48 72
Radiology (diagnostic) 377,300 to $478,000 58
Surgery (general) 284,642 to $383,333 60
Urology 331,192 to $443,518 60.5
Neurological surgery 350,000 to $705,000 132
Plastic surgery 265,000 to $500,000 114
Gastroenterology 251,026 to $396,450 93
Pulmonology 165,000 to $365,875 72

According to a 2010 study, physician and surgeon median annual income was $166,400.[11]

Specialties by country

Australia and New Zealand

Specialty training in Australia and New Zealand is overseen by the specialty colleges:

Canada

Specialty training in Canada is overseen by the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, and by Collège des médecins du Québec.

India

Specialty training in India is overseen by the Medical Council of India, which is responsible for recognition of post graduate training and by the National Board of Examinations. And education of Ayurveda in overseen by Central Council of Indian Medicine (CCIM), the council conducts u.g and p.g courses all over India, while Central Council of Homoeopathy does the same in the field of Homeopathy.

United States

There are three agencies or organizations in the United States that collectively oversee physician board certification of MD and DO physicians in the United States in the 26 approved medical specialties recognized in the country. These organizations are the American Board of Medical Specialties (ABMS) and the American Medical Association (AMA); the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) and the American Osteopathic Association; the American Board of Physician Specialties (ABPS) and the American Association of Physician Specialists (AAPS). Each of these agencies and their associated national medical organization functions as its various specialty academies, colleges and societies.

Certifying board National organization Physician type
ABMS AMA MD and DO
AOABOS AOA DO only
ABPS AAPS MD and DO

All boards of certification now require that medical practitioners demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years.

Specialty and Physician Location

There are hierarchies of medical specialties in the cities of a region. Small towns and cities have primary care, middle sized cities offer secondary care, and metropolitan cities have tertiary care. Income, size of population, population demographics, distance to the doctor, all influence the numbers and kinds of specialists and physicians located in a city. (Smith, 1977, 1979)

Economic demand influences the location of particular specialties. For example, more orthopedic surgeons are found in ski areas, obstetricians in the suburbs, and boutique specialties such as hypnosis, plastic surgery, psychiatry are more likely to practice in high income areas. Small populations can usually only support primary care. A large population is needed to support specialists who treat rare diseases. Some specialties need to cooperate and thus locate near each other, such as hematology, oncology, and pathology, or cardiology, thoracic surgery and pulmonology.

A population's income level determines whether sufficient physicians can practice in an area and whether public subsidy is needed to maintain the health of the population. Developing countries and poor areas usually have shortages of physicians and specialties, and those in practice usually locate in larger cities. For some underlying theory regarding physician location, see Central Place Theory. (Smith, 1977, 1979)

Other uses

In the U.S. Army, the term "medical specialist" refers to occupational therapists, physical therapists, dietitians and physician assistants, also known as allied health professionals. Also included in the term "medical specialist", but not in the term "allied health professional" are EMT/combat medics.

Satisfaction

A survey of physicians in the United States came to the result that dermatologists are most satisfied with their choice of specialty followed by radiologists, oncologists, plastic surgeons, and gastroenterologists.[12] In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists.[12] Surveys have also revealed high levels of depression (22 - 43%) among physicians in training, which for many specialties, continue into regular practice.[13]

Specialty Overall satisfaction[12] Feeling of enough compensation[12] Would have chosen same specialty again[12]
Dermatologist 80% 71% 93%
Radiologist 72% 69% 82%
Oncologist 70% 55% 79%
Gastroenterologist 69% 52% 80%
Ophthalmologist 67% 55% 79%
Infectious disease/HIV physician 66% 54% 73%
Plastic surgeon 66% 53% 82%
Anesthesiologist 65% 63% 70%
Orthopedic surgeon 65% 47% 83%
Psychiatrist 65% 58% 67%
Rheumatologist 65% 53% 66%
Podiatrist 64% 51% 75%
Emergency medicine physician 63% 65% 56%
Urologist 63% 47% 78%
Cardiologist 62% 46% 75%
Pediatrician 62% 51% 61%
Diabetes specialist/Endocrinologist 61% 45% 68%
Neurologist 60% 49% 63%
General surgeon 58% 44% 60%
Nephrologist 57% 45% 55%
Obstetrician/Gynecologist 57% 50% 53%
Pulmonologist 57% 45% 52%
Primary care physician 54% 48% 43%

See also

Notes and references

  1. ↑ http://www.webmd.com/a-to-z-guides/medical-specialists-medical-specialists
  2. ↑ Weisz G (Fall 2003). "The Emergence of Medical Specialization in the Nineteenth Century". Bull Hist Med 77 (3): 536–574. doi:10.1353/bhm.2003.0150. PMID 14523260.
  3. ↑ "Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications". European Parliament and Council. Retrieved 19 April 2011.
  4. 1 2 3 Regeringen.se – new grouping of the medical specialties Archived April 10, 2008, at the Wayback Machine.
  5. ↑ "Becoming a Registered Dietitian". Department of Food Science and Human Nutrition. University of Illinois at Urbana-Champaign. Retrieved 21 April 2016.
  6. 1 2 ibmdllc.com -Physician income not rising as fast as other professional pay Archived April 10, 2008, at the Wayback Machine.
  7. ↑ "Physician Separation Issues". The National Law Review. Baker & Hostetler LLP. 2011-11-21. Retrieved 2012-01-13.
  8. ↑ Physician Compensation Survey [special feature]. Modern Healthcare. July 19, 2010: 20-26. Archived November 30, 2010, at the Wayback Machine.
  9. ↑ Physician work hours (2003) Medfriends.org. Accessed 15 December 2010.
  10. ↑ Leigh JP; Tancredi D; Jerant A; Kravitz RL (October 2010). "Physician wages across specialties: informing the physician reimbursement debate". Arch. Intern. Med. 170 (19): 1728–34. doi:10.1001/archinternmed.2010.350. PMID 20975019.
  11. ↑ Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Physicians and Surgeons, on the Internet at http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm (visited November 01, 2013).
  12. 1 2 3 4 5 Medscape Physician Compensation Report: 2011
  13. ↑ Douglas A. Mata, Marco A. Ramos, Narinder Bansal, Rida Khan, Constance Guille, Emanuele Di Angelantonio & Srijan Sen (2015). "Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis". JAMA 314 (22): 2373–2383. doi:10.1001/jama.2015.15845. PMID 26647259.

Smith, Margot W. Physician's Specialties and Medical Trade Areas: An Application of Central Place Theory. Papers and Proceedings of Applied Geography Conferences, Vol. 9, West Point NY 1986.

Smith, Margot W. A Guide to the Delineation of Medical Care Regions, Medical Trade Areas and Hospital Service Areas. Public Health Reports, 94:3:247 May 1979

Smith, Margot W. The Economics of Physician Location, Western Regional Conference, American Association of Geographers, Chicago, Illinois, 1979

Smith, Margot W. The Distribution of Medical Care in Central California: a Social and Economic Analysis, Thesis, School of Public Health, University of California, Berkeley, 1977 - 1004 pages

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