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.
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.
Classification of medical specialization
Medical specialties can be classified along several axes. These are:
- Surgical or internal medicine
- Age range of patients
- Diagnostic or therapeutic
- Organ-based or technique-based
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 world-wide
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. 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.
- Accident and emergency medicine
- Allergology
- Anaesthetics
- Biological hematology
- Cardiology
- Child psychiatry
- Clinical biology
- Clinical chemistry
- Clinical neurophysiology
- Craniofacial surgery
- Dental, oral and maxillo-facial surgery
- Dermato-venerology
- Dermatology
- Endocrinology
- Gastro-enterologic surgery
- Gastroenterology
- General hematology
- General Practice
- General surgery
- Geriatrics
- Immunology
- Infectious diseases
- Internal medicine
- Laboratory medicine
- Maxillo-facial surgery
- Microbiology
- Nephrology
- Neuro-psychiatry
- Neurology
- Neurosurgery
- Nuclear medicine
- Obstetrics and gynecology
- Occupational medicine
- Ophthalmology
- Orthopaedics
- Otorhinolaryngology
- Paediatric surgery
- Paediatrics
- Pathology
- Pharmacology
- Physical medicine and rehabilitation
- Plastic surgery
- Podiatric Surgery
- Psychiatry
- Public health and Preventive Medicine
- Radiology
- Radiotherapy
- Respiratory medicine
- Rheumatology
- Stomatology
- Thoracic surgery
- Tropical medicine
- Urology
- Vascular surgery
- Venereology
List of North American medical specialties and others
In this table, as in many healthcare arenas, medical specialties are organized into the following groups:
- Surgical specialties focus on manually operative and instrumental techniques to treat disease.
- Medical specialties that focus on the diagnosis and non-surgical treatment of disease.
- Diagnostic specialties focus more purely on diagnosis of disorders.
Physician compensation
The mean annual salary of a medical specialist is $175,011 in the US, and $272,000 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.
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).
According to a 2010 study, physician and surgeon median annual income was $166,400.
Specialties by country
Australia and New Zealand
Specialty training in Australia and New Zealand is overseen by the specialty colleges:
- Australasian College for Emergency Medicine
- Australasian College of Dermatologists
- Australasian College of Physical Medicine
- Australasian College of Podiatric Surgeons
- Australasian College of Sports Physicians
- Australian and New Zealand College of Anaesthetists
- Australasian Faculty of Rehabilitation Medicine
- Australian College of Rural and Remote Medicine
- College of Intensive Care Medicine
- Royal Australasian College of Dental Surgeons (supervises training of medical practitioners specializing in Oral and Maxillofacial Surgery in addition to its role in the training of dentists)
- Royal Australasian College of Medical Administrators
- Royal Australasian College of Physicians
- Royal Australasian College of Surgeons
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Royal Australian and New Zealand College of Ophthalmologists
- Royal Australian and New Zealand College of Psychiatrists
- Royal Australian and New Zealand College of Radiologists
- Royal Australian College of General Practitioners
- Royal New Zealand College of General Practitioners
- Royal College of Pathologists of Australasia
Canada
Specialty training in Canada is overseen by the Royal College of Physicians and Surgeons of Canada
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.
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. In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists. Surveys have also revealed high levels of depression (22 - 43%) among physicians in training, which for many specialties, continue into regular practice.
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