A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (pediatrics), cancer (oncology), laboratory medicine (pathology), or primary care (family medicine). After completing medical school or other basic training, physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.[1]
History of medical specialization
To a certain extent, medical practitioners have long been specialized. According to Galen, specialization was common among Roman physicians.[citation needed] The particular system of modern medical specialties 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 specialties varies from country to country, and is somewhat arbitrary.[2]
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 those 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. Pediatricians handle most complaints and diseases in children that do not require surgery, and there are several subspecialties (formally or informally) in pediatrics that mimic the organ-based specialties in adults. Pediatric 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.
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] 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.
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.
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.
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.
Child and adolescent psychiatry focuses on the care of children and adolescents with mental, emotional, and learning problems including ADHD, autism, and family conflicts.
Public health focuses on the health of populations. Physicians employed in this field work in policy, research or health promotion, taking a broad view of health that encompasses the social determinants of health.
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.
According to the 2022 Medscape Physician Compensation Report, physicians on average earn $339K annually. Primary care physicians earn $260K annually while specialists earned $368K annually.[6]
The table below details the average range of salaries for physicians in the US of medical specialties:[6][7]
There are 15 recognised specialty medical Colleges in Australia.[8][9][10] The majority of these are Australasian Colleges and therefore also oversee New Zealand specialist doctors. These Colleges are:
Addiction medicine, Adolescent and young adult medicine, Cardiology, Clinical Genetics, Clinical haematology, Clinical pharmacology, Community child health, Endocrinology, Gastroenterology, General and acute care medicine, General paediatrics Geriatric medicine, Haematology, Infectious diseases, Immunology and allergy, Neonatal and perinatal medicine, Nephrology, Neurology, Nuclear medicine, Occupational medicine, Oncology, Paediatric emergency medicine, Palliative medicine, Public health, Rehabilitation, Respiratory and sleep medicine, Rheumatology, Sexual Health
There are some collegiate bodies in Australia that are not officially recognised as specialties by the Australian Medical Council but have a college structure for members, such as: Australasian College of Physical Medicine
There are some collegiate bodies in Australia of Allied Health non-medical practitioners with specialisation. They are not recognised as medical specialists, but can be treated as such by private health insurers, such as: Australasian College of Podiatric Surgeons
In Sweden, a medical license is required before commencing specialty training. Those graduating from Swedish medical schools are first required to do a rotational internship of about 1.5 to 2 years in various specialties before attaining a medical license. The specialist training lasts 5 years.[12]
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.
In the United States 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.[13]
Demography
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.[13]
The proportion of men and women in different medical specialties varies greatly.[14] Such sex segregation is largely due to differential application.[15]
Satisfaction and burnout
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.[16] In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists.[16] Surveys have also revealed high levels of depression among medical students (25 - 30%) as well as among physicians in training (22 - 43%), which for many specialties, continue into regular practice.[17][18] A UK survey conducted of cancer-related specialties in 1994 and 2002 found higher job satisfaction in those specialties with more patient contact. Rates of burnout also varied by specialty.[19]
Occupational medicine – branch of clinical medicine that provides health advice to organizations and individuals concerning work-related health and safety issues and standards. See occupational safety and health.
Preventive medicine – part of medicine engaged with preventing disease rather than curing it. It can be contrasted not only with curative medicine, but also with public health methods (which work at the level of population health rather than individual health).
^"Becoming a Registered Dietitian". Department of Food Science and Human Nutrition. University of Illinois at Urbana-Champaign. Retrieved 21 April 2016.
^Taylor, Cath; Graham, Jill; Potts, Henry WW; Richards, Michael A.; Ramirez, Amanda J. (2005). "Changes in mental health of UK hospital consultants since the mid-1990s". The Lancet. 366 (9487): 742–744. doi:10.1016/S0140-6736(05)67178-4. PMID16125591. S2CID11391979.
