Specialty (medicine)

A specialty (or speciality) in medicine is a branch of medical science. 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 doctors. 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.^[1]

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

The most important historically is the division into surgical and internal medicine specialties. The surgical specialties are the specialties where an important part of diagnosis and treatment is achieved through major surgical techniques. The internal medicine specialties are the specialties where the main diagnosis and treatment is never major surgery. 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 mainly based 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 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 mainly or only perform 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

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	Pediatrics or Internal medicine	Both	I	All	O
Anaesthesiology	None	T	S	All	T
Pathology	None	D	Neither	All	T
Cardiology	Internal medicine	T	I	Adults	O
Pediatric cardiology	Pediatrics	T	I	Pediatric	O
Cardiothoracic surgery	General surgery	T	S	Adults	O
Child and adolescent psychiatry and psychotherapy	None	T	I	Pediatric	O
Clinical neurophysiology	Neurology	D	I	All	Both
Dermato-Venereology	None	T	I	All	O
Endocrinology	Internal medicine	T	I	Adults	O
Gastroenterology	Internal medicine	T	I	Adults	O
Geriatrics	Internal medicine	T	I	Geriatric	Multidisciplinary
Gynaecology and obstetrics	None	T	S	All	O
Health Informatics	None	T & D	Neither	All	Multidisciplinary
Infectious diseases	Internal medicine	T	I	Variable	Neither
Internal Medicine	None	T	I	Adults	Neither
Interventional Radiology	Radiology	T	Both	All	Multidisciplinary
Vascular medicine	Internal medicine	T	I	Adults	O
Microbiology	None	D	I	All	T
Nephrology	Internal medicine	T	I	Adults	O
Neurology	None	T	I	Adults	O
Neurosurgery	None	T	S	All	O
Nuclear medicine	None	D	I	All	T
Occupational medicine	None	T	I	Working age	Multidisciplinary
Ophthalmology	None	T	S	All	O
Orthopaedics	General surgery	T	S	All	O
Oro-Maxillo-Facial Surgery	Several	T	S	All	O
Otorhinolaryngology	None	T	S	All	O
Paediatrics	None	T	I	Pediatric	Neither
Paediatric allergology	Paediatrics	T	I	Pediatric	O
Paediatric endocrinology and diabetes	Paediatrics	T	I	Pediatric	O
Paediatric gastroenterology, hepatology and nutrition	Paediatrics	T	I	Pediatric	O
Paediatric haematology and oncology	Paediatrics	T	I	Pediatric	O
Paediatric infectious diseases	Paediatrics	T	I	Pediatric	O
Neonatology	Paediatrics	T	I	Neonatal	Neither
Paediatric Nephrology	Paediatrics	T	I	Pediatric	O
Paediatric respiratory medicine	Paediatrics	T	I	Pediatric	O
Paediatric rheumatology	Paediatrics	T	I	Pediatric	O
Paediatric surgery	General Surgery	T	S	Pediatric	O
Physical and Rehabilitation Medicine	None	T	I	Adults	Multidisciplinary
Plastic, Reconstructive and Aesthetic Surgery	General surgery	T	S	All	O
Pneumology	Internal medicine	T	I	Adults	O
Psychiatry	Internal medicine	T	I	Adults	O
Public Health	None	Neither	Neither	All	T
Radiology	None	D	I	All	T
Neuroradiology	Radiology	D	I	All	Both
Radiotherapy	(unknown)	T	Unknown	Unknown	T
General surgery	None	T	S	Variable	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.^[2] 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.

Anesthesiology	Clinical chemistry	Tropical medicine
General surgery	Clinical biology	Child psychiatry
Neurosurgery	*Immunology	Geriatrics
Obsetrics and gynecology	Plastic surgery	Nephrology
Internal medicine	Thoracic surgery	Infectious diseases
**Ophthalmology	Pediatric surgery	Public health
Otorhinolaryngology	Vascular surgery	Pharmacology
Pediatrics	Cardiology	Occupational medicine
Respiratory medicine	Gastroenterology	Allergology
Urology	Rheumatology	Gastro-enterologic surgery
Orthopaedics	General hematology	Nuclear medicine
Pathology	Endocrinology	Accident and emergency medicine
Neurology	Physical medicine and rehabilitation	Clinical neurophysiology
Psychiatry	Stomatology	Maxillo-facial surgery
Clinical radiology	Neuro-psychiatry	Dental, oral and maxillo-facial surgery
Radiotherapy	Dermato-venerology
Laboratory medicine	Dermatology
Biological hematology	Venerology
Microbiology	Radiology

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.

Specialty	Code	Group	Subspecialties	Focus
Allergy and Immunology				Allergic reactions, asthma, and the immune system
Anesthesiology	AN, PAN	Surgery[3]	Paediatrics, Pain management, Intensive Care, Critical Care, Obstetrics and gynaecology, Cardiothoracic anesthesiology, Trauma Care, Pre and Post Operative Assessment and Care, Generalist (covers all the sub-specialties)	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	Transfusion medicine is concerned with the transfusion of blood and blood component, including the maintenance of a "blood bank". Cellular pathology is concerned with diagnosis using samples from patients taken as tissues and cells using histology and cytology. Clinical chemistry is concerned with diagnosis by making biochemical analysis of blood, body fluids and tissues. Hematology is concerned with diagnosis by looking at changes in the cellular composition of the blood and bone marrow as well as the coagulation system in the blood. Clinical microbiology is concerned with the in vitro diagnosis of diseases caused by bacteria, viruses, fungi, and parasites. Clinical immunology is concerned with disorders of the immune system and related body defenses. It also deals with diagnosis of allergy.	Application of diagnostic techniques in medical laboratories such as assays, microscope analysis.
Dermatology	D, DS	Medicine	Dermatopathology, Mohs Surgery	Skin and its appendages (hair, nails, sweat glands etc.).
Dietetics				Food and nutrition
Emergency medicine	EM	Medicine	Emergency Medical Services Hospice and palliative medicine Medical toxicology Pediatric emergency medicine Sports medicine Undersea and hyperbaric 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 health care 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[3]		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.
Maxillofacial surgery	Maxfacs, OMFS	Surgery	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.
Medical research			Anatomy, Biochemistry, Embryology, Genetics, Pharmacology, Toxicology
Nephrology		Medicine		Kidney diseases
Neurology	N	Medicine	Behavioral Neurology Clinical Neurophysiology Geriatric Neurology Headache Medicine Neuromuscular Medicine Neurodevelopmental Disabilities Neuro-oncology Neuroradiology Vascular Neurology Hospice and Palliative Medicine Pain Medicine Sleep 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[3]	Maternal-fetal medicine Reproductive medicine Fertility medicine Gynecologic Oncology
Oncology	ON	Medicine	Radiation oncology – pertains to the use of radiation therapy (the medical use of ionizing radiation) as part of cancer treatment to control malignant cells (not to be confused with radiology).	Cancer and other malignant diseases, often grouped with hematology.
Ophthalmology	OPH	Surgery	Retina, Cornea	Diseases of the visual pathways, including the eyes, brain, etc.
Orthopedic surgery	ORS	Surgery	hand surgery, surgical sports medicine, adult reconstruction, spine surgery, foot and ankle, musculoskeletal oncology, orthopaedic trauma surgery, paediatric orthopedic surgery	Injury and disease of the musculoskeletal system.
Otolaryngology, 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 which 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 which uses tissues and body fluids to obtain clinically useful information, as well as the related scientific study of disease processes.
Pediatrics	PD	Medicine	Children. Like internal medicine, pediatrics has many subspecialities for specific age ranges, organ systems, disease classes, and sites of care delivery. Most subspecialities of adult medicine have a pediatric equivalent such as pediatric cardiology, 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.
Proctology	PRO	Medicine		(or Colorectal Surgery) Treats disease in the rectum, anus, and colon.
Psychiatry	P	Medicine	Child and adolescent psychiatry focuses on the care of children and adolescents with mental, emotional, and learning problems including ADHD, autism, and family conflicts. Geriatric psychiatry focuses on the care of elderly people with mental illnesses including dementias, post-stroke cognitive changes, and depression. Addiction psychiatry focuses on substance abuse and its treatment. Forensic psychiatry focuses on the interface of psychiatry and law. Neuropsychiatry focuses on affective, cognitive and behavioral disorders attributable to diseases of the nervous system Sleep medicine focuses on the diagnosis and treatment of sleep disorders. Psychosomatic medicine Hospice and Palliative Medicine Pain 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 using either 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 of the central nervous system (treated by neurosurgery)

Future Medical Specialties

Due to the large decline in men's use of healthcare services and facilities, there may be a future in creating a specialty dedicated exclusively to men's health and well being. It would be a conterpart to gynecology and would be most aptly named andrology.

Physician compensation

The mean annual salary of a medical specialist is $175,011^[4] in the US, and $272,000^[4] 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.

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)[5]	Average hours work/week[6]	Average salary/hour (USD)[7]
Anesthesiology	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 practice	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
Pathology	239,000 to $331,842	45.5
Pediatrics	160,111 to $228,750	54	69
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

Specialties by country

Australia and New Zealand

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

• Royal Australasian College of Surgeons
• Royal Australasian College of Physicians

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 which collectively oversee physician board certification of MD and DO (allopathic and osteopathic) 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; 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. 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
AOA-BOS	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.

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.^{[citation needed]}

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 orthopedic surgeons, radiologists, oncologists, plastic surgeons, and gastroenterologists.^[8] In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists.^[8]

Specialty	Overall satisfaction[8]	Feeling of enough compensation[8]	Would have chosen same specialty again[8]
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%
Emergency medicine physician	63%	65%	56%
Urologist	63%	47%	78%
Cardiologist	62%	46%	75%
Paediatrician	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

• Interdisciplinary sub-specialties of medicine, including
  • Occupational medicine – branch of clinical medicine which provides health advice to organizations and individuals concerning work-related health and safety issues and standards. See occupational safety and health.
  • Disaster medicine – branch of medicine that provides healthcare services to disaster survivors; guides medically related disaster preparation, disaster planning, disaster response and disaster recovery throughout the disaster life cycle and serves as a liaison between and partner to the medical contingency planner, the emergency management professional, the incident command system, government and policy makers.
  • 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).
  • Medical genetics – the application of genetics to medicine. Medical genetics is a broad and varied field. It encompasses many different individual fields, including clinical genetics, biochemical genetics, cytogenetics, molecular genetics, the genetics of common diseases (such as neural tube defects), and genetic counseling.
• Specialty Registrar
• Federation of National Specialty Societies of Canada
• Society of General Internal Medicine

References

1. ^ Weisz G (Fall, 2003). "The Emergence of Medical Specialization in the Nineteenth Century". Bull Hist Med 77 (3): 536–574. PMID 14523260. http://muse.jhu.edu/journals/bhm/summary/v077/77.3weisz.html. 
2. ^ "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. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32005L0036:EN:NOT. Retrieved 19 April 2011. 
3. ^ ^{a b c} Regeringen.se - new grouping of the medical specialties
4. ^ ^{a b} ibmdllc.com -Physician income not rising as fast as other professional pay^{[dead link]}
5. ^ Physician Compensation Survey [special feature]. Modern Healthcare. July 19, 2010: 20-26. [1]
6. ^ Physician work hours (2003) Medfriends.org. Accessed 15 December 2010.
7. ^ 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.  [2]
8. ^ ^{a b c d e} Medscape Physician Compensation Report: 2011