Specialty (medicine)


A medical speciality is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children, cancer, laboratory medicine, or primary care. 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 long been specialized. According to Galen, specialization was common among Roman physicians. 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.

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 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. Paediatricians handle most complaints and diseases in children that do not require surgery, and there are several subspecialties 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

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.
In this table, as in many healthcare arenas, medical specialties are organized into the following groups:
SpecialtyCodeGroupSub-specialtiesFocus
Allergy and immunologyAllergic reactions, asthma, and the immune system
AnesthesiologyAN, PANSurgery
  • Pediatric anesthesia
  • Pain management
  • Intensive care
  • Critical care
  • Obstetrics and gynaecology
  • Cardiothoracic anesthesiology
  • Trauma care
  • Pre- and Post-Operative Assessment and Care
  • Generalist
Anesthesia
CardiologyMedicine
  • Interventional cardiology
  • Echocardiography
  • Electrocardiography
  • Sports Cardiology
  • Cardiogeriatrics
  • Preventive Cardiology and Cardiac Rehabilitation
  • Pediatric Cardiology
    		• Disease of the cardiovascular system
    Cardiovascular surgerySurgeryThe operation of heart and major blood vessels of the chest.
    Clinical laboratory sciencesDiagnostic
  • 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.
    DermatologyD, DSMedicineDermatology, Mohs surgerySkin and its appendages.
    DieteticsRDFood and nutrition
    Emergency medicineEMMedicine
  • 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.
    EndocrinologyMedicineThe endocrine system and its diseases, including diabetes and thyroid diseases.
    Family medicineFMMedicine
  • Addiction medicine
  • Adolescent medicine
  • Anesthesia
  • Emergency medicine
  • Care of the elderly
  • Clinical environmental health
  • Global health
  • HIV care
  • Hospital medicine
  • Indigenous health
  • Low-risk obstetrics
  • Medical education
  • Medical oncology
  • Medical simulation
  • Pain medicine
  • Palliative care
  • Point of Care Ultrasound
  • Research
  • Sleep medicine
  • Sports and exercise medicine
  • Women's health
    		• 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 medicineMedicine
    GastroenterologyGIMedicineThe alimentary tract
    General surgeryGSSurgery
  • Colorectal surgery
  • Gastrointestinal surgery
  • Transplant surgery
  • Trauma surgery
    • GeriatricsIMGMedicineElderly patients
    GynecologyFemale reproductive health
    HepatologyMedicineThe liver and biliary tract, usually a part of gastroenterology.
    Hospital medicineMedicine
    Infectious diseaseIDMedicineDiseases caused by biological agents
    Intensive care medicineMedicineLife support and management of critically ill patients, often in an ICU.
    Internal MedicineMedicine
    Medical researchAnatomy, Biochemistry, Embryology, Genetics, Pharmacology, ToxicologyCare of hospitalized patients
    NephrologyMedicineKidney diseases
    NeurologyNMedicine
  • 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
    NeurosurgeryNSSurgery
  • Cerebrovascular
  • Neurosurgical oncology
  • Stereotactic and functional
  • Spine
  • Neurotrauma
  • Skull base
  • Peripheral nerve
  • Pediatric neurosurgery
    		• Disease of the central nervous system, peripheral nervous system, and spinal column.
    Obstetrics and gynecologyOB/GYNSurgery
  • Maternal-fetal medicine
  • Reproductive medicine
  • Fertility medicine
  • Gynecologic oncology
    • OncologyONMedicine
  • Radiation oncology – pertains to the use of radiation therapy as part of cancer treatment to control malignant cells.
    		• Cancer and other malignant diseases, often grouped with hematology.
    OphthalmologyOPHSurgeryRetina, CorneaDiseases of the visual pathways, including the eyes, brain, etc.
    Oral and maxillofacial surgeryMaxfacs, OMSSurgery
  • Oral and Craniofacial surgery
  • 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 surgeryORSSurgeryHand surgery, surgical sports medicine, adult reconstruction, spine surgery, foot and ankle, musculoskeletal oncology, orthopedic trauma surgery, pediatric orthopedic surgeryInjury and disease of the musculoskeletal system.
    Otorhinolaryngology, or ENTORL, ENTSurgeryHead and neck, facial cosmetic surgery, Neurotology, LaryngologyTreatment 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 carePLMMedicineA 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.
    PathologyPTHDiagnosticUnderstanding 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.
    PediatricsPDMedicineChildren. 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.
    Pediatric surgerySurgeryTreats a wide variety of thoracic and abdominal diseases of childhood.
    Physical medicine and rehabilitation Or PhysiatryPM&RMedicine
  • Cancer Rehabilitation
  • Pain Management
  • Traumatic Brain Injury
  • Spinal Cord Injury
  • Sports Medicine
  • Pediatrics
  • Hospice & Palliative Medicine
    		• Concerned with functional improvement after injury, illness, or congenital disorders.
    Plastic surgeryPSSurgery
  • Cosmetic surgery
  • Burn
  • Microsurgery
  • Hand surgery
  • Craniofacial surgery
    		• Elective cosmetic surgery as well as reconstructive surgery after traumatic or operative mutilation.
    PodiatryPODSurgery
  • 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.
    ProctologyPROMedicine Treats disease in the rectum, anus, and colon.
    PsychiatryPMedicine
  • Addiction psychiatry focuses on substance abuse and its treatment.
  • Child and adolescent psychiatry focuses on the care of children and adolescents with mental, emotional, and learning problems including ADHD, autism, and family conflicts.
  • Consultation-Liaison psychiatry focuses on the interface between general medicine and psychiatry.
  • Forensic psychiatry focuses on the interface of psychiatry and law.
  • Geriatric psychiatry focuses on the care of elderly people with mental illnesses including dementias, post-stroke cognitive changes, and depression.
  • 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.
  • 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.
    PulmonologyMedicineThe 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.
    Public HealthPublic 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.
    RadiologyR, DRDiagnostic 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, biopsies and minimally invasive oncologic procedures
  • 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.
    RheumatologyRHUMedicineAutoimmune and inflammatory diseases of the joints and other organ systems, such as arthritis and other rheumatic diseases.
    Surgical oncologySOSurgeryCurative and palliative surgical approaches to cancer treatment.
    Thoracic surgeryTSSurgerySurgery of the organs of the thoracic cavity: the heart, lungs, and great vessels.
    Transplant surgeryTTSSurgeryTransplantation of organs from one body to another
    Urgent Care MedicineUCMMedicineImmediate medical care offering outpatient care for the treatment of acute and chronic illness and injury
    UrologyUSurgeryUrinary tracts of males and females, and the male reproductive system. It is often practiced together with andrology.
    Vascular surgeryVSSurgeryThe peripheral blood vessels – those outside the chest and outside the central nervous system

    Salaries

    The mean annual salary of a medical specialist in the US in 2006 was $175,011 and $272,000 for surgeons.
    The table below details the average range of salaries for physicians in the US of selected specialties as of July 2010. Also given in the average number of hours worked per week for full-time physicians.
    SpecialtyMedian salary Average hours
    work/week    		Average salary/hour
    Anaesthesia331,000 to $423,50761
    Dermatology313,100 to $480,08845.5103
    Emergency medicine239,000 to $316,2964687
    Cardiac Surgery218,684 to $500,00055
    Family medicine175,000 to $220,19652.558
    Internal medicine184,200 to $231,6915758
    Neurology213,000 to $301,32755.593
    Obstetrics and Gynecology251,500 to $326,9246183
    Ophthalmology150,000 to $351,00047
    Orthopedic surgery397,879 to $600,00058
    Otolaryngology191,000 to $393,00053.5
    Oral and Maxillofacial Surgery360,000 to $625,21053
    Pediatrics160,111 to $228,7505469
    Podiatry170,800 to $315,1504580
    Psychiatry173,800 to $248,1984872
    Radiology 377,300 to $478,00058
    Surgery 284,642 to $383,33360
    Urology331,192 to $443,51860.5
    Neurosurgery350,000 to $705,000132
    Plastic surgery265,000 to $500,000114
    Gastroenterology251,026 to $396,45093
    Pulmonology165,000 to $365,87572

    Specialties by country

    Australia and New Zealand

    There are 15 recognised specialty medical Colleges in Australia. The majority of these are Australasian Colleges and therefore also oversee New Zealand specialist doctors. These Colleges are:
    Specialist CollegeMajor SubspecialtiesApproximate number of specialist doctors/trainees
    Australasian College for Emergency MedicinePaediatric emergency medicine5,000
    Australasian College of Dermatologists700
    Australasian College of Sport and Exercise Physicians350
    Australian and New Zealand College of AnaesthetistsPain medicine7,000
    Australian College of Rural and Remote Medicine4,500
    College of Intensive Care MedicinePaediatric Intensive care1,200
    Royal Australasian College of Medical Administrators800
    Royal Australasian College of PhysiciansAddiction medicine, Cardiology, Endocrinology, Gastroenterology, Genetics, Geriatrics, Haematology, Infectious diseases, Immunology, Neonatal, Nephrology, Neurology, Occupational, Oncology, Paediatrics, Palliative medicine, Public Health, Rehabilitation, Respiratory, Rheumatology, Sexual Health25,000
    Royal Australasian College of SurgeonsCardiothoracic, General surgery, Head & neck, Neurosurgery, Orthopaedics, Paediatric surgery, Plastics, Urology, Vascular9,000
    Royal Australian and New Zealand College of Obstetricians and GynaecologistsObstetrics, Gynaecology, Fertility medicine, Obstetric ultrasound, Gynaecological oncology, Urogynaecology2,500
    Royal Australian and New Zealand College of Ophthalmologists1,100
    Royal Australian and New Zealand College of Psychiatrists5,000
    Royal Australian and New Zealand College of RadiologistsDiagnostic, Interventional, Ultrasound, Nuclear medicine3,500
    Royal Australian College of General Practitioners40,000
    Royal College of Pathologists of AustralasiaAnatomical, Chemical, Clinical, Forensic, Genetic, Haematological, Immunological, Microbiological Pathology1,000

    In addition, the Royal Australasian College of Dental Surgeons supervises training of specialist medical practitioners specializing in Oral and Maxillofacial Surgery in addition to its role in the training of dentists. There are approximately 260 faciomaxillary surgeons in Australia.
    The Royal New Zealand College of General Practitioners is a distinct body from the Australian Royal Australian College of General Practitioners. There are approximately 5100 members of the RNZCGP.
    Within some of the larger Colleges, there are sub-faculties, such as: within the Royal Australasian College of Physicians
    There are some collegiate bodies in Australia that are not officially recognised as specialities by the Australian Medical Council but have a College structure for members, such as:
    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

    Canada

    Specialty training in Canada is overseen by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. For specialists working in the province of Quebec, the Collège des médecins du Québec also oversees the process.

    Germany

    In Germany these doctors use the term Facharzt.

    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, 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.

    Sweden

    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.

    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 and the American Medical Association ; the American Osteopathic Association Bureau of Osteopathic Specialists and the American Osteopathic Association; the American Board of Physician Specialties 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 boardNational organizationPhysician type
    ABMSAMAMD and DO
    AOABOSAOADO only
    ABPSAAPSMD 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.
    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.

    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.
    The proportion of men and women in different medical specialties varies greatly. Such sex segregation is largely due to differential application.

    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. In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists. Surveys have also revealed high levels of depression among medical students as well as among physicians in training, which for many specialties, continue into regular practice. 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.