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
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 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
Anaesthetics None T I or S All T
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 T & D I All Both
Endocrinology Internal medicine T I Adults O
Gastroenterology Internal medicine T I Adults O
General Practice None Both Neither All ages Multidisciplinary
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 & D I Variable Neither
Internal Medicine None T I Adults Neither
Interventional Radiology Radiology T & D 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 Internal medicine T I Adults O
Neurosurgery Surgery T S All O
Nuclear medicine None D & T I All T
Occupational medicine None T I Working age Multidisciplinary
Ophthalmology None T S All O
Orthopaedics General surgery T S All O
Oral and Maxillofacial Surgery Several 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 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 T
Public Health None Neither Neither All T
Radiology None D & T I All T
Neuroradiology Radiology D & T 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.

Anaesthetics Clinical chemistry Tropical medicine
General surgery Clinical biology Child psychiatry
Neurosurgery *Immunology Geriatrics
Obstetrics and gynecology Plastic surgery Nephrology
Internal medicine Thoracic surgery Infectious diseases
**Ophthalmology Paediatric surgery Public health and Preventive Medicine
Otorhinolaryngology Vascular surgery Pharmacology
Paediatrics 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 Podiatric Surgery
Laboratory medicine Dermatology Podiatric Medicine
Biological hematology Venereology General Practice
Microbiology Radiology 

List of North American medical specialities and others  The examples and perspective in this article may not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page. (January 2010)

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] Pediatrics, 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 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[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.
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 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 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.
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, orthopaedic 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 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.
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.
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 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 of the central nervous system (treated by neurosurgery)

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. 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.[5]

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)[6] Average hours
work/week[7]
 Average salary/hour (USD)[8]
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

According to a 2010 study, physician and surgeon median annual income was $166,400.[9]

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 Sports Physicians
Australian and New Zealand College of Anaesthetists
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.

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.

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 radiologists, oncologists, plastic surgeons, and gastroenterologists.[10] In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists.[10]

Specialty Overall satisfaction[10] Feeling of enough compensation[10] Would have chosen same specialty again[10]
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%
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%