Medical specialty

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Specialist physician
)

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 (paediatrics), 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. 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 worldwide

Specialty May be subspecialty of Age range
of patients
Diagnostic (D) or
therapeutic (T)
specialty
Surgical (S) or
internal medicine (I)
specialty
Organ-based (O)
or technique-based (T)
Allergy and immunology Internal medicine
Pediatrics
All Both I O
Adolescent medicine Pediatrics
Family medicine
Pediatric Both I T
Anesthesiology None All T Both Both
Aerospace medicine Family Medicine All Both Neither Both
Bariatrics Several All Both Both Both
Cardiology Internal medicine Adults T I O
Cardiothoracic surgery General surgery Adults T S O
Child and adolescent psychiatry Psychiatry Pediatric T I T
Clinical neurophysiology Neurology All D I Both
Colorectal surgery General Surgery All Both S O
Dermatology None All T I O
Developmental pediatrics Pediatrics Pediatric T I Neither
Emergency medicine Family Medicine All Both Both Both
Endocrinology Internal medicine Adults Both I Multidisciplinary
Family Medicine
None All Both Both Multidisciplinary
Forensic pathology Pathology All D Neither T
Forensic psychiatry Psychiatry All D I T
Gastroenterology Internal medicine Adults T I O
General surgery None Adults T S T
General surgical oncology General surgery Adults T S T
Geriatrics Family medicine
Internal medicine
Geriatric T I Multidisciplinary
Geriatric psychiatry Geriatrics
Psychiatry
Geriatric T I Neither
Gynecologic oncology Obstetrics and gynecology All T S O
Hematology Internal medicine
pathology
Adults D I Neither
Hematologic pathology Hematology
Pathology
All D Neither T
Infectious disease
Internal medicine
Pediatrics
All Both I Neither
Internal medicine None Adults Both I Neither
Interventional radiology Radiology All Both - Multidisciplinary
Intensive care medicine Anesthesiology
Emergency medicine
Internal medicine
All T Both Both
Maternal-fetal medicine
Obstetrics and gynecology Adults T S Both
Medical biochemistry
Internal medicine All D I Neither
Medical genetics None All D I Neither
Medical oncology
Internal medicine Adults D I Neither
Neonatology Pediatrics Neonatal T I Neither
Nephrology Internal medicine All T I O
Neurology Internal medicine All Both I O
Neuropathology Pathology All D Neither T
Neurosurgery None All T S O
Nuclear medicine (Nucleology) None All Both I T
Obstetrics and gynecology
Family medicine All T S O
Occupational medicine Family medicine
Internal medicine
Adults T I Multidisciplinary
Ophthalmology None All T S O
Orthopedic surgery None All T S O
Oral and maxillofacial surgery None All T S O
Otorhinolaryngology None All T S O
Palliative care Family Medicine
Internal medicine
Pediatrics
All Both Neither Neither
Pathology None All D Neither T
Pediatrics None Pediatric Both I Neither
Pediatric allergy and immunology Pediatrics Pediatric T I O
Pediatric cardiology Pediatrics Pediatric T I O
Pediatric emergency medicine Pediatrics Pediatric Both Both Both
Pediatric endocrinology Pediatrics Pediatric Both I Multidisciplinary
Pediatric gastroenterology Pediatrics Pediatric T I O
Pediatric hematology and oncology Pediatrics Pediatric T I O
Pediatric infectious disease Pediatrics Pediatric T I O
Pediatric nephrology Pediatrics Pediatric T I O
Pediatric respiratory medicine Pediatrics Pediatric T I O
Pediatric rheumatology Pediatrics Pediatric T I O
Pediatric surgery General surgery Pediatric T S O
Physical medicine and rehabilitation None All T I Multidisciplinary
Plastic, reconstructive and aesthetic surgery General surgery All T S O
Psychiatry Family medicine All Both I T
Public health Family medicine All Neither Neither T
Radiation oncology
None All T Neither T
Radiology None All Both I T
Reproductive endocrinology and infertility Obstetrics and gynecology Adults T S T
Pulmunology or Respiratory medicine Internal medicine Adults T I O
Rheumatology Internal medicine Adults T I Neither
Sports medicine Family medicine All Both Neither Multidisciplinary
Thoracic surgery
General surgery Adults T S T
Toxicology Emergency Medicine All Both Neither O
Transfusion Medicine
None All Both Neither Both
Neuroradiology Radiology All Both I Both
Urology None All T S O
Vascular surgery General surgery All T S 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.[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.

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 Sub-specialties Focus
Allergy and immunology Allergic reactions, asthma, and the immune system.
Anesthesiology AN, PAN Surgery[4][citation needed] Anesthesia
Bariatrics Deals with the causes, prevention, and treatment of obesity.
Cardiology Medicine Disease of the
cardiovascular system
.
Cardiovascular surgery
Surgery The operation of
chest
.
Clinical laboratory
sciences
Diagnostic
  • 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.
  • coagulation system
    in the blood.
  • 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 Dermatology, Mohs surgery Skin and its appendages (hair, nails, sweat glands etc.).
Dietetics
RD[5] 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
  • Addiction medicine
  • Adolescent medicine
  • Anesthesia
  • Emergency medicine
  • Care of the elderly (geriatric medicine)
  • 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 (POCUS)
  • 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 medicine Medicine
Gastroenterology GI Medicine The
alimentary tract
General surgery GS Surgery
  • Colorectal surgery
  • Gastrointestinal surgery
  • Transplant surgery
  • Trauma surgery
Geriatrics IMG Medicine[4][citation needed] Elderly patients
Gynecology
Female reproductive health
Hepatology Medicine The liver and biliary tract, usually a part of gastroenterology.
Hospital medicine Medicine
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.
Internal medicine Medicine
Medical research Anatomy, Biochemistry, Embryology, Genetics, Pharmacology, Toxicology Care of hospitalized patients
Nephrology Medicine Kidney diseases
Neurology N Medicine Diseases involving the central, peripheral, and autonomic nervous systems.
Neurosurgery NS Surgery Disease of the
spinal column
.
Obstetrics and gynecology
OB/GYN Surgery[4][citation needed]
Oncology ON Medicine Cancer and other malignant diseases, often grouped with hematology.
Ophthalmology OPH Surgery 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, orthopedic 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
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 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 oncology, pediatric ophthalmology, and neonatology
.
Deals with the medical care of
newborn
to age 16–21, depending on the country).
Pediatric surgery Surgery Treats a wide variety of
abdominal (and sometimes urologic
) diseases of childhood.
Physical medicine and rehabilitation Or Physiatry PM&R Medicine
  • 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 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,
mononeuropathy conditions. Reconstructive foot & ankle surgery
.
Proctology
PRO Medicine (or
colon
.
Psychiatry P Medicine
  • Addiction psychiatry focuses on substance abuse and its treatment.
  • 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
behavioral disorders. Related 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.
Public Health 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.
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)
  • 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
rheumatic diseases
.
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.
Toxicology Diagnostic and Therapeutic
  • Environmental
  • Forensic
  • Occupational
  • Pediatric
Poisonings, Overdoses; Environmental, and Occupational Exposures
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 the
cardiovascular surgeons) and outside the central nervous system (treated by neurosurgery
).

Salaries

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:[7][8]

Specialty Average salary (USD) Average hours

work/week

Average salary/hour (USD)
Allergy & Immunology $298K
Anesthesiology
$405K 59
Dermatology $438K 44 103
Emergency medicine $373K 44 180
Endocrinology $257K
Cardiac Surgery
218,684 to $500,000
Cardiology $490K 55
Critical care $369K
Infectious disease $260K
Internal medicine $264K 55 58
Family medicine $255K 51 58
Nephrology $329K
Neurology $301K 54 93
Obstetrics and Gynecology
$336K 59 83
Oncology $411K
Ophthalmology $417K 45
Orthopedic surgery $557K 56
Otolaryngology
$469K 52
Oral and Maxillofacial Surgery
360,000 to $625,210 53
Pathology $334K 44
Pediatrics 244K 52 69
Rheumatology $289K
Physical Medicine & Rehabiliation $322K
Podiatry 170,800 to $315,150 45 80
Preventative medicine $243K
Pulmonary medicine $353K 55
Psychiatry $287K 46 72
Radiology (diagnostic) $437K 56
Surgery (general) $402K 58
Urology $461K 59
Neurosurgery 350,000 to $705,000 132
Plastic surgery $576K 114
Gastroenterology $453K 55 93

Specialties by country

Australia and New Zealand

There are 15 recognised specialty medical Colleges in Australia.[9][10][11] The majority of these are Australasian Colleges and therefore also oversee New Zealand specialist doctors. These Colleges are:

Specialist College Major Subspecialties Approximate number of specialist doctors/trainees
Australasian College for Emergency Medicine Paediatric emergency medicine 5,000
Australasian College of Dermatologists 700
Australasian College of Sport and Exercise Physicians Exercise medicine 350
Australian and New Zealand College of Anaesthetists Pain medicine 7,000
Australian College of Rural and Remote Medicine 4,500
College of Intensive Care Medicine Paediatric Intensive care 1,200
Royal Australasian College of Medical Administrators 800
Royal Australasian College of Physicians 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 28,000
Royal Australasian College of Surgeons Cardiothoracic, General surgery, Head & neck, Neurosurgery, Orthopaedics, Paediatric surgery, Plastics, Urology, Vascular 9,000
Royal Australian and New Zealand College of Obstetricians and Gynaecologists Obstetrics, Gynaecology, Fertility medicine, Obstetric ultrasound, Gynaecological oncology, Urogynaecology 2,500
Royal Australian and New Zealand College of Ophthalmologists 1,100
Royal Australian and New Zealand College of Psychiatrists 5,000
Royal Australian and New Zealand College of Radiologists Diagnostic, Interventional, Ultrasound, Nuclear medicine 3,500
Royal Australian College of General Practitioners 40,000
Royal College of Pathologists of Australasia Anatomical, Chemical, Clinical, Forensic, Genetic, Haematological, Immunological, Microbiological Pathology 1,000

In addition, the

dentists. There are approximately 260 faciomaxillary surgeons in Australia.[12]

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: Australasian Faculty of Rehabilitation Medicine Archived 2014-12-11 at the Wayback Machine 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: 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

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

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.[13]

United States

There are three agencies or organizations in the United States that collectively oversee

(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
ABPS AAPS MD and DO
AOABOS AOA DO only

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.[14]

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.[14]

The proportion of men and women in different medical specialties varies greatly.[15] Such sex segregation is largely due to differential application.[16]

Satisfaction and burnout

A survey of

pulmonologists.[17] 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.[18][19] 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.[20]

See also

References

  1. ^ "Different Types of Doctors: Find the Specialist You Need". webmd.com. Retrieved 17 March 2018.
  2. S2CID 23694173
    .
  3. ^ "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. 7 September 2005. Retrieved 19 April 2011.
  4. ^ a b c Regeringen.se – new grouping of the medical specialties Archived April 10, 2008, at the Wayback Machine
  5. ^ "Becoming a Registered Dietitian". Department of Food Science and Human Nutrition. University of Illinois at Urbana-Champaign. Retrieved 21 April 2016.
  6. ^ "Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain". Medscape. Retrieved 2022-07-23.
  7. ^ "Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain". Medscape. Retrieved 2022-07-23.
  8. ^ Katzowitz, Josh (2022-02-02). "How Much Do Doctors Make? [Salary by Specialty 2022] | White Coat Investor". The White Coat Investor - Investing & Personal Finance for Doctors. Retrieved 2022-07-23.
  9. ^ Council of Presidents of Medical Colleges, https://cpmc.edu.au/
  10. ^ Medical Board of Australia, https://www.medicalboard.gov.au/registration/types/specialist-registration/medical-specialties-and-specialty-fields.aspx
  11. ^ "What sort of doctor do you want to be? Medical specialties in Australia". 15 May 2014.
  12. ^ "What is ANZAOMS? - ANZAOMS".
  13. ^ "Specialty training / residency". Lund University, Faculty of Medicine. 2015-05-20. Retrieved 2016-11-26.
  14. ^
    PMID 582210
    .
  15. ^ "These medical specialties have the biggest gender imbalances". American Medical Association. Retrieved 17 July 2020.
  16. PMID 30837254
    .
  17. ^ a b "Medscape: Medscape Access".
  18. PMID 27923088
    .
  19. .
  20. .