Medical specialty explained

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. 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:

Throughout history, the most important has been the division into surgical and internal medicine specialties. The surgical specialties are those in which an important part of diagnosis and treatment is achieved through major surgical techniques. The internal medicine specialties are the specialties in which the main diagnosis and treatment is never major surgery. In some countries, anesthesiology is classified as a surgical discipline, since it is vital in the surgical process, though anesthesiologists never perform major surgery themselves.

Many specialties are organ-based. Many symptoms and diseases come from a particular organ. Others are based mainly around a set of techniques, such as radiology, which was originally based around X-rays.

The age range of patients seen by any given specialist can be quite variable. Pediatricians handle most complaints and diseases in children that do not require surgery, and there are several subspecialties (formally or informally) in pediatrics that mimic the organ-based specialties in adults. Pediatric surgery may or may not be a separate specialty that handles some kinds of surgical complaints in children.

A further subdivision is the diagnostic versus therapeutic specialties. While the diagnostic process is of great importance in all specialties, some specialists perform mainly or only diagnostic examinations, such as pathology, clinical neurophysiology, and radiology. This line is becoming somewhat blurred with interventional radiology, an evolving field that uses image expertise to perform minimally invasive procedures.

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)
Internal medicine
Pediatrics
AllBoth I O
Pediatrics
Family medicine
PediatricBoth I T
None AllT Both Both
Family Medicine AllBoth Neither Both
Several AllBoth Both Both
Internal medicine AdultsT I O
General surgery AdultsT S O
Child and adolescent psychiatry Psychiatry PediatricT I T
Neurology AllD I Both
General Surgery AllBoth S O
None AllT I O
Developmental pediatrics Pediatrics PediatricT I Neither
Family Medicine AllBoth Both Both
Internal medicine AdultsBothI Multidisciplinary
None AllBoth Both Multidisciplinary
Pathology AllD Neither T
Psychiatry AllD I T
Internal medicine AdultsT I O
None AdultsT S T
General surgical oncology General surgery AdultsT S T
Family medicine
Internal medicine
GeriatricT I Multidisciplinary
Geriatrics
Psychiatry
GeriatricT I Neither
Obstetrics and gynecology AllT S O
Internal medicine
Pathology
AdultsD I Neither
Hematologic pathology Hematology
Pathology
AllD Neither T
Internal medicine
Pediatrics
AllBoth I Neither
None AdultsBoth I Neither
Radiology AllBoth - Multidisciplinary
Anesthesiology
Emergency medicine
Internal medicine
AllT Both Both
Obstetrics and gynecology AdultsT S Both
Internal medicine AllD I Neither
None AllD I Neither
Internal medicine AdultsD I Neither
Pediatrics NeonatalT I Neither
Internal medicine AllT I O
Internal medicine AllBoth I O
Pathology AllD Neither T
None AllT S O
None AllBoth I T
Family medicine AllT S O
Family medicine
Internal medicine
AdultsT I Multidisciplinary
None AllT S O
None AllT S O
None AllT S O
None AllT S O
Family Medicine
Internal medicine
Pediatrics
AllBoth Neither Neither
None AllD Neither T
None PediatricBoth I Neither
Pediatric allergy and immunology Pediatrics PediatricT I O
Pediatric cardiology Pediatrics PediatricT I O
Pediatrics PediatricBoth Both Both
Pediatric endocrinology Pediatrics PediatricBoth I Multidisciplinary
Pediatric gastroenterology Pediatrics PediatricT I O
Pediatric hematology and oncology Pediatrics PediatricT I O
Pediatric infectious disease Pediatrics PediatricT I O
Pediatric nephrology Pediatrics PediatricT I O
Pediatric respiratory medicine Pediatrics PediatricT I O
Pediatric rheumatology Pediatrics PediatricT I O
General surgery PediatricT S O
None AllT I Multidisciplinary
General surgery AllT S O
Family medicine AllBoth I T
Family medicine AllNeither Neither T
None AllT Neither T
None AllBoth I T
Reproductive endocrinology and infertility Obstetrics and gynecology AdultsT S T
Internal medicine AdultsT I O
Internal medicine AdultsT I Neither
Family medicine AllBoth Neither Multidisciplinary
General surgery AdultsT S T
ToxicologyEmergency MedicineAllBothNeitherO
None AllBoth Neither Both
Radiology AllBoth I Both
None AllT S O
General surgery AllT 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:

SpecialtyCodeGroupSub-specialtiesFocus
Allergy and immunologyAllergic reactions, asthma, and the immune system.
AnesthesiologyAN, PANSurgery Anesthesia
Deals with the causes, prevention, and treatment of obesity.
CardiologyMedicine Disease of the cardiovascular system.
Cardiovascular surgerySurgeryThe operation of heart and major blood vessels of the chest.
Clinical laboratory sciencesDiagnostic Application of diagnostic techniques in medical laboratories such as assays, microscope analysis.
DermatologyD, DSMedicineDermatology, Mohs surgerySkin and its appendages (hair, nails, sweat glands etc.).
DieteticsRD[4] Food and nutrition
Emergency medicineEMMedicine The initial management of emergent medical conditions, often in hospital emergency departments or the field.
EndocrinologyMedicineThe endocrine system (i.e., endocrine glands and hormones) and its diseases, including diabetes and thyroid diseases.
Family medicineFMMedicine
  • 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 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 Diseases involving the central, peripheral, and autonomic nervous systems.
NeurosurgeryNSSurgery Disease of the central nervous system, peripheral nervous system, and spinal column.
Obstetrics and gynecologyOB/GYNSurgery[5]
OncologyONMedicine
  • 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.
OphthalmologyOPHSurgery Diseases of the visual pathways, including the eyes, brain, etc.
Oral and maxillofacial surgeryMaxfacs, OMSSurgery
  • 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 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 (from newborn to age 16–21, depending on the country).
Pediatric surgerySurgeryTreats a wide variety of thoracic and abdominal (and sometimes urologic) 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(or Colorectal Surgery) Treats disease in the rectum, anus, and colon.
PsychiatryPMedicine The bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related 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 (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.
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.
ToxicologyDiagnostic and Therapeutic
  • Environmental
  • Forensic
  • Occupational
  • Pediatric
Poisonings, Overdoses; Environmental, and Occupational Exposures
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 ("men's health").
Vascular surgeryVSSurgeryThe peripheral blood vessels – those outside the chest (usually operated on by 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]

SpecialtyAverage salary (USD)Average hourswork/weekAverage salary/hour (USD)
Allergy & Immunology$298K
Anesthesiology$405K59
Dermatology$438K44103
Emergency medicine$373K44180
Endocrinology$257K
Cardiac Surgery218,684 to $500,000
Cardiology$490K55
Critical care$369K
Infectious disease$260K
Internal medicine$264K5558
Family medicine$255K5158
Nephrology$329K
Neurology$301K5493
Obstetrics and Gynecology$336K5983
Oncology$411K
Ophthalmology$417K45
Orthopedic surgery$557K56
Otolaryngology$469K52
Oral and Maxillofacial Surgery360,000 to $625,21053
Pathology$334K44
Pediatrics244K5269
Rheumatology$289K
Physical Medicine & Rehabilitation$322K
Podiatry170,800 to $315,1504580
Preventative medicine$243K
Pulmonary medicine$353K55
Psychiatry$287K4672
Radiology (diagnostic)$437K56
Surgery (general)$402K58
Urology$461K59
Neurosurgery350,000 to $705,000132
Plastic surgery$576K114
Gastroenterology$453K5593

Specialties by country

Australia and New Zealand

There are 15 recognised specialty medical Colleges in Australia.[8] [9] [10] The majority of these are Australasian Colleges and therefore also oversee New Zealand specialist doctors. These Colleges are:

Specialist College Major Subspecialties Approximate number of specialist doctors/trainees
Paediatric emergency medicine 5,000
700
Exercise medicine350
Pain medicine7,000
4,500
Paediatric Intensive care1,200
800
Royal Australasian College of PhysiciansAddiction 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
Cardiothoracic, General surgery, Head & neck, Neurosurgery, Orthopaedics, Paediatric surgery, Plastics, Urology, Vascular9,000
Obstetrics, Gynaecology, Fertility medicine, Obstetric ultrasound, Gynaecological oncology, Urogynaecology 2,500
1,100
Royal Australian and New Zealand College of Psychiatrists5,000
Diagnostic, Interventional, Ultrasound, Nuclear medicine3,500
40,000
Anatomical, Chemical, Clinical, Forensic, Genetic, Haematological, Immunological, Microbiological Pathology 1,000

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.[11]

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 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 Medical Council of India, responsible for recognition of post graduate training and by the National Board of Examinations. Education of Ayurveda in overseen by Central Council of Indian Medicine (CCIM), the council conducts UG and PG 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.[12]

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 boardNational organizationPhysician type
ABMSAMAMD and DO
ABPSAAPSMD and DO
AOABOSAOADO 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.[13]

Demography

A population's income level determines whether sufficient physicians can practice in an area and whether public subsidy is needed to maintain the health of the population. Developing countries and poor areas usually have shortages of physicians and specialties, and those in practice usually locate in larger cities. For some underlying theory regarding physician location, see central place theory.

The proportion of men and women in different medical specialties varies greatly.[14] Such sex segregation is largely due to differential application.[15]

Satisfaction and burnout

A survey of physicians in the United States came to the result that dermatologists are most satisfied with their choice of specialty followed by radiologists, oncologists, plastic surgeons, and gastroenterologists. In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists.[16] Surveys have also revealed high levels of depression among medical students (25 - 30%) as well as among physicians in training (22 - 43%), which for many specialties, continue into regular practice.[17] [18] A UK survey conducted of cancer-related specialties in 1994 and 2002 found higher job satisfaction in those specialties with more patient contact. Rates of burnout also varied by specialty.[19]

See also

Notes and References

  1. Web site: Different Types of Doctors: Find the Specialist You Need. webmd.com. 17 March 2018.
  2. Weisz G . The Emergence of Medical Specialization in the Nineteenth Century . Bull Hist Med . Fall 2003 . 536–574 . 77 . 3 . 14523260 . 10.1353/bhm.2003.0150. 23694173 .
  3. Web site: Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications. 7 September 2005 . European Parliament and Council. 19 April 2011.
  4. Web site: Becoming a Registered Dietitian. Department of Food Science and Human Nutrition. University of Illinois at Urbana-Champaign. 21 April 2016.
  5. http://www.regeringen.se/content/1/c6/05/69/05/0678f033.pdf Regeringen.se – new grouping of the medical specialties
  6. Web site: Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain . 2022-07-23 . Medscape . en.
  7. Web site: Katzowitz . Josh . 2022-02-02 . How Much Do Doctors Make? [Salary by Specialty 2022] White Coat Investor ]. 2022-07-23 . The White Coat Investor - Investing & Personal Finance for Doctors . en-US.
  8. Council of Presidents of Medical Colleges, https://cpmc.edu.au/
  9. Medical Board of Australia, https://www.medicalboard.gov.au/registration/types/specialist-registration/medical-specialties-and-specialty-fields.aspx
  10. Web site: What sort of doctor do you want to be? Medical specialties in Australia. 15 May 2014.
  11. Web site: What is ANZAOMS? - ANZAOMS.
  12. Web site: Specialty training / residency. Lund University, Faculty of Medicine. 2015-05-20. 2016-11-26.
  13. Smith . Margot Wiesinger . A guide to the delineation of medical care regions, medical trade areas, and hospital service areas . Public Health Reports . 1979 . 94 . 3 . 248–254 . 4596085. 1431844 . 582210 .
  14. Web site: These medical specialties have the biggest gender imbalances . American Medical Association . 17 July 2020.
  15. 10.1136/bmjopen-2018-025004. 30837254. 6429837. Effect of sex on specialty training application outcomes: A longitudinal administrative data study of UK medical graduates. BMJ Open. 9. 3. e025004. 2019. Woolf. Katherine. Jayaweera. Hirosha. Unwin. Emily. Keshwani. Karim. Valerio. Christopher. Potts. Henry.
  16. Web site: Medscape: Medscape Access.
  17. Rotenstein. Lisa S.. Ramos. Marco A.. Torre. Matthew. Segal. J. Bradley. Peluso. Michael J.. Guille. Constance. Sen. Srijan. Mata. Douglas A.. 2016-12-06. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 316. 21. 2214–2236. 10.1001/jama.2016.17324. 1538-3598. 27923088. 5613659.
  18. Douglas A. Mata . Marco A. Ramos . Narinder Bansal . Rida Khan . Constance Guille . Emanuele Di Angelantonio . Srijan Sen . Douglas A. . Mata . Marco A. . Ramos . Narinder . Bansal . Rida . Khan . Constance . Guille . Emanuele Di . Angelantonio . Srijan . Sen . Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis . . 314 . 22 . 2373–2383 . 2015 . 10.1001/jama.2015.15845 . 26647259 . 4866499.
  19. 10.1016/S0140-6736(05)67178-4. 16125591. Changes in mental health of UK hospital consultants since the mid-1990s. The Lancet. 366. 9487. 742–744. 2005. Taylor. Cath. Graham. Jill. Potts. Henry WW. Richards. Michael A.. Ramirez. Amanda J.. 11391979.