Medicina interna

Specialization, Subspecialization, and Subsubspecialization in Internal Medicine

At a time when most authorities believe that the country desperately needs more generalists, the American Board of Internal Medicine (ABIM) is adding new subspecialties. In addition, the ABIM has received requests from specialty societies to approve several new subspecialties, including medical informatics, clinical pharmacology, vascular medicine, addiction medicine, and obesity medicine. Each of these applications raises issues of a societal nature (i.e., the benefits to the public of having clear standards for emerging areas of medical specialization) versus issues of practicality (e.g., the cost of creating and maintaining certification examinations and the ongoing worry about fragmentation of care). These issues have been coupled with the concerns of different specialties that favored or opposed particular subspecialty designations. Most important, we receive clear but contradictory messages from physicians: on the one hand, “recognize what I do” (i.e., create a subspecialty for my niche practice); on the other hand, “stop fragmenting an already overfragmented system.”
Approfondisci

 http://www.nejm.org/doi/full/10.1056/NEJMsb1012647?ai=rv&af=...

New England Journal of Medicine