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Subspecialization in the Field of Orthopaedic Surgery
Abstract
Background: Subspecialization within the various specialties of medicine is on the rise in the world. The orthopaedic community is experiencing the same with academic centers tending to develop subspecialty practices in the developing world.
Objectives: This article reviews literature on the history of subspecialization in medicine, the current status of subspecialization in orthopaedics, the perceived benefits and challenges of this process; and suggests a rationale for the application of orthopaedic subspecialization in the developing world.
Data source: A pubmed search with the mesh term “subspecialization.” Data selection/extraction: Using the pubmed search engine, 452 abstracts were found discussing subspecialization. Twenty two relevant articles were found, studied and used in this review.
Results: Subspecialization involves physician focus on a certain area of practice. This leads to better results, progress in the area of choice, higher surgical case rates, fewer complications; and to some extent, lower healthcare costs. However, it causes artificial shortages of surgeons, decreased generalist entry to the field, fragmentation of the specialty field with loss of unity, less trainee experience for residents and does not necessarily translate to a higher income.
Conclusions/Recommendations: The developing world faces an enormous shortage of orthopaedic surgeons. A balance is needed in order to provide an orthopaedic surgeon who can take care of most orthopaedic problems; while also providing a subspecialist orthopaedic surgeons in subspecialty centres and academic centres to manage complex and rare conditions. A middle ground would be an orthopaedic surgeon with a subspecialty area, who practices general orthopaedics in addition to the subspecialty area of interest to manage orthopaedic problems in most hospitals in the developing world.
Objectives: This article reviews literature on the history of subspecialization in medicine, the current status of subspecialization in orthopaedics, the perceived benefits and challenges of this process; and suggests a rationale for the application of orthopaedic subspecialization in the developing world.
Data source: A pubmed search with the mesh term “subspecialization.” Data selection/extraction: Using the pubmed search engine, 452 abstracts were found discussing subspecialization. Twenty two relevant articles were found, studied and used in this review.
Results: Subspecialization involves physician focus on a certain area of practice. This leads to better results, progress in the area of choice, higher surgical case rates, fewer complications; and to some extent, lower healthcare costs. However, it causes artificial shortages of surgeons, decreased generalist entry to the field, fragmentation of the specialty field with loss of unity, less trainee experience for residents and does not necessarily translate to a higher income.
Conclusions/Recommendations: The developing world faces an enormous shortage of orthopaedic surgeons. A balance is needed in order to provide an orthopaedic surgeon who can take care of most orthopaedic problems; while also providing a subspecialist orthopaedic surgeons in subspecialty centres and academic centres to manage complex and rare conditions. A middle ground would be an orthopaedic surgeon with a subspecialty area, who practices general orthopaedics in addition to the subspecialty area of interest to manage orthopaedic problems in most hospitals in the developing world.
