Specialization, Subspecialization, and Subsubspecialization in Internal Medicine
- 24 March 2011
- journal article
- review article
- Published by Massachusetts Medical Society in The New England Journal of Medicine
- Vol. 364 (12), 1169-1173
- https://doi.org/10.1056/nejmsb1012647
Abstract
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. Specifically, in the past 2 years the ABIM has launched certification in the fields of hospice and palliative care and advanced heart failure and has begun a process for internal-medicine certification with a focused practice in hospital medicine. The ABIM has also approved the subspecialty of adult congenital heart disease to move forward to the American Board of Medical Specialties (ABMS) for final approval. 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.”Keywords
This publication has 9 references indexed in Scilit:
- Considering RecertificationThe New England Journal of Medicine, 2010
- American Board of Internal Medicine Maintenance of Certification ProgramThe New England Journal of Medicine, 2010
- 21st-Century Primary CareJAMA, 2008
- Who Is Maintaining Certification in Internal Medicine—and Why? A National Survey 10 Years after Initial CertificationAnnals of Internal Medicine, 2006
- The Role of Physician Specialty Board Certification Status in the Quality MovementJAMA, 2004
- Primary care physicians should be coordinators, not gatekeepers.JAMA, 1999
- As the Board Sees ItThe New England Journal of Medicine, 1978
- The Doctors' DilemmaThe New England Journal of Medicine, 1978
- The Rise of the Practice of Internal Medicine as a SpecialtyThe New England Journal of Medicine, 1950