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Amedical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, orphilosophy. Examples include those branches of medicine that deal exclusively with children (pediatrics), cancer (oncology), laboratory medicine (pathology), or primary care (family medicine). After completingmedical school or other basic training,physicians orsurgeons and otherclinicians usually further theirmedical education in a specific specialty of medicine by completing a multiple-yearresidency to become a specialist.[1]
To a certain extent, medical practitioners have long been specialized. According toGalen, specialization was common among Roman physicians.[2] 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]
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 asradiology, which was originally based aroundX-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 aspathology,clinical neurophysiology, and radiology. This line is becoming somewhat blurred withinterventional radiology, an evolving field that uses image expertise to perform minimally invasive procedures.
| 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 | Both | 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 | Both | 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 orRespiratory 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 |
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.
In this table, as in many healthcare arenas, medical specialties are organized into the following groups:
| Specialty | Code | Group | Sub-specialties | Focus |
|---|---|---|---|---|
| Allergy andimmunology | Allergic reactions, asthma, and the immune system. | |||
| Anesthesiology | AN, PAN | Surgery[4][citation needed] |
| Anesthesia |
| Bariatrics | Deals with the causes, prevention, and treatment ofobesity. | |||
| Cardiology | Medicine |
| Disease of thecardiovascular system. | |
| Cardiovascular surgery | Surgery | The operation ofheart and majorblood vessels of thechest. | ||
| Clinical laboratory sciences | Diagnostic |
| Application of diagnostic techniques inmedical laboratories such asassays,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 |
| The initial management of emergent medical conditions, often in hospitalemergency departments or the field. |
| Endocrinology | Medicine | Theendocrine system (i.e.,endocrine glands andhormones) and its diseases, includingdiabetes andthyroid diseases. | ||
| Family medicine | FM | Medicine |
| 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 | Thealimentary tract | |
| General surgery | GS | Surgery |
| |
| Geriatrics | IMG | Medicine[4][citation needed] | Elderly patients | |
| Gynecology | Female reproductive health | |||
| Hepatology | Medicine | Theliver andbiliary 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 anICU. | ||
| 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 autonomicnervous systems. |
| Neurosurgery | NS | Surgery | Disease of thecentral nervous system,peripheral nervous system, andspinal 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 |
| 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 themusculoskeletal system. |
| Otorhinolaryngology, or ENT | ORL, ENT | Surgery | Head and neck, facial cosmetic surgery,Neurotology, Laryngology | Treatment of ear, nose, and throat disorders. The termhead and neck surgery defines a closely related specialty that is concerned mainly withthe 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 withterminal illnesses includingcancer andheart failure. | |
| Pathology | PTH | Diagnostic | Understandingdisease through examination ofmolecules,cells,tissues andorgans. The term encompasses both the medical specialty that uses tissues and body fluids to obtain clinically useful information and the relatedscientific 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 aspediatric cardiology,pediatric emergency medicine,pediatric endocrinology,pediatric gastroenterology,pediatric hematology,pediatric oncology,pediatric ophthalmology, andneonatology. | Deals with the medical care ofinfants,children, andadolescents (fromnewborn to age 16–21, depending on the country). |
| Pediatric surgery | Surgery | Treats a wide variety ofthoracic andabdominal (and sometimesurologic) diseases of childhood. | ||
| Physical medicine and rehabilitation Or Physiatry | PM&R | Medicine |
| Concerned with functional improvement after injury, illness, orcongenital disorders. |
| Plastic surgery | PS | Surgery |
| Elective cosmetic surgery as well as reconstructive surgery after traumatic or operative mutilation. |
| Podiatry | POD | Surgery |
| Elective podiatric surgery of the foot and ankle, lower limb diabetic wound and salvation,peripheral vascular disease limb preservation, lower limbmononeuropathy conditions. Reconstructivefoot & ankle surgery. |
| Proctology | PRO | Medicine | (orcolorectal surgery) treats disease in therectum,anus, andcolon. | |
| Psychiatry | P | Medicine |
| Thebio-psycho-social study of theetiology,diagnosis, treatment andprevention ofcognitive,perceptual,emotional andbehavioral disorders. Related fields includepsychotherapy andclinical psychology. |
| Pulmonology | Medicine | The lungs andrespiratory system.Pulmonology is generally considered a branch ofinternal medicine, although it is closely related tointensive care medicine when dealing with patients requiringmechanical ventilation. | ||
| Public Health | Public health focuses on the health of populations. Physicians employed in this field work in policy, research orhealth promotion, taking a broad view of health that encompasses thesocial determinants of health. | |||
| Radiology | R, DR | Diagnostic and Therapeutic |
| The use of expertise in radiation in the context ofmedical imaging fordiagnosis or image guided minimally invasive therapy.X-rays, etc. |
| Rheumatology | RHU | Medicine | Autoimmune and inflammatory diseases of thejoints and other organ systems, such asarthritis and otherrheumatic diseases. | |
| Surgical oncology | SO | Surgery | Curative and palliative surgical approaches tocancer treatment. | |
| Thoracic surgery | TS | Surgery | Surgery of the organs of thethoracic cavity: the heart, lungs, and great vessels. | |
| Transplant surgery | TTS | Surgery | Transplantation oforgans from one body to another. | |
| Toxicology | Diagnostic and Therapeutic |
| 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 themale reproductive system. It is often practiced together withandrology ("men's health"). | |
| Vascular surgery | VS | Surgery | The peripheral blood vessels – those outside thechest (usually operated on bycardiovascular surgeons) and outside thecentral nervous system (treated byneurosurgery). |
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:[6][7]
| Specialty | Average salary (USD) | Average hours work/week | Average salary/hour (USD) |
|---|---|---|---|
| Allergy and 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 and rehabilitation | $322K | ||
| Preventative medicine | $243K | ||
| Pulmonary medicine | $353K | 55 | |
| Psychiatry | $287K | 46 | 72 |
| Radiology | $437K | 56 | |
| General surgery | $402K | 58 | |
| Urology | $461K | 59 | |
| Neurosurgery | 350,000 to $705,000 | 132 | |
| Plastic surgery | $576K | 114 | |
| Gastroenterology | $453K | 55 | 93 |
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 |
|---|---|---|
| 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 |
TheRoyal Australasian College of Dental Surgeons supervises training of specialist medical practitioners specializing inoral and maxillofacial surgery in addition to its role in the training ofdentists. There are approximately 260 faciomaxillary surgeons in Australia.[11]
TheRoyal New Zealand College of General Practitioners is a distinct body from the AustralianRoyal 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 MedicineArchived 2014-12-11 at theWayback Machine within theRoyal Australasian College of Physicians
There are some collegiate bodies in Australia that are not officially recognised as specialties 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
Specialty training in Canada is overseen by theRoyal College of Physicians and Surgeons of Canada and theCollege of Family Physicians of Canada. For specialists working in the province ofQuebec, theCollège des médecins du Québec also oversees the process.
In Germany these doctors use the termFacharzt.
Specialty training in India is overseen by theMedical Council of India, responsible for recognition of post graduate training and by theNational Board of Examinations. Education ofAyurveda in overseen byCentral Council of Indian Medicine (CCIM), the council conducts UG and PG courses all over India, whileCentral Council of Homoeopathy does the same in the field of Homeopathy.
In Sweden, amedical license is required before commencing specialty training. Those graduating from Swedishmedical schools are first required to do a rotationalinternship of about 1.5 to 2 years in various specialties before attaining a medical license. The specialist training lasts 5 years.[12]
There are three agencies or organizations in the United States that collectively overseephysician board certification ofMD andDOphysicians in the United States in the 26 approved medical specialties recognized in the country. These organizations are theAmerican Board of Medical Specialties (ABMS) and theAmerican Medical Association (AMA); theAmerican Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) and theAmerican Osteopathic Association; theAmerican Board of Physician Specialties (ABPS) and theAmerican 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 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 thatmedical 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]
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, seecentral place theory.[13]
The proportion of men and women in different medical specialties varies greatly.[14] Such sex segregation is largely due to differential application.[15]
A survey ofphysicians in the United States came to the result that dermatologists are most satisfied with their choice of specialty followed byradiologists,oncologists,plastic surgeons, andgastroenterologists.[16] In contrast,primary care physicians were the least satisfied, followed bynephrologists,obstetricians/gynecologists, andpulmonologists.[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]
