It’s like the Wild, Wild West, the (physician specialty) turf wars…. (A)

My first experience with clinical turf competition was in 1968 as administrator of the Department of Surgery at Wilford Hall U.S.A.F. Medical Center. The Chiefs of general surgery, E.N.T., and Oral Maxillofacial Surgery each needed Head & Neck surgical cases for their residents. Time and time again protocols were agreed upon to rotate the cases but they always broke down when residents in one specialty or another needed the required number of H&N cases before they graduated. Interestingly I never recall that any of the Chiefs thought the patients had a role in the decision-making.


Fast Forward! STENTS

We all know about cardiac stents. Now cardiologists have seamlessly moved on to use stents for treatment of renal artery stenosis (B) and carotid artery disease (C).

But this is just the tip of the iceberg. “Currently, the major interventional specialties are interventional (or vascular) radiology, interventional cardiology, and endovascular surgical (interventional) neuroradiology. All three are perfecting the use of stents and other procedures to keep diseased arteries open, while also evaluating the application these procedures. The rapid new development of imaging technologies, mechanical devices, and types of treatment, while certainly beneficial to the patient, can also lead to ambiguity regarding specific specialty claims on certain techniques and devices.” (D)


Some other clinical areas where specialties overlap or may not be intuitively understood.


Urogynecology. Female Urology.

An urogynecologist is an obstetrician/gynecologist who has completed fellowship training in the evaluation and treatment of pelvic floor disorders. (E)

Urology is a surgical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs……Female Urology (urinary incontinence and pelvic outlet relaxation disorders) (F)


Child Neurology. Pediatric Neurology.

Child neurologists are medical doctors who have completed: Four years of medical school; At least 1 to 2 years of pediatric residency; Three or more years of residency training in adult and child neurology. In addition, most child neurologists have certification from the American Board of Pediatrics and the American Board of Psychiatry and Neurology (with special competency in child neurology). (G)


Sports Medicine

AOSSM members are orthopaedic surgeons and allied health professionals who demonstrate scientific leadership, involvement and dedication in the daily practice of sports medicine. (H)

Sports medicine physicians, who may be allopathic or osteopathic physicians, focus their practice on health care for athletes and physically active individuals. Sports medicine primary care physicians treat anyone who is physically active help them improve performance, enhance overall health, prevent injury and maintain their physical activity throughout their lives. Some work with professional and amateur sports teams. (I)


Pain Medicine

The American Academy of Pain Medicine (AAPM) is the medical specialty society representing physicians practicing in the field of pain medicine. As a medical specialty society, the Academy is involved in education, training, advocacy, and research in the specialty of pain medicine.

The practice of pain medicine is multi-disciplinary in approach, incorporating modalities from various specialties to ensure the comprehensive evaluation and treatment of the pain patient. AAPM represents the diverse scope of the field through membership from a variety of origins, including such specialties as anesthesiology, internal medicine, neurology, neurological surgery, orthopedic surgery, physiatry, and psychiatry. (J)


Board Certified

No matter which type of physician you choose, only go to those who are BOARD CERTIFIED. “Board Certification is a voluntary process, and one that is very different from medical licensure. Obtaining a medical license sets the minimum competency requirements to diagnose and treat patients, it is not specialty specific. Board Certification demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice.” (K)

Typically, for example a Board Certified surgeons will have F.A.C.S. (Fellow, American College of Surgeons) after their names. John Smith, M.D., F.A.C.S. There is no modesty here, a Board Certified physician will let you know.

There used to be the term “Board Eligible” which meant a physician finished residency training but had not taken and/ or passed the Board exam. Some physicians called themselves Board Eligible for their entire careers. Beware the use of the term Board Eligible unless the physician has just finished training and waiting to take the Board exam the first time it is given.


On the horizon a new clinical specialty? Complex Care Management

“Persons whose conditions require complex continuous care and frequently require services from different practitioners in multiple settings.

Care management of patients with complex care needs Usually patients who are Medicare beneficiaries with multiple chronic conditions, frequent hospitalizations, and limitations on their ability to perform basic daily functions due to physical, mental and psychosocial challenges. Patients with complex health care are patients at the far end of a population-wide spectrum ranging from health individuals to people with serious medical problems and high utilization of heath care services.” (L)


Dentistry is getting confusing too:

We are used to the traditional array of dental residency training programs and Board Certification: Dental Public Health; Endodontics; Oral and Maxillofacial Pathology; Oral and Maxillofacial Radiology; (Pathology and Radiology are news to me) Oral and Maxillofacial Surgery; Orthodontics and Dentofacial Orthopedics; Pediatric Dentistry; Periodontics; Prosthodontics. (M)

Now we see: the elevation of general dentistry (N); cosmetic dentistry (O); sedation dentistry (P); geriatric dentistry (Q); and full mouth reconstruction (have you seen the TV ads for FMR all in one day, financing available!)

As always when faced with difficult and complex clinical options, in this case being certain you are going to see the right specialist, your primary care physician should be your advisor and advocate (and should disclose any “conflicts” he or she has related to the issue at hand).

















Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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