A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children (paediatrics), cancer (oncology), laboratory medicine (pathology), or primary care (family medicine). After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.
To a certain extent, medical practitioners have long been specialized. According to Galen, specialization was common among Roman physicians. 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.
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 as radiology, which was originally based around X-rays.
The age range of patients seen by any given specialist can be quite variable. Paediatricians handle most complaints and diseases in children that do not require surgery, and there are several subspecialties (formally or informally) in paediatrics that mimic the organ-based specialties in adults. Paediatric 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 as pathology, clinical neurophysiology, and radiology. This line is becoming somewhat blurred with interventional radiology, an evolving field that uses image expertise to perform minimally invasive procedures.
|Specialty||May be subspecialty of||Age range|
|Diagnostic (D) or|
|Surgical (S) or|
internal medicine (I)
or technique-based (T)
|Allergy and immunology||Internal medicine|
|Aerospace medicine||Family Medicine||All||Both||Neither||Both|
|Cardiothoracic surgery||General surgery||Adults||T||S||O|
|Child and adolescent psychiatry||Psychiatry||Paediatric||T||I||T|
|Colorectal surgery||General Surgery||All||Both||S||O|
|Emergency medicine||Family Medicine||All||Both||Both||Both|
|General surgical oncology||General surgery||Adults||T||S||T|
|Gynecologic oncology||Obstetrics and gynecology||All||T||S||O|
|Infectious disease||Internal medicine|
|Intensive care medicine||Anesthesiology|
|Maternal-fetal medicine||Obstetrics and gynecology||Adults||T||S||Both|
|Medical biochemistry||Internal medicine||All||D||I||Neither|
|Medical oncology||Internal medicine||Adults||D||I||Neither|
|Obstetrics and gynecology||Family medicine||All||T||S||O|
|Occupational medicine||Family medicine|
|Oral and maxillofacial surgery||None||All||T||S||O|
|Palliative care||Family Medicine|
|Pediatric allergy and immunology||Pediatrics||Pediatric||T||I||O|
|Pediatric emergency medicine||Pediatrics||Pediatric||Both||Both||Both|
|Pediatric hematology and oncology||Pediatrics||Pediatric||T||I||O|
|Pediatric infectious disease||Pediatrics||Pediatric||T||I||O|
|Pediatric respiratory medicine||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|
|Public health||Family medicine||All||Neither||Neither||T|
|Reproductive endocrinology and infertility||Obstetrics and gynecology||Adults||T||S||T|
|Respiratory medicine||Internal medicine||Adults||T||I||O|
|Sports medicine||Family medicine||All||Both||Neither||Multidisciplinary|
|Thoracic surgery||General surgery||Adults||T||S||T|
|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. Note that 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:
|Allergy and immunology||Allergic reactions, asthma, and the immune system|
|Anesthesiology||AN, PAN||Surgery||Anesthesia|
|Bariatrics||Deals with the causes, prevention, and treatment of obesity.|
|Cardiology||Medicine||Disease of the cardiovascular system|
|Cardiovascular surgery||Surgery||The operation of heart and major blood vessels of the chest.|
|Clinical laboratory sciences||Diagnostic||Application of diagnostic techniques in medical laboratories such as assays, microscope analysis.|
|Dermatology||D, DS||Medicine||Dermatology, Mohs surgery||Skin and its appendages (hair, nails, sweat glands etc.).|
|Dietetics||RD||Food and nutrition|
|Emergency medicine||EM||Medicine||The initial management of emergent medical conditions, often in hospital emergency departments or the field.|
|Endocrinology||Medicine||The endocrine system (i.e., endocrine glands and hormones) and its diseases, including diabetes and thyroid 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.|
|Gastroenterology||GI||Medicine||The alimentary tract|
|Geriatrics||IMG||Medicine||Elderly patients|
|Gynecology||Female reproductive health|
|Hepatology||Medicine||The liver and biliary tract, usually a part of gastroenterology.|
|Infectious disease||ID||Medicine||Diseases caused by biological agents|
|Intensive care medicine||Medicine||Life support and management of critically ill patients, often in an ICU.|
|Medical research||Anatomy, Biochemistry, Embryology, Genetics, Pharmacology, Toxicology||Care of hospitalized patients|
|Neurology||N||Medicine||Diseases involving the central, peripheral, and autonomic nervous systems|
|Neurosurgery||NS||Surgery||Disease of the central nervous system, peripheral nervous system, and spinal column.|
|Obstetrics and gynecology||OB/GYN||Surgery|
|Oncology||ON||Medicine||Cancer and other malignant diseases, often grouped with hematology.|
|Ophthalmology||OPH||Surgery||Retina, Cornea||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 the musculoskeletal system.|
|Otorhinolaryngology, or ENT||ORL, ENT||Surgery||Head and neck, facial cosmetic surgery, Neurotology, Laryngology||Treatment of ear, nose, and throat disorders. The term head and neck surgery defines a closely related specialty that is concerned mainly with the 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 with terminal illnesses including cancer and heart failure.|
|Pathology||PTH||Diagnostic||Understanding disease through examination of molecules, cells, tissues and organs. The term encompasses both the medical specialty that uses tissues and body fluids to obtain clinically useful information and the related scientific 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 as pediatric cardiology, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, pediatric oncology, pediatric ophthalmology, and neonatology.||deals with the medical care of infants, children, and adolescents (from newborn to age 16–21, depending on the country).|
|Pediatric surgery||Surgery||Treats a wide variety of thoracic and abdominal (and sometimes urologic) diseases of childhood.|
|Physical medicine and rehabilitation Or Physiatry||PM&R||Medicine||Concerned with functional improvement after injury, illness, or congenital 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 limb mononeuropathy conditions. Reconstructive foot & ankle surgery.|
|Proctology||PRO||Medicine||(or Colorectal Surgery) Treats disease in the rectum, anus, and colon.|
|Psychiatry||P||Medicine||The bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related fields include psychotherapy and clinical psychology.|
|Pulmonology||Medicine||The lungs and respiratory system. Pulmonology is generally considered a branch of internal medicine, although it is closely related to intensive care medicine when dealing with patients requiring mechanical ventilation.|
|Public Health||Public health focuses on the health of populations. Physicians employed in this field work in policy, research or health promotion, taking a broad view of health that encompasses the social determinants of health.|
|Radiology||R, DR||Diagnostic and Therapeutic||The use of expertise in radiation in the context of medical imaging for diagnosis or image guided minimally invasive therapy. X-rays, etc.|
|Rheumatology||RHU||Medicine||Autoimmune and inflammatory diseases of the joints and other organ systems, such as arthritis and other rheumatic diseases.|
|Surgical oncology||SO||Surgery||Curative and palliative surgical approaches to cancer treatment.|
|Thoracic surgery||TS||Surgery||Surgery of the organs of the thoracic cavity: the heart, lungs, and great vessels.|
|Transplant surgery||TTS||Surgery||Transplantation of organs from one body to another|
|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 the male reproductive system. It is often practiced together with andrology ('men's health').|
|Vascular surgery||VS||Surgery||The peripheral blood vessels – those outside the chest (usually operated on by cardiovascular surgeons) and outside the central nervous system (treated by neurosurgery)|
The mean annual salary of a medical specialist in the US in 2006 was $175,011 and $272,000 for surgeons.
The table below details the average range of salaries for physicians in the US of selected specialties as of July 2010. Also given in the average number of hours worked per week for full-time physicians (2003 data).
|Specialty||Median salary (USD)||Average hours|
|Average salary/hour (USD)|
|Anaesthesia||331,000 to $423,507||61|
|Dermatology||313,100 to $480,088||45.5||103|
|Emergency medicine||239,000 to $316,296||46||87|
|Cardiac Surgery||218,684 to $500,000||55|
|Family medicine||175,000 to $220,196||52.5||58|
|Internal medicine||184,200 to $231,691||57||58|
|Neurology||213,000 to $301,327||55.5||93|
|Obstetrics and Gynecology||251,500 to $326,924||61||83|
|Ophthalmology||150,000 to $351,000||47|
|Orthopedic surgery||397,879 to $600,000||58|
|Otolaryngology||191,000 to $393,000||53.5|
|Oral and Maxillofacial Surgery||360,000 to $625,210||53|
|Pediatrics||160,111 to $228,750||54||69|
|Podiatry||170,800 to $315,150||45||80|
|Psychiatry||173,800 to $248,198||48||72|
|Radiology (diagnostic)||377,300 to $478,000||58|
|Surgery (general)||284,642 to $383,333||60|
|Urology||331,192 to $443,518||60.5|
|Neurosurgery||350,000 to $705,000||132|
|Plastic surgery||265,000 to $500,000||114|
|Gastroenterology||251,026 to $396,450||93|
|Pulmonology||165,000 to $365,875||72|
There are 15 recognised specialty medical Colleges in Australia. 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||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, Cardiology, Endocrinology, Gastroenterology, Genetics, Geriatrics, Haematology, Infectious diseases, Immunology, Neonatal, Nephrology, Neurology, Occupational, Oncology, Paediatrics, Palliative medicine, Public Health, Rehabilitation, Respiratory, Rheumatology, Sexual Health||25,000|
|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|
In addition, the Royal Australasian College of Dental Surgeons supervises training of specialist medical practitioners specializing in Oral and Maxillofacial Surgery in addition to its role in the training of dentists. There are approximately 260 faciomaxillary surgeons in Australia.
The Royal New Zealand College of General Practitioners is a distinct body from the Australian Royal 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 Medicine within the Royal Australasian College of Physicians
There are some collegiate bodies in Australia that are not officially recognised as specialities 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 the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. For specialists working in the province of Quebec, the Collège des médecins du Québec also oversees the process.
In Germany these doctors use the term Facharzt.
Specialty training in India is overseen by the Medical Council of India, which is responsible for recognition of post graduate training and by the National Board of Examinations. And education of Ayurveda in overseen by Central Council of Indian Medicine (CCIM), the council conducts u.g and p.g courses all over India, while Central Council of Homoeopathy does the same in the field of Homeopathy.
In Sweden, a medical license is required before commencing specialty training. Those graduating from Swedish medical schools are first required to do a rotational internship of about 1.5 to 2 years in various specialties before attaining a medical license. The specialist training lasts 5 years.
There are three agencies or organizations in the United States that collectively oversee physician board certification of MD and DO physicians in the United States in the 26 approved medical specialties recognized in the country. These organizations are the American Board of Medical Specialties (ABMS) and the American Medical Association (AMA); the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) and the American Osteopathic Association; the American Board of Physician Specialties (ABPS) and the American 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|
All boards of certification now require that medical 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.
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, see central place theory.
The proportion of men and women in different medical specialties varies greatly. Such sex segregation is largely due to differential application.
A survey of physicians in the United States came to the result that dermatologists are most satisfied with their choice of specialty followed by radiologists, oncologists, plastic surgeons, and gastroenterologists. In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists. 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. 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.