Specialties & Specialty Medicine
By Alexander Germanis
My wife pretty consistently chides me for having too many interests and stretching myself too thin when it comes to learning new skills. I will admit that while trying to learn a lot of things is an admirable pursuit, it does all but prevent me from truly mastering even one skill.
For many years, physicians the nation over probably understood this quandary. The town doctor or the family physician had to know a little bit of everything in order to do their job at a decent level of efficacy.
The problem lies in the fact the human body is capable of contracting so many illnesses, getting injured in so many ways, and requires a level of knowledge so varied as to maintaining its wellness, we are still only scratching the surface of truly comprehensive healthcare. The need for medical professionals and programs as diverse as our bodies, therefore, is a necessity for tackling all the many issues one may encounter throughout one’s life.
Changing Needs
The growing need for specialization in medicine has not grown alone within the medical world. The simple increase in population demands an increase in numbers in the field of medicine. Anyone who has felt more like they’re waiting for a pastrami on rye at the deli instead of for a checkup with their doctor has experienced the uneven doctor/patient ratio firsthand.
Still, the ratio has improved. The latest data gathered was in 2019, which showed a 9.3 percent increase since 2009 in the doctor-to-patient ratio in the United States. Regardless, the current numbers reveal there are only roughly 250 to 280 physicians per 100,000 people. That ratio varies, of course, depending on location.
Growth within certain demographics has placed more of a need on medical specialty growth as well. Sports medicine, for instance, is one of the fastest-growing specialties, due to an increased interest not just in athletics but also in general fitness. According to a 2022 study conducted by the Association of American Medical Colleges (AAMC), sports medicine has seen an increased rate of 42.5 percent between 2015 and 2022, with the most recent numbers showing the numbers are continuing to increase. Sports medicine orthopedics has shown similar growth.
Pediatric anesthesiology and interventional cardiology have shown larger numbers in recent years as well. With the Baby Boomer Generation in their senior years, it is not surprising that there has also been an increased number of specialists in hospice and palliative medicine. Surgical critical care, critical care medicine (also called intensive care), and neuroradiology physicians have also increased. The COVID year also prompted a shift in specialties, with telehealth and team-based care becoming a new reality for many in the medical field.
Alphabet Soup
In the days of house calls and town doctors, the doctor might have had the letters MD after their name. The ‘medical doctor’ title was universally understood and, likewise, was expected to provide fairly universal care.
Any visit to a doctor’s office now, however, may reveal a veritable alphabet soup of post-name abbreviations. The AuD, or doctor of audiology is an expert in hearing. DPMs or doctors of podiatric medicine are trained in the care of the foot. An otolaryngologist (ENT) specializes in the ear, nose, and throat, while OB/GYNs focus on women’s reproductive health and childbirth.
These make up just a small fraction of specialists in the medical world. Depending on your personal needs, any number of specialists might be needed to treat or prevent your health conditions. Neurologists, physiatrists, urologists, radiologists, pathologists, dermatologists, ophthalmologists, and oncologists are all given further training beyond medical school, focusing on their respective specialties.
It is becoming more and more common for one’s primary care physician (PCP) to refer patients to a specialist in cases when a patient could benefit from their focused experience.
No ‘I’ in ‘Team’
If you’ve been to the doctor recently, it is highly unlikely you left the office with nothing expected of you. You were either prescribed new medication, asked to read up on your health condition, encouraged to exercise more, or scolded into eating healthier. Being an active participant in your own healthcare team is part of the team-based or collaborative care model.
Team-based care is as it sounds – a team of medical professionals working together toward the best health outcome for you. The team may include physicians, nurse practitioners, physicians’ assistants, medical assistants, pharmacists, social workers, and of course, the patient and their family.
As an example, an overweight person may suffer from obstructive sleep apnea. A team-based approach to their care would involve the primary care physician, a sleep physician to study the person’s sleep cycles, a dietician to focus on improving diet, a cardiologist to monitor the effects their apnea is having on their heart, and so on.
Utilizing modern technology is a key aspect of team-based care. Through telehealth, text communication, online conferencing between physicians, etc., the team can better communicate and update one another and make the best decisions as to a treatment moving forward.
31-ish Flavors of Care
If you’ve ever had the fortune to stay in a hotel where you didn’t have to inspect the bedsheets before lying down, you may have experienced a degree of specialized care from the hotel concierge. The concierge is meant to be at one’s beck and call 24 hours a day, catering to the needs of the guests.
Concierge care, also called boutique or retainer-based medicine, is somewhat similar in concept. With a flat monthly fee, a patient can have unlimited visits, are often seen the same day or day after making an appointment, spend more time with their doctor per visit, don’t have to worry about copays or other charges, have direct access to their direct care physicians (DCPs) day and night, and more. Patient-to-doctor ratios are closer to 80 patients per physician. Fees do, however, vary by practice, increase as one ages, and are in addition to regular insurance premiums. Subscription-based medical service is similar to concierge care in many ways.
Integrative Medicine is another ‘flavor’ of healthcare in today’s medical world. Integrative medicine treats the whole person rather than just treating symptoms. While it uses a more holistic approach to treatment, it is not the same as holistic medicine. As intimated by its name, integrative medicine involves not only conventional Western treatments but also Eastern therapies such as acupuncture and yoga. By combining multiple disciplines, it focuses on all facets of one’s health: physical, mental, emotional, and spiritual. Most importantly, integrative medicine integrates the patient directly as an active participant in their health care.
Assess Your Needs
The medical care landscape has certainly changed in the last several decades, with the number of specialists and specialties on the increase, an expansion in the modalities of medicine, and even in how healthcare is being dispensed. How one decides to access this changing healthcare world depends on multiple factors.
What personal health issues do you have? Based on your family medical history, what conditions or diseases are you worried about becoming a reality in your future? What kind of healthcare model best fits your personal beliefs or concerns? How convenient do you want to make healthcare for yourself? How much can you sensibly afford?
Finding many masters in their respective fields or trying a new method for your personal healthcare are two things to strongly consider. Ultimately, the decision to take care of your health is yours and yours alone. The first, last, and most important member of your personal healthcare team is you.
