THE HISTORY AND EFFECTS OF SUBSPECIALIZATION Elijah Muteti

The earliest reference to physician specialization is in the records of Herodotus. He commented: “In Egypt, unlike Babylon, physicians treated only one illness. As a result, there were physicians everywhere in Egypt”

Doctor Was Clear Medicine was one = true GPs Late 19th century- Dentistry 1929- Medicine and Surgery

Surgery 1937- ophthalmology, otolaryngology & urology 1943- obstetrics & gynaecology 1944- orthopaedics 1945- neurosurgery

2nd half of the 20th century- europe Traumatologist Injuries musculoskeletal, abdomen, genitourinary, vessels and nerves

Orthopaedic Surgery 1960s- John Charnley Hand society was the first recognised in USA 2003- 19 societies

Benefits of Subspecialization ?Need: Clement 13-25% of cases Muzumdar: “Era of refinement” One cannot maintain expertise in all fields Innovative methods- perception change in doctors and patients

Overall costs lower Case loads increased, standardization of procedures =Outcomes Better Personal interests

Challenges of Subspecialization SAOA and AAOS: Fragmentation and loss of unity Shortage of general surgeons Artificial shortage of orthopaedic surgeons Compromised resident training

Financial returns Adult spine, shoulder and elbow, sports medicine, hand, and adult arthroplasty may yield a positive return Trauma yields a neutral return Pediatrics and foot and ankle have negative net Working hours were controlled for, the returns for adult arthroplasty and trauma became neg

Conclusion Balance is needed (service, interest, investment) Generalist with a sub-specialty Sub-specialists in academic and national hospitals