Medical specialty

A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children, cancer, laboratory medicine, or primary care. After completing medical school or other basic training, physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.

History

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.

Classification

Medical specialties can be classified along several axes. These are:

Surgical or internal medicine
Age range of patients
Diagnostic or therapeutic
Organ-based or technique-based

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. Pediatricians handle most complaints and diseases in children that do not require surgery, and there are several subspecialties 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 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.

List of specialties recognized in the European Union and European Economic Area

The European Union publishes a list of specialties recognized in the European Union, and by extension, the European Economic Area. 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.

List of North American medical specialties and others

In this table, as in many healthcare arenas, medical specialties are organized into the following groups:

Surgical specialties focus on manually operative and instrumental techniques to treat disease.
Medical specialties that focus on the diagnosis and non-surgical treatment of disease.
Diagnostic specialties focus more purely on diagnosis of disorders.

Specialty	Code	Group	Sub-specialties	Focus
Allergy and immunology				Allergic reactions, asthma, and the immune system.
Anesthesiology	AN, PAN	Surgery	Pediatric anesthesia Pain management Intensive care Critical care Obstetrics and gynaecology Cardiothoracic anesthesiology Trauma care Pre- and Post-Operative Assessment and Care Generalist	Anesthesia
Bariatrics				Deals with the causes, prevention, and treatment of obesity.
Cardiology		Medicine	Interventional cardiology Echocardiography Electrocardiography Sports cardiology Cardiogeriatrics Preventive cardiology and Cardiac Rehabilitation Pediatric cardiology	Disease of the cardiovascular system.
Cardiovascular surgery		Surgery		The operation of heart and major blood vessels of the chest.
Clinical laboratory sciences		Diagnostic	Transfusion medicine is concerned with the transfusion of blood and blood component, including the maintenance of a "blood bank". Cellular pathology is concerned with diagnosis using samples from patients taken as tissues and cells using histology and cytology. Clinical chemistry is concerned with diagnosis by making biochemical analysis of blood, body fluids, and tissues. Hematology is concerned with diagnosis by looking at changes in the cellular composition of the blood and bone marrow as well as the coagulation system in the blood. Clinical microbiology is concerned with the in vitro diagnosis of diseases caused by bacteria, viruses, fungi, and parasites. Clinical immunology is concerned with disorders of the immune system and related body defenses. It also deals with diagnosis of allergy.	Application of diagnostic techniques in medical laboratories such as assays, microscope analysis.
Dermatology	D, DS	Medicine	Dermatology, Mohs surgery	Skin and its appendages.
Dietetics	RD			Food and nutrition
Emergency medicine	EM	Medicine	Disaster medicine Emergency medical services Hospice and palliative medicine International Emergency Medicine and Global Health Medical toxicology Pediatric emergency medicine Research Simulation Sports medicine Toxicology Ultrasound Undersea and hyperbaric medicine Wilderness medicine	The initial management of emergent medical conditions, often in hospital emergency departments or the field.
Endocrinology		Medicine		The endocrine system and its diseases, including diabetes and thyroid diseases.
Family medicine	FM	Medicine	Addiction medicine Adolescent medicine Anesthesia Emergency medicine Care of the elderly Clinical environmental health Global health HIV care Hospital medicine Indigenous health Low-risk obstetrics Medical education Medical oncology Medical simulation Pain medicine Palliative care Point of Care Ultrasound Research Sleep medicine Sports and exercise medicine Women's health	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		The alimentary tract
General surgery	GS	Surgery	Colorectal surgery Gastrointestinal surgery Transplant surgery Trauma surgery
Geriatrics	IMG	Medicine		Elderly patients
Gynecology				Female reproductive health
Hepatology		Medicine		The liver and biliary 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 an ICU.
Internal medicine		Medicine
Medical research			Anatomy, Biochemistry, Embryology, Genetics, Pharmacology, Toxicology	Care of hospitalized patients
Nephrology		Medicine		Kidney diseases
Neurology	N	Medicine	Behavioral neurology Clinical neurophysiology Geriatric neurology Headache medicine Neuromuscular medicine Neurodevelopmental disabilities Neuro-oncology Neuroradiology Vascular neurology Hospice and palliative medicine Pain medicine Sleep medicine	Diseases involving the central, peripheral, and autonomic nervous systems.
Neurosurgery	NS	Surgery	Cerebrovascular Neurosurgical oncology Stereotactic and functional Spine Neurotrauma Skull base Peripheral nerve Pediatric neurosurgery	Disease of the central nervous system, peripheral nervous system, and spinal column.
Obstetrics and gynecology	OB/GYN	Surgery	Maternal-fetal medicine Reproductive medicine Fertility medicine Gynecologic oncology
Oncology	ON	Medicine	Radiation oncology – pertains to the use of radiation therapy as part of cancer treatment to control malignant cells.	Cancer and other malignant diseases, often grouped with hematology.
Ophthalmology	OPH	Surgery	Anterior segment surgery Cornea Glaucoma Neuro-ophthalmology Ocular oncology Oculoplastics and Orbital surgery Ophthalmic pathology Pediatric ophthalmology/strabismus Refractive surgery Medical retina Uveitis Vitreo-retinal surgery	Diseases of the visual pathways, including the eyes, brain, etc.
Oral and maxillofacial surgery	Maxfacs, OMS	Surgery	Oral and Craniofacial surgery Facial cosmetic surgery Craniomaxillofacial trauma	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.
Pediatric surgery		Surgery	Treats a wide variety of thoracic and abdominal diseases of childhood.
Physical medicine and rehabilitation Or Physiatry	PM&R	Medicine	Cancer Rehabilitation Pain Management Traumatic Brain Injury Spinal Cord Injury Sports Medicine Pediatrics Hospice & Palliative Medicine	Concerned with functional improvement after injury, illness, or congenital disorders.
Plastic surgery	PS	Surgery	Cosmetic surgery Burn Microsurgery Hand surgery Craniofacial surgery	Elective cosmetic surgery as well as reconstructive surgery after traumatic or operative mutilation.
Podiatry	POD	Surgery	Forefoot surgery Midfoot surgery Rearfoot surgery Ankle surgery Soft tissue leg 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		treats disease in the rectum, anus, and colon.
Psychiatry	P	Medicine	Addiction psychiatry focuses on substance abuse and its treatment. Child and adolescent psychiatry focuses on the care of children and adolescents with mental, emotional, and learning problems including ADHD, autism, and family conflicts. Consultation-Liaison psychiatry focuses on the interface between general medicine and psychiatry. Forensic psychiatry focuses on the interface of psychiatry and law. Geriatric psychiatry focuses on the care of elderly people with mental illnesses including dementias, post-stroke cognitive changes, and depression. Neuropsychiatry focuses on affective, cognitive and behavioral disorders attributable to diseases of the nervous system Sleep medicine focuses on the diagnosis and treatment of sleep disorders. Hospice and Palliative Medicine Pain 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	Interventional radiology is concerned with using expert imaging of the human body, usually via CT, ultrasound, fluoroscopy, or MRI to perform a breadth of intravascular procedures, biopsies and minimally invasive oncologic procedures Nuclear medicine uses radioactive substances for in vivo and in vitro diagnosis either using imaging of the location of radioactive substances placed into a patient or using in vitro diagnostic tests utilizing radioactive substances.	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.
Toxicology		Diagnostic and Therapeutic	Environmental Forensic Occupational Pediatric	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 the male reproductive system. It is often practiced together with andrology.
Vascular surgery	VS	Surgery		The peripheral blood vessels – those outside the chest and outside the central nervous system.

Salaries

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.
The table below details the average range of salaries for physicians in the US of medical specialties:

Specialty	Average salary	Average hours work/week	Average salary/hour
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

By country

Australia and New Zealand

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	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	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

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: within the Royal 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:
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

Canada

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.

Germany

In Germany these doctors use the term Facharzt.

India

Specialty training in India is overseen by the National Medical Commission, responsible for recognition of post graduate training and by the National Board of Examinations. Education of Ayurveda in overseen by Central Council of Indian Medicine, the council conducts UG and PG courses all over India, while Central Council of Homoeopathy does the same in the field of Homeopathy.
Specialization and superspecialization in medicine and surgery are pursued after completing MBBS, for which higher medical and surgical degrees are awarded. The following medical and surgical specialties and superspecialties are recognized by the National Medical Commission and National Board of Examinations in Medical Sciences:

Sweden

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.

United States

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 and the American Medical Association ; the American Osteopathic Association Bureau of Osteopathic Specialists and the American Osteopathic Association; the American Board of Physician Specialties and the American Association of Physician Specialists. 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 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.

Demography

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.

Satisfaction and burnout

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 as well as among physicians in training, 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 Theo's specialties with more patient contact. Rates of burnout also varied by specialty.