In my friend Mark Aronson’s accompanying article, “Be Careful What You Ask For,” he makes very reasonable proposals for what I see as intermediate steps toward specialty status. And he makes good points about some risks of becoming a specialty. I think we should move somewhat slowly toward specialty status so that the concerns he identifies can be addressed. But rather than identifying issues that are unique for Hospital Medicine, he has listed questions that probably arose in the formative years of every specialty and were subsequently addressed as the field “grew up.” He uses the example of electrophysiology as a field that requires additional training beyond the standard cardiology fellowship, and he suggests that it is the additional training that justifies the field’s exam and subspecialty status. But at some point in the early evolution of electrophysiology and any other field, there was no unique training program and practitioners learned the discipline through things such as self study, CME courses, and concentrating their practice on that clinical area. Isn’t that where we find ourselves in Hospital Medicine today?
Summary
The benefits of continued movement toward recognizing Hospital Medicine as a distinct specialty outweigh the costs. Indeed, without ever having an organized effort or agenda for this, our field has made many significant steps in that direction. What will require ongoing careful consideration is the pace at which the next steps in maturation of the field should proceed. While there are sure to be many differences in the path Hospital Medicine takes to specialty status, there are numerous lessons to be learned from the history of other specialties, such as Emergency Medicine. In 1969, Dr. John Wiegenstein wrote in the first Newsletter of the American College of Emergency Physicians that “We are, in a sense, a new breed of doctors dedicated to a new concept of medicine.” Most hospitalists feel the same way about Hospital Medicine, and I think we will mark very similar milestones toward specialty status in the coming years.
Reference
- Brennan TA, Horwitz RI, Duffy FD, Cassel CK, Goode LD, Lipner RS. The Role of Physician Specialty Board Certification Status in the Quality Movement. JAMA.2004;292:1038-43.