January 30, 2014
Weekly Language Usage Tips: specialty or subspecialty
A reader writes:
During one of our faculty meetings yesterday, an argument erupted over the use of “specialist” vs. “subspecialist.” While no punches were thrown, the discussion was quite heated, and we figured out that the only way to get resolution would be to consult with the WLUT specialist (or subspecialist). To my knowledge, this has not been previously discussed in this forum (and I did check the web link).
The question would be, is a cardiologist a “specialist” or a “subspecialist”?
Argument #1: A cardiologist is a specialist. We (gen med types) are also internal medicine specialists. An invasive cardiologist (or a palliative care oncologist) would be a subspecialist.
Argument #2: We (gen med types) are internal medicine specialists. A cardiologist is also an internal medicine specialist, with a cardiology subspecialty (making her a subspecialist).
What say you?
I feel that I am a good person to answer this burning question, especially with all of my extensive medical training and background. (NOT) But since when has that ever stopped me? I’ll take this on.
I have to admit, my views have changed over time. When I first started working in medicine specifically in the Division of General Internal Medicine (DGIM), having absolutely no background or understanding of medicine or the training associated with it, I assumed that all the physicians in DGIM were generalists. What did I know? The logic made sense to me. General medicine—generalists. I very quickly learned that internal medicine was a specialty, and my colleagues were specialists in internal medicine. Okay. Got that.
But what about cardiologists? I did some research on the Internet to come up with my answer.
[Man, what did we do before search engines? I lived it, but I honestly can’t imagine it now.]
My inclination is to go with argument number 2, above. She is a subspecialist. A cardiologist is an internal medicine specialist with a subspecialty in cardiology. An invasive cardiologist would still be a subspecialist. I have read that some, in the academic community, are talking about sub-subspecialists, but that has not completely caught on yet, and I’d stay away from that.
One finding of interest is that the US has many more specialties and subspecialties than any other country, about 160 in 2011, and there are proponents of increased specialization as well as opponents.
Finally, I decided to ask a cardiologist, who confirmed my point of view. He told me:
“Cardiologists are required to train in the specialty of internal medicine prior to cardiovascular disease fellowship. So, cardiology is considered a subspecialty.”
And there you have it.