Internal Medicine 1976: Consequences of Subspecialization and Technology

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Abstract
Subspecialization can give the best in technical medicine, but it is expensive. Increased costs of fees result, as well as additional risk to patients when specialized techniques are used. Proliferating procedures lead to increases in hospital costs. The ever increasing supply of subspecialists will eventually alter relations between supply and demand. If the subspecialist is not sufficiently occupied due to shrinking work he may look to "primary care" or general medicine, for which he is not as well trained. Excessive subspecialization leads to fragmented care. With several specialists handling a case, ''medicine by committee'' may be needed to unravel a complex case. The general internist will remain as a major provider of primary care, but postgraduate training programs in medicine need to provide more emphasis on ambulatory care and continuing care, a stronger orientation to general medicine and acquisition of knowledge in some of the ambulatory specialities such as dermatology, neurology, office gynecology and psychosmatic medicine.

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