1. THE HISTORY AND EFFECTS OF SUBSPECIALIZATION
Elijah Muteti

2. 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”

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

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

5. 2nd half of the 20th century- europe
Traumatologist
Injuries musculoskeletal, abdomen, genitourinary, vessels and nerves

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

7. 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

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

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

10. 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

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