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Invited Commentary
February 2014

Evolution of a New Specialty

Author Affiliations
  • 1Department of Surgery, Johns Hopkins Medicine, Bethesda, Maryland
  • 2SUNY Downstate School of Public Health, Brooklyn, New York
JAMA Surg. 2014;149(2):193. doi:10.1001/jamasurg.2013.4378

Did you think that specialization is only for the tertiary care centers? Think again. In my innovative role as regional director for surgery for several community hospitals in a rapidly growing health care system, I have an interesting perspective on what community hospitals are facing with the increasing specialization of surgery. A perfect example is breast surgery.

Within the past 2 years, I have been contacted by the chief executive officers (CEOs) of our community hospitals with the same request: “We are building a breast center; I need a fellowship-trained female breast surgeon as soon as possible.” After convincing them that I am not a short-order cook, that not all breast fellowships are high quality (not all are accredited by bodies such as the Society of Surgical Oncology; a listing of the ones that are accredited is available1), and that obtaining the perfect match for the program they envision will take time, with some work we have been successful in recruiting exactly what we needed. However, it has not been easy—highly qualified surgeons are scarce for this rapidly growing and rapidly changing field.

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