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May 16, 2012

Specialization in Health Care

Author Affiliations

Author Affiliations: Emory University, Atlanta, Georgia (Dr Johns; mmejohns@emory.edu); University of California, San Francisco (Dr Debas); and American Board of Otolaryngology, Houston, Texas (Dr Miller).

JAMA. 2012;307(19):2025. doi:10.1001/jama.2012.3625

To the Editor: Specialties are established based on scientific knowledge and technology, and they evolve as knowledge expands and technologies develop. It is the nature of progress.

Dr Detsky and colleagues1 do not distinguish between specialties and specialists. Physicians enter a specialty because of their interest, inspirational role models, and the characteristics of that specialty. While financial gain may sometimes play a role, we have observed that professional inquisitiveness and the personal satisfaction of having expert knowledge are the much stronger drivers for selection of any specialty, including primary care. Said differently, financial gain may sometimes be a reason for physicians choosing a specialty, but that is not the driver for the creation of specialties.