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Article
March 9, 1984

XXI. Medical Practice: Specialization

Author Affiliations

From the Morris Fishbein Center, University of Chicago.

JAMA. 1984;251(10):1333-1338. doi:10.1001/jama.1984.03340340061030
Abstract

Shortly after the middle of the 19th century, specialization in medicine increased greatly. It formed part of the vast expansion of knowledge and the improvement in patient care that characterized the era. However, there also developed many internal strains whose study provides an excellent approach to medical practice and the sociology of medicine.

Central to the story of specialization is the consultant, who could help the general practitioner with a difficult case. In the 17th and 18th centuries, in Great Britain, the physician, who held an MD degree, would act as consultant for the apothecary, who did not have university training.1 In the United States, even though the distinction of physician and apothecary did not obtain, the consultation always had a prominent part in medical practice. By virtue of training and experience the consultant was qualified to give advice. When called in consultation he could unearth new evidence, or

References
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 Specialization in medicine has a vast literature. For an orientation into the larger problems I suggest Rosemary Stevens ,  American Medicine and the Public Interest , New Haven, Conn, Yale University Press, 1971
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Burton J. Bledstein,  The Culture of Professionalism , New York, Norton, 1976. Specific references are indicated below.
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Lester S. King, " The AMA Gets a New Code of Ethics ,"  JAMA 1983; 249:1338-1342Crossref
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Maynard C. Wheeler,  The American Ophthalmological Society: The First Hundred Years , University of Toronto Press, 1964, p 5.
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 A particularly important source of opinion is the extensive discussion that followed several papers on specialism. The discussion is much more revealing than the actual papers and is found  Bull Am Acad Med 18994, p 191
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Woods Hutchinson, " Some of the Disadvantages of Specialism ,"  Med Rec 1895; 48:518-519
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