Recent essays by prominent surgical leaders1-5 have drawn attention to the phenomenon of specialization in medicine. Along with other major categories of change (technology, education, economic, political), one impact of specialization is its tendency to rearrange the existing patterns of medical and surgical care. In some instances, specialization leads to a significant change in the way specialties interact with each other.
This process is evolutionary and dynamic, and it attracts attention, because it modifies the status quo. Even so, the majority of those in such organizations as the American Board of Medical Specialties are on record as concluding that the growth of subspecialization is inevitable and is not inherently bad. What is particularly unpleasant, however, is the tendency for change to stimulate divisiveness and disparagement between competing groups—and this is what all of us should oppose. The most effective opposition can be found in efforts to work together toward