Perspectives on Medical Specialization

The role of specialization in pharmacy practice is an important issue confronting the profession today. The historical evolution of specialization in American medicine is presented. Medicine, while not a complete model of specialization, probably has the most mature structure of any profession. Pharmacy, in directing its own specialization process, can learn from medicine's experience. Emergence of specialties is a function of both social and technological change. An increase in the knowledge base and an expanding technology stimulated physicians to specialize. The narrowing technical interests of the medical specialist led to the formation of elite specialty societies. While these organizations initially moved to develop specialty education and training programs, later they came to have a significant impact on the entire medical profession. A major decision for medicine was the requirement that all physicians receive the same general medical education — the M.D. degree — prior to entering specialty training. Advanced specialty training through internship and residency programs predominated over programs offered by degree-granting institutions. Attempts by state agencies to license medical specialists were defeated, and a system of certification by specialty boards has flourished. The specialization process in pharmacy, however, has not developed to the same extent as in medicine. The process in pharmacy has been characterized by a lack of coordination between involved organizations and institutions. If specialization is to enhance the individual specialties, the profession of pharmacy, and the public interest, it must be developed as a planned, rather than a random, process.

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