Drawbacks of Medical Specialization 

One of the biggest shifts in American healthcare over the past half-century has been the rise of specialists [4]. In 1940, 75% of physicians in the United States were general practitioners [4]. By 1960, specialists outnumbered generalists, and by 1970 only 25% of physicians identified as generalists [4]. While medical specialization has led to many advancements in healthcare, it also has drawbacks that impact patients, providers, and the healthcare system. 

A primary example among the drawbacks of medical specialization is the potential for fragmented care. A 2012 article published in the online newspaper The Atlantic highlights this issue by discussing how medical specialization has become the norm in the American healthcare system which has led to unstable healthcare costs [1]. While specialization has led to advances in medical knowledge and treatment, it has also created a system in which patients are referred to multiple specialists, leading to fragmented care, increased healthcare costs, and a lack of coordination between healthcare providers [1]. The author highlights examples of patients who have been subject to unnecessary tests and procedures due to a lack of communication between their various specialists [1]. This lack of coordination can be dangerous, leading to missed diagnoses and delayed treatments [1].  

The increased specialization of the physician workforce has also led to an increase in medical expenses in the United States, one of the most salient drawbacks for the average person [4]. Americans currently spend roughly $3 trillion annually on healthcare, and overspecialization is a contributing factor to this figure [4]. The referral rates in the United States are twice as high as those in Britain, with a nearly 9% probability of referral to a specialist, up from 5% ten years ago [4].  

Furthermore, the rapid increase in medical specialization has led to a shortage of primary care physicians, which exacerbates other problems and drawbacks in the healthcare system [1,2]. According to a report released by the Association of American Medical Colleges, the primary care physician shortage is expected to worsen [3]. By 2034, it projects a shortage of between 17,800 and 48,000 primary care physicians [3]. The primary care physician shortage will be particularly problematic for patients in rural areas or low-income communities who may not have access to specialized medical care. Data published in a 2019 study found a disproportionate loss of primary care physicians in the United States between 2005 and 2015, with greater losses in rural areas [2]. It is crucial to address this issue to ensure equitable access to medical care for all patients. 

One possible solution to address the problems associated with medical specialization is to shift towards a more holistic approach to healthcare. A more integrated approach could help address the fragmentation of care that patients receive and improve coordination between healthcare providers [1]. Accountable-care organizations, proposed by the Affordable Care Act, are one potential solution. They aim to encourage coordinated care among generalists and specialists by having teams of physicians take responsibility for their patients’ clinical outcomes [4]. 

References 

1. Emery, N. (2012). Our unsustainable culture of medical specialization. Retrieved from https://www.theatlantic.com/health/archive/2012/07/our-unsustainable-culture-of-medical-specialization/260504/ 

2. Basu, S., Berkowitz, S., Phillips, R., Bitton, A., Landon, B., & Phillips, R. (2019). Association of primary care physician supply with population mortality in the United States, 2005-2015. JAMA internal medicine, 179(4), 506-514. 

3. Robeznieks, A. (2022). Doctor shortages are here-and they’ll get worse if we don’t act fast. Retrieved from https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act 

4. Jauhar, S. (2014). Overspecialized doctors make for expensive and sloppy healthcare. Retrieved from https://time.com/3138561/specialist-doctors-high-cost/