Despite the increased specialisation in medical professions and the requirement for continuous education, healthcare professionals still prefer to work in departments, practises, or sites that they have come to understand and that they work most successfully. They prefer to work in settings that are familiar, in which they have experienced success. To a certain extent, this is reflected in medical specialisations. Of the 50 percent of doctors in the United States who specialise in one medical field, most focus on specific areas of medicine, not necessarily general practice. This is an example of the wide variation in medicine; the more specialisations that occur, the wider the variety of ways that doctors can approach patient care.
This applies to the cosmetic branch of the medical field too, like how the Dr Hennessy name is becoming synonymous with specialist botox training.
What are the origins of the specific medical specialisations?
The existence of specialisations goes back to the early 1800s. On many of the earliest healthcare systems, such as in the Netherlands and Britain, the specialty of a physician was identified by their birth. This has led to the founding of hospitals where doctors could learn specific skills, such as surgery. Today, medicine is further specialised into specific sub-specialties, called systems, that define the specific functions in which a particular doctor specialises. These include cardiology, nephrology, pediatrics, neurology, emergency medicine, and others.
Since these new systems are constantly being devised, it is impossible to maintain a current list of all the different specialisations in medicine. In fact, in some systems, there is much debate about the existence of specialisations at all, since different specialisations have been proposed at different times and many have already been discarded. In the United States, a doctor who identifies himself as a general physician typically applies for a medical licence with the State. As such, he is normally required to register with the Board of Medical Examiners. The board then requires a medical doctor to provide evidence of their specialisation, but this is sometimes subjective and the criteria can change from time to time. There is an additional requirement to take continuing medical education and to participate in clinical studies. The State may also require a doctor to take additional exams to qualify to be licensed, depending on the extent of their specialisation. The State may require a physician to demonstrate that they have been in practice for five years before allowing them to be licensed; this is in case of duplication of services provided in another state.
The advent of the National Healthcare System in the United States in the 1970s led to increasing requirements to apply for licensure in order to work in a particular area of medicine. In the late 1980s, many countries began to privatise healthcare services by privatising the organisation that provides healthcare. In Canada, for example, a medical professional specialising in a particular area such as emergency medicine may apply for a medical licence and enter the hospital or community that they wish to work in. If the hospital that the physician wishes to work in does not have a department for emergency medicine, then the physician will be required to work under a specific department. The physician must be registered in that hospital, and may not work in a different hospital in the same province, unless specifically permitted by the Health Insurance Board. In some countries, these regulations are a prerequisite for working in a particular hospital. These regulations vary greatly from country to country and each has its own criteria.
A few countries allow a physician to choose to work in any hospital in the country, provided that he or she has completed a residency in medicine. The majority of countries require a physician to have graduated from medical school and to work in a particular hospital or medical centre for a minimum number of years.