![]() ![]() An ophthalmologist should have the ability to spend a year studying pulmonary medicine, for example, if they want to moonlight with an ICU physician in the future. Going forward, there should be opportunities for post-residency, mid-career physicians to complete fellowship programs outside of their sub-specialty’s usual offerings. I hope that the government will issue more detailed “good Samaritan” type laws to protect mentors and their subspecialty partners from frivolous law suits in times of COVID (those in place are for volunteer positions only), and that the house of medicine, led by the AMA and other sub-specialty organizations, will pave the way for rapid cross-disciplinary instruction and certification. I believe that medical school and internship are a solid foundation for COVID management (common to all physicians), and that given a designated EM, IM, or CCM mentor, the willing subspecialists will be able to follow protocols and take on new challenges rapidly and with excellence. Perhaps it’s a radical idea to consider pairing subspecialist physicians with current frontline COVID-19 doctors – but turfing patients to “non physician practitioners” or NPPs when access is limited to an emergency medicine specialist, internist, or intensivist, seems to be the current plan. So now, there needs to be a pathway available for those who have completed residency to re-train to meet the demands of this crisis and others. The old adage: “see one, do one, teach one” is the bedrock of how we train. Upon graduation from medical school, physicians are deemed ineligible to treat patients until they have practical experience under their belts. Medicine is fundamentally based upon apprentice-style learning – this is why we undergo years of residency training – to stand shoulder-to-shoulder with more senior experts and learn their craft under close supervision. But what are they to do? They are not trained to manage airways, place central lines, or monitor renal function, and legitimately fear legal repercussions should they attempt to do so. Retina specialists, plastic surgeons, rheumatologists, and radiation oncologists (to name just a few) may want to help emergency medicine physicians (EM), internists (IM), and intensivists (CCM) expand their reach as COVID cases surge and hospitals become overwhelmed. And now, the COVID-19 pandemic has unmasked the biggest downside of niche medicine: a hardening of the categories that prevents many physicians from being able to help in times of crisis. The continued march towards ultra-subspecialization has been a boon in urban and academic centers, but has left spotty expertise in surrounding areas and small towns. Neurologists who focus on movement disorders become comfortable with a small subset of diseases such as Parkinson’s, but then close their doors to patients with migraines or strokes. For example, an orthopedist who has subspecialized in the surgical management of the shoulder joint doesn’t keep her skills sharp in knee replacement surgery or other general surgical procedures that she once performed. However, the consequences of narrowing one’s expertise is that you lose flexibility. Just filtering the signal from the noise can be a full time job. “Carving out a niche” makes sense in a profession where new research is being published at a rate of two million articles per year. Val Jones in Health Policy, Opinionīecause science is advancing our understanding of medicine at an exponential rate, physicians and surgeons have been turning to subspecialization as a means to narrow their required domains of expertise.
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