Postgraduate Medical Education

One of medicine's attractions is the numerous and wide variety of career options it offers. These options range from allergy to women's health, and incorporate an intense work style, from emergency or critical care medicine to a more dispassionate approach such as psychiatry. Medicine may involve actively seeing patients or dealing primarily with one's peers (pathology or radiology). A practice can require superior manipulative skills such as surgery or primarily diagnosis and prescribing medications (family practice) or both (urology). Because of this disparity of options, individuals having a broad range of interests, talents, and personalities can usually find an appropriate outlet for them.

Once you succeed in getting into medical school, within the span of a little more than two years you will be faced with the challenge of selecting a residency. Competition for appointments varies depending on the area in question.

The characteristics of the common specialties are identified in Table 12.1 and will be elaborated upon somewhat below so as to familiarize prospective medical students with the array of choices they face. Details can be obtained from the specialty organizations whose addresses and Web sites are given in Appendix D.

Allergy and Immunology. This is a subspecialty of both pediatrics and internal medicine. It is concerned with the diagnosis and treatment of allergic, asthmatic, and immunologic diseases. Patients are seen largely by referral. This is largely an office-based practice with few night calls. Practices are located primarily in metropolitan areas. Although there is competition from nonspecialists, opportunities are increasing.

Contact Organization: American Academy of Allergy, Asthma, and Immunology.

Anesthesiology. Specialists in this area are qualified to provide general or regional anesthesia during a variety of procedures. These include both surgical and diagnostic as well as obstetric activities. They may also be involved in critical care and pain management. This is largely a hospital-based practice, but some specialists may be involved in office-based activities when some routine procedures need to be performed (endo-scopies). Night call is common for hospital-affiliated specialists.

Contact Organization: American Society of Anesthesiologists.

Cardiovascular Diseases. These specialists diagnose and treat patients who have heart or circulatory system problems. Cardiology is a subspecialty of internal medicine and its practice has both noninvasive and invasive components. In the former, the history, physical examination, and appropriate tests serve as the standard approach to patient care. Invasive cardiologists perform angiographies to evaluate the status of the coronary or other arteries or insert “stents” to maintain their function as an open blood pathway. Noninvasive cardiologists are usually hospital-based and night call is quite common.

Contact Organization: American College of Cardiology.

Child and Adolescent Psychiatry. This is a subspecialty of psychiatry. It involves the diagnosis and treatment of children and adolescents having emotional, behavioral, and mental problems. These specialists operate private practices and work in both in- and out-patient care. They get referrals from pediatricians and social service agencies.

Contact Organization: American Academy of Child and Adolescent Psychiatry.

Colon and Rectal Surgery. This is a subspecialty of general surgery. It involves the diagnosis and surgical treatment of disorders of the colon, rectum, anal canal, and perianal region. Colonoscopy and more limited endoscopy procedures are the standard diagnostic techniques employed in this specialty.

Contact Organization: American Society of Colon and Rectal Surgeons.

Critical Care Medicine. This hospital-based specialty is concerned with the care of critically ill medical and surgical patients. It requires a broad medical background with special knowledge of fluid, cardiovascular, and respiratory management in order to stabilize such patients. Specialists in this area commonly tend to be pulmonary medicine specialists.

Contact Organization: Society of Critical Care Medicine.

Dermatology. This specialty deals with the diagnosis and treatment of acute and chronic diseases of the skin of individuals of all ages. Both medical and surgical modalities are used in this specialty.

Contact Organization: American Academy of Dermatology.

Diagnostic Radiology. This diagnostic specialty utilizes X-rays, ultrasounds, magnetic fields, and other energy source. Consequently, aside from interpreting basic radiographs, diagnostic radiologists must learn to interpret scans and images. There is also a need to learn a variety of diagnostic interventional procedures.

Contact Organization: American College of Radiology.

Emergency Medicine. This is a hospital-based specialty. These physicians treat a broad spectrum of illnesses and injuries for individuals in all age groups. They seek to stabilize patients with critical illnesses and injuries, and work on a fixed schedule.

Contact Organization: American College of Emergency Physicians.

Family Practice. These specialists are qualified to provide general medical care to all members of the family. The exact nature of an individual's practice depends on his or her own special qualifications and interests as well as location and affiliated hospitals. The services provided are mostly in an office setting and involve seeing patients of varying ages and a broad spectrum of illnesses. Their patients may include both children and seniors. Family practice physicians are even involved in providing counseling for psychological issues that are part of life such as childbirth, stress, and grief.

Contact Organization: American Academy of Family Physicians.

Gastroenterology. This is a subspecialty of internal medicine. Practitioners diagnose and treat diseases of the digestive tract, liver, and gallbladder. Technical improvements in directly inspecting the GI tract have expanded the procedures that can now be performed.

Contact Organization: American College of Gastroenterology.

Geriatric Medicine. This is a relatively new subspecialty of medicine that involves primary medical and psychosocial care of senior citizens. There is an increasing demand for such specialists as the population rapidly ages. The demand will be accelerated as the current small group of certified gerontologists retires. Geriatric physicians usually work in conjunction with a multispecialty team of medical and nonmedical professionals. There also are opportunities aside from private practice in the academic community or corporate medicine.

Contact Organization: American Geriatric Society.

Hand Surgery. This is a subspecialty of general orthopedic or plastic surgery. It deals with diseases of or injuries to the hand or forearm. This specialty utilizes the many developed microsurgical techniques derived from the fields of plastic and orthopedic surgery. The surgical procedures used can usually be performed on an outpatient basis.

Contact Organization: American Association of Hand Surgery.

Hematology-Oncology. These two distinct subspecialties are linked together by both training and practice. Hematology involves the diagnosis and treatment of blood diseases, while oncology is associated with cancer-type illnesses. Advances in these two fields have allowed for therapeutic results that can provide for the extension of life. Preliminary specialization in internal medicine is required in this office-based specialty, but significant in-patient service and night calls can be anticipated.

Contact Organizations: American Society of Hematology and The American Society of Clinical Oncology.

Infectious Diseases. Another subspecialty of internal medicine, this involves the diagnosis and treatment of infectious diseases. The status of this subspecialty initially was revitalized due to the introduction of antibiotics. It now flourishes because of the HIV/AIDS epidemic, the bioterrorism threat, and development of drug-resistant bacteria. The physicians may be involved in internal medicine practice in addition to working in this area directly or as a consultant.

Contact Organization: Infectious Disease Society of America.

Internal Medicine. This specialty provides training for those interested in becoming general internists as well as for a large variety of potential medical subspecialists. It can also be combined in an internal medicine-pediatric residency. The general internist treats adults suffering from both acute and chronic diseases and also provides primary care facilitating health maintenance. The status of this specialty has become elevated with the flourishing of HMOs.

Contact Organization: American College of Physicians-American Society of Internal Medicine.

Neonatal-Perinatal Medicine. These pediatric subspecialists provide medical care to newborns in the intensive care unit who usually are placed there because they are born prematurely. They are qualified to provide the medical intervention that is so essential for survival. They direct a team of ancillary professionals needed to provide a variety of services.

Contact Organization: American Academy of Pediatrics.

Nephrology. This subspecialty of internal medicine is involved in the diagnosis and nonsurgical treatment of kidney and urinary tract diseases. It is essentially an office-based practice, usually treating older adults suffering from chronic kidney disease who require long-term care. The service provided usually is associated with managing dialysis and providing care for kidney transplant patients.

Contact Organization: American Society of Nephrology.

Neurological Surgery. This surgical subspecialty deals with the management of lesions of the brain, spinal cord, peripheral nerves, and their supporting structures. While commonly a surgical approach is the treatment of choice, it need not always be so. This is a very challenging surgical subspecialty; it can produce both dramatic success and dismal failures with tragic consequences. A broad range of patients, from newborn to the elderly are seen and treated.

Contact Organization: American Association of Neurological Surgeons.

Neurology. Practitioners in this area are involved in the diagnosis and treatment of brain, spinal cord, peripheral nerve, and neuromuscular diseases. They frequently attend patients suffering from stroke, seizure, and a severe headache. This is primarily an office-based specialty whose demand is increasing as the number of its elderly in the population increases.

Contact Organization: American Neurological Association.

Nuclear Medicine. Specialists in this field use radioactive materials for both diagnostic and treatment purposes. A variety of aspects of physics, statistics, computer science, and math are used in conjunction with medicine. The radioactive material is introduced into the bloodstream to provide imaging of selected body organ systems. Practitioners are hospital-based and secure their initial training in internal medicine, radiology, or pathology.

Contact Organization: American College of Nuclear Medicine.

Obstetrics and Gynecology. This dual specialty deals with the female reproductive tract both in health and illnesses. The former involves providing medical and, when necessary, surgical care to pregnant women. Gynecologists apply the same two approaches to diseases of the reproductive tract and also deal with problems of infertility. Specialists commonly work in both areas, but as they advance in years they tend to remain only in gynecology. This specialty is considered part primary care because of a broader interest in women's health.

Contact Organization: American College of Obstetricians and Gynecologists.

Occupational Medicine. A subspecialty of preventive medicine, it focuses on the effects of certain potentially hazardous occupations on the worker's health. Occupational physicians, therefore, work for the government, industry, academic institutions, and specialized clinics.

Contact Organization: American College of Occupational and Environmental Medicine.

Ophthalmology. This specialty is concerned with the diagnosis and treatment of diseases of the eye and periocular area. It is largely office-based, but involves medical and surgical components and thus is very popular. Patients of all ages are seen and subspecialization is common due to the technological and medical advances made in this field.

Contact Organization: American Academy of Ophthalmology.

Orthopedic Surgery. Specialists are engaged in diagnosing diseases and injuries to the bones of the extremities and the vertebral column. Aiming to preserve maximal musculoskeletal function, surgical, medical, and physical therapy approaches are used. This specialty is appealing to those who have superior manual dexterity and like to work with their hands. It commonly involves emergency and night calls.

Contact Organization: American Academy of Orthopedic Surgeons.

Pediatrics. These specialists are concerned with the general well-being of children and adolescents and even adults. They provide routine, preventive care and treat acute and many chronic illnesses for those in the lower age range, with whom they establish long-term relationships. This is, for the most part, an office-based specialty, with currently more females entering than men practicing.

Contact Organization: American Academy of Pediatrics.

Physical Medicine and Rehabilitation. Specialists in this field are known as physiatrists. They are involved in the diagnosis and location and treatment of individuals with impaired musculoskeletal, neurological, and other body system disabilities. Patients of all ages are treated. Their problem may have originated due to brain or spinal cord damage or as the result of accidents. Physiatrists seek to positively impact upon patients' physical, psychosocial, and career-related activities as well as seek remission of pain.

Contact Organization: American Academy of Physical Medicine and Rehabilitation.

Plastic Surgery. These specialists apply their surgical skills to rectify body disfigurements. The source of the impaired area may be due to a birth defect, injury, disease, or aging process. Aside from being surgically highly skilled, one needs a strong aesthetic sense to achieve the desirable results in both reconstructive and cosmetic undertakings. Much of the procedures are carried out on an ambulatory basis.

Contact Organization: American Academy of Plastic and Reconstructive Surgery.

Preventive Medicine. This field is involved in population-based approaches to environmental health promotion and disease prevention. Physicians in this field are employed by government agencies, managed care organizations, industry, and academic institutions. It involves, in addition to knowledge of general preventive medicine, a background in epidemiology, informatics, and biostatistics.

Contact Organization: American College of Preventive Medicine.

Psychiatry. Specialists in this area diagnose diseases of the mind. They treat a very broad spectrum of mental illness. While usually practicing in an office-based setting, they also see patients in psychiatric hospitals and community health and substance abuse centers. The impressive development in potent psychotropic medications has broadened this field potential for treatment.

Contact Organization: American Psychiatric Association.

Public Health. This is a subspecialty of preventive medicine. It deals with health issues capable of or affecting entire communities, in addition to individuals. To promote health and understand the possible danger of disease or risky situations, these specialists evaluate relevant community information, develop suitable protective public health policies, and seek to facilitate achieving set goals. Those in this field work for government agencies and private health organizations, as well as academic and research institutions.

Contact Organization: American College of Preventive Medicine.

Surgery. The area of general surgery covers the diagnosis and treatment of diseases of and injuries to the abdominal organs and the soft tissues of the trunk. It forms the basis for subspecialization in a wide variety of areas. General surgeons require five years of training and usually have a short-term contract with their patients.

Contact Organization: American College of Surgeons.

Thoracic Surgery. These subspecialists apply their surgical skills to treat diseases of and injuries to the heart and lungs as well as other components of the chest. Common procedures are coronary artery bypass, heart valve repair, and lung lesions. This is a very stressful specialty, given the physical and emotional demands involved. It requires lengthy training of up to six years.

Contact Organization: American College of Surgeons.

Urology. In males, these specialists treat diseases of and injuries to the urethras, bladder, prostate, and genitals. In females they are concerned with the first two of these organs.

Contact Organization: American College of Urologists.

Vascular Surgery. This subspecialty of general surgery is associated with the diagnosis and treatment of diseases of the arterial, venous, and lymphatic systems. To maintain an active practice, many of these specialists combine their practice with that of general surgery.

Contact Organization: American Association for Vascular Surgery.