ALL OF YOU WILL BEGIN YOUR RESIDENCY TRAINING IN ONE of the specialties recognized by the American Board of Medical Specialties and described in Part 2 of this book. However, after completing basic residency training, an increasing number of physicians are branching out in a variety of career directions—what I am calling epispecialties. This is a neologism describing special areas of expertise often with certificates of added qualifications or other formal attestations of expertise. This does not refer to those starting a second residency in another field, but rather those building on the skills and knowledge gained during residency years. Some are motivated by personal interests outside of medicine, such as performing arts or competitive sports; others, by populations served in their geographic location, such as the elderly in a retirement community or students in private school or college setting. Your original desire to be a physician may be related to an interest in women's health, addiction problems in society, or the medical needs of immigrants. During residency or practice years, you may discover that you have unexpected talent in a field such as administrative medicine.
There are opportunities to practice in specific settings—international medicine, as a full- or part-time medical missionary or a consultant to an international agency for health development; the travel industry, as the physician on adventure tours or cruise ships; a pharmaceutical company, as a clinical researcher; an institution, such as a prison; the media, as a journalist or radio/television consultant; or federal or state government, as a health policy analyst. All these opportunities are open to physicians from a variety of specialty backgrounds. Whatever you choose as a specialty generally does not limit you to one practice style or setting.
On the basis of students' suggestions, seven "emerging" epispecialty areas are discussed in Part 3: addiction, administrative, adolescent, critical care, geriatrics, hospice and palliative, and sports medicine. Many current residents and practicing physicians are incorporating these aspects of medicine into their practices. None is recognized as a separate specialty by the American Board of Medical Specialties (ABMS), which grants approval to a new board upon demonstration of a body of knowledge that can be taught, tested, and practiced. ABMS policy is, "They must demonstrate that it is a new field of medical science, and not just a new technique, that there are a sizable number of residency programs in that field, and that a sizable group of physicians limit their practice to that field." The creation of a new ABMS board also must be supported by specialty societies in the field.1
Pinkney DS. Specialty board in addiction medicine eyed. AMNews 1990;33:9-10.