Specialization Is the Way Forward-But Don't Generalize

摘要

Today I rang Cingular customer service and was greeted with a phone tree that began, "To cancel an existing order, press 1; to pay bills, press 2; to report a loss, press 3 ...." Clearly, the concept of specialization has permeated the business world. To what extent does radiol-' ogy residency training need to change to incorporate this trend? Radiology residency training is by most people's reckoning excellent, although this assessment is anecdotal. Yet the urge to change it persists and is like seasonal rhinitis: one can be sure that it will go and that it will return. Myriad changes have been proposed and executed by the powers that be, including some not intuitively advantageous to residents, such as curtailment of time at the Armed Forces Institute of Pathology. The current flavor of the month, as heard on the grapevine, is the push to make residency training more specialized. This will produce a cadre of radiologists who subspe-cialize early on and who can talk the talk, discussing, for example, chest x-ray findings with a pulmonologist, offering a range of diagnoses not thought of by a generalise The idea is part of a grand design: the bigger picture. We are living in a highly competitive world in which radiology is at risk from both forces within, such as pulmonologists, neurologists, and orthopedic surgeons, and forces without, such as outsourcing. In such a climate, precocious and complete subspecialization will offer "added value." No longer will that vague opacity on a chest computed tomographic (CT) scan be described as "neoplastic, infectious or inflammatory, correlate clinically." Instead, a more specific diagnosis will be given; more specific recommendations on the need, method, and strategy for obtaining tissue offered; and a more specific plan of action on treatment and follow-up elaborated.