The University Record, October 28, 1998

Forum examines past, present, future of medical specialization

By Kerry Colligan

The reorganization of the American health care system occurring this decade is a response to the state of medical specializations, according to Rosemary Stevens.

Stevens, professor of history and sociology of science at the University of Pennsylvania, discussed the “unfinished business” of specializations at the Forum on Health Policy earlier this month.

For much of the 20th century, Stevens said, the model of physician as explorer/engineer, the medical school as a bastion of science, and medical care facilities as unexamined social goods served us well. Yet, that model is changing.

Unlike the 1960s and ’70s when medicine was viewed as an “expansionist and arrogant entity,” Stevens argued, “now the villain is the marketplace, with medicine as the victim.”

“Professional and social policy coexist. Managed health systems change professional roles and self-perceptions, and thus may challenge professional identity,” Stevens said.

Traditionally, American medicine has focused on the doctor-patient relationship. But, she continued, that approach will not address the organizational complexities of specialized medicine.

Three sets of policy problems define those complexities in the 1990s: coordinating patient care; defining and educating physicians in what to treat and what to refer (the boundaries of specializations); and defining the owner of the health system in which physicians practice.

Ironing out these complexities is the task at hand, Stevens noted, because the boundaries between related specialty fields have become increasingly blurred. There are, she said, 24 approved specialty certifying boards and more than 100 others “operating outside the system of certification . . . The result is a cacophony of territorial claims.”

In that environment, it is no wonder patients have difficulty deciding which physician—a family physician or one of several specialists—should coordinate their care, Stevens said.

The Forum on Health Policy was sponsored by the Program in Society and Medicine. For more information about the forum, contact the Program in Society and Medicine, 647-0571.


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