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Are We Training Too Many Subspecialists?

Leonard Sax, MD, PhD
JAMA. 1988;259(18):2697-2698. doi:10.1001/jama.1988.03720180025024.
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To the Editor.  —Schwartz et al1 ask: Are we training too many medical subspecialists? Most of their article is devoted to demonstrating that many small cities and towns do not have their own hematologist, endocrinologist, or pulmonologist. The authors draw a startling conclusion from this unremarkable finding: they believe that there is, and will continue to be, a significant shortage of medical subspecialists. This conclusion makes sense only if you believe, as they do, that every small town needs every kind of medical subspecialist: "We believe that cities with a population over 50 000 easily warrant the presence of at least one board-certified subspecialist in each field (including rheumatology, nephrology, endocrinology, and so on)."They give two grounds for this questionable belief. First, "cities with a population of 50 000 to 125 000 have an average of... 343 occupied beds" and, second, "subspecialists in these cities will also treat


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