Rethinking neurosurgical subspecialization.

In this article, the authors trace the evolution of subspecialty development in the relatively young specialty of neurosurgery. The current categorization of neurosurgical subspecialties represents an incongruent group of "areas of interest" whose origins are historical in their development and whose boundaries are indistinct, artificial, and often fail to share a common theme. While subspecialty development has undoubtedly improved the quality of care of patients with neurosurgical disease in these respective areas, the authors present important questions invoked by the artificial boundaries. The current move towards formalization of subspecialty training and accreditation, with ultimate certification, poses both intended and unintended consequences. The implications of these trends in neurosurgery are discussed.