Hinman F
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
J Urol. 1989 Mar;141(3):482-5. doi: 10.1016/s0022-5347(17)40865-2.
Subspecialization within urology is growing, affecting not only teaching and research but the general practice of urology as well. To evaluate present attitudes towards subspecialization a questionnaire was sent to the membership of the Western Section of the American Urological Association. The responses from 561 members (53 per cent) were tabulated by computer and analyzed. Of those in private practice 16 per cent consider themselves to be subspecialists, although half of these have had no formal training. More subspecialize in oncology, andrology and gynecology than in pediatric urology. Opinions toward issuing certificates of special competence are mixed but opposition to board certification is general. A majority of respondents believe that subspecialization might provide better care for some patients but would increase costs, especially for tertiary care. It would not result in inferior care for patients not having access to the subspecialist. Subspecialization would be expected to reduce the economic return to the nonspecialist without increasing it for the specialist. Respondents believe that it would advance diagnosis, treatment and research in special areas, and improve training and competence but at greater expense. Finally, they express concern that subspecialization may well restrict the experience and competence of general urologists and cause conflict.
泌尿外科领域的亚专业正在不断发展，不仅影响教学和研究，也对泌尿外科的日常临床实践产生影响。为了评估目前对亚专业的态度，向美国泌尿外科协会西部分会的会员发放了一份调查问卷。对561名会员（占比53%）的回复进行了计算机制表和分析。在私人执业的医生中，16%认为自己是亚专科医生，不过其中一半没有接受过正规培训。相比小儿泌尿外科，更多人在肿瘤学、男科学和妇科领域进行亚专业细分。对于颁发特殊能力证书的意见不一，但普遍反对委员会认证。大多数受访者认为，亚专业细分可能会为一些患者提供更好的治疗，但会增加成本，尤其是三级医疗的成本。对于无法获得亚专科医生治疗的患者，这不会导致治疗质量下降。预计亚专业细分会减少非专科医生的经济回报，而不会增加专科医生的回报。受访者认为，这将推动特殊领域的诊断、治疗和研究，提高培训水平和专业能力，但成本更高。最后，他们担心亚专业细分很可能会限制普通泌尿外科医生的经验和能力，并引发冲突。
