Subspecialization and general urology.

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.