Sawyer Business School, Suffolk University, Boston, Massachusetts, United States of America.
PLoS One. 2021 Dec 30;16(12):e0262019. doi: 10.1371/journal.pone.0262019. eCollection 2021.
Historical context and converging market conditions present a unique opportunity to study the factors contributing to the formalization of foregut, or upper gastrointestinal, surgery as a new subspecialty in United States healthcare. The aim of this study was to examine the justifications of those pursuing the formalization of a foregut subspecialty and to extract lessons for healthcare leaders on the evolving relationships between competing providers. This was a qualitative, cross-sectional study consisting of interviews, secondary survey data, and observation of society meetings between October 2018 and June 2019. Thirty interviews with healthcare professionals were conducted, transcribed, and analyzed for themes using qualitative coding software. Themes were correlated with observational field notes and archival data and compared against established social theories on professions and medical specialization. Analysis revealed that traditionally competing surgeons and gastroenterologists articulate a professional need to qualify foregut surgical expertise based on superior knowledge and outcomes, to define the allocation of certain tasks and procedures, and to foster collaboration across specialties. Converging market conditions precipitate individual and organizational decisions to pursue formal specialization. Participants in the formalization of this subspecialty should consider the history of professional competition and turf wars to achieve meaningful collaboration. Advocacy for multi-specialty societies and organizational movements could be a model for reduced conflict in other specialties as well.
历史背景和趋同的市场条件为研究促成美国医疗保健中前肠（或上消化道）手术正式成为新亚专科的因素提供了独特的机会。本研究旨在探讨那些追求前肠亚专科正式化的人的理由，并为医疗保健领导者提供有关竞争供应商之间不断发展关系的经验教训。这是一项定性的、横断面研究，包括 2018 年 10 月至 2019 年 6 月期间的访谈、二次调查数据和对学会会议的观察。对 30 名医疗保健专业人员进行了访谈、转录，并使用定性编码软件对主题进行了分析。主题与观察性现场记录和档案数据相关联，并与关于职业和医学专业化的既定社会理论进行了比较。分析表明，传统上相互竞争的外科医生和胃肠病学家基于卓越的知识和结果来阐明对前肠手术专业知识进行资格认证的专业需求，以定义某些任务和程序的分配，并促进跨专业的合作。趋同的市场条件促使个人和组织做出追求正式专业化的决策。从事这个亚专科正式化的参与者应该考虑到专业竞争和地盘之争的历史，以实现有意义的合作。倡导多专业协会和组织运动可能是减少其他专业领域冲突的一个模式。
