Recognition of special qualifications in neurological surgery.

In recent years, one-half of the 23 recognized specialty boards in medicine have begun formally to recognize subspecialization with some type of certification process. One such board, the American Board of Internal Medicine, examines and certifies in 11 subspecialty areas while the American Board of Pathology does so in nine, the American Board of Pediatrics in eight, the American Board of Obstetrics and Gynecology in four, and the American Board of General Surgery in three. Arguments for and against similar recognition of subspecialization within neurosurgery are reviewed. The present position of other specialties and their boards regarding this sensitive issue is summarized, as well as their certification structure. The various pathways available to certifying boards for recognition of subspecialization are also presented. The American Board of Neurological Surgery (ABNS) has approved a subspecialty certificate called a "certificate of Special Qualification in Critical Care Medicine." This is a subspecialty that is longitudinally oriented, touching on a number of other specialties in addition to neurosurgery, and thus differs from a vertical subspecialty such as Pediatric Neurosurgery or Cerebrovascular Neurosurgery. The background for development of such a certificate and the current requirements for obtaining it are reviewed. At the present time, the ABNS opposes the possible fragmentation of neurosurgery by offering certification in multiple subspecialty areas. Nonetheless, the current trend in medicine as a whole is in the direction of such subspecialization and its formal recognition. Increasing numbers of neurosurgeons tend to concentrate all or a good deal of their professional efforts in a specific area. Thus, organized neurosurgery must continue to consider methods for subspecialty recognition.