Editor's Opinion: The Promise and Challenge of Specialization
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The proportion of clinicians who are specialists, including those with subspecialty certifications, has increased for decades. In the US, several social forces are believed to be behind this trend. First, if medicine is a science, advances will require the subdivision of efforts1; to advance usually implies that a person must look deeper into or approach the problem at hand from a different angle, which often requires special knowledge and expertise. Second, historic beliefs that experts have superior skills continue to be bolstered by evidence, especially from the surgical literature. Practice makes perfect. Third, with the support of private and public health insurance, specialization has encouraged competitive, rather than collaborative, medical practice.1 Thus, specialization has been blamed for causing disorganization in care (and poor patient outcomes), challenges in medical education, profit-seeking behavior, and competition.
How can our healthcare systems realize the benefits of specialization while improving patient outcomes without breaking the bank? Follow our lead! Clinicians in the area of wound, skin, ostomy, and continence care have practiced and preached the value of multidisciplinary and interdisciplinary approaches for decades. First published as Ostomy Management in 1980, and relaunched in 1985 as Ostomy Wound Management, our journal always has been dedicated and loyal to proliferating multidisciplinary readers, reviewers, and editorial staff. Case in point: when I joined the editorial staff of OWM in May 1990, we had 11 editorial advisory board members — eight nurses and three physicians. Mind you, in 1990 the National Library of Medicine (NLM) indexed only 555 publications with the terms multidisciplinary or interdisciplinary in the abstract!
Six of the names on the 1990 OWM Editorial Board remain on the January 2012 page, notably Nancy Faller, Evonne Fowler, Diane Krasner, Glenda Motta, Bonnie Sue Rolstad, and Manfred Rothstein. Today they are joined by more than 60 additional Board members/reviewers, representing the areas of administration, education, medicine and surgery, nursing, nutrition, pharmacology, physical therapy, podiatry, and research.
Until now, OWM conducted business with the help of two Editorial Boards. As of this issue, the OWM Board will become one entity to better utilize and acknowledge the time and dedication of all our reviewers. Manuscripts submitted to OWM have always been reviewed by members of several disciplines; the revised editorial page simply clarifies this practice for our readers. Of course, we also hope this change sends a message about the importance of multidisciplinary and interdisciplinary education, research, and care.
We need a multidisciplinary approach involving people from various disciplines to conduct research and help answer the plethora of remaining questions.2 At the same time, we need an interdisciplinary approach to patient care, as well as educators and researchers crossing disciplinary boundaries to find connections. And, the more healthcare is specialized, the greater the need to work with (interdisciplinary) others instead of alongside each other (multidisciplinary). In response to this need, interdisciplinary care is now the central feature of many programs and initiatives by professional organizations and government agencies. A 2010 Medline search of publications containing the words multidisciplinary or interdisciplinary in the abstract yields 4,012 publications, eight times the number published in 1990!
Because specialization in the area of skin, incontinence, wound care and wound care research has increased substantially, OWM’s multidisciplinary and interdisciplinary focus is more important than ever.