Clinical Genomicist in the Future of Medical Practice

Abstract

Medical subspecialties commonly arise from either primarily academic origins or because of practical need. A subspecialty often coalesces around academic thought leaders enunciating a cogent intellectual construct, regardless of whether there is a demand for such consultants in the practice setting. Alternatively, subspecialization emerges as a natural consequence of the complexity of medical knowledge and the practical need for division of labor in day-to-day clinical practice. An example of a subspecialty that still remains largely academic is clinical pharmacology. By contrast, physical impossibility for the two essential functions in the operating room to reside in the same person – surgery and anesthesia – accelerated the emergence of anesthesiology as a clinical discipline. In reality, the distinction between an academic and a practical subspecialty is artificial since many subdisciplines start as academic societies and only later emerge as bona fide clinical specialties. This branch point occurs when the intellectual complexity of the science or the difficulty of diagnostic or therapeutic procedures requires special training and where mastery of special procedures/techniques has significant impact on patient care. For example, in the early part of the twentieth century, a well-trained general surgeon commonly did most invasive operations which would include abdominal and orthopedic surgery. A century later, orthopedics is a separate department from general surgery with a highly differentiated training and accreditation program. Similarly, it can be argued that renal dialysis differentiated nephrology into a subspecialty essential to the operation of a health-care system. In so many cases, from gastroenterology to invasive cardiology and to neuroradiology, it was the availability of innovative and powerful technologies that spawned new clinical subspecialties.