The Shift Towards Specialization and Advanced Practice

1. Introduction

Specialization refers to the process of becoming an expert in a particular field, instead of focusing on a wide range of tasks. With advancements in science and technology, there has been a growing trend towards specialization in various areas, such as medicine, business, and education. This has also led to the development of specific advanced practice roles in different industries. Advanced practice is a term used to describe a level of practice, rather than a specific role. Such roles are ‘advanced’ as they require higher levels of decision-making and more autonomy. Advanced practice is not just limited to the medical profession. We can see this type of practice in social work, nursing, and other health and social care professions. In recent years, advanced practice roles have been developed in sectors such as paramedics and occupational therapists. The growth of advanced practice roles in the health sector reflects the demand for expert professionals who can support and complement medical services. This has been seen as a way to modernize healthcare systems and improve the efficiency and effectiveness of patient care. Advances in medicine and changes to the workings of the healthcare industry have allowed some medical professionals to move away from traditional, multidisciplinary roles and increase their level of specialization. One of the main reasons for this shift is the recognition that specialists who focus solely on one area are able to develop their expertise and provide a more efficient and high-quality service. As well as improved patient care, the adoption of advanced specialist practitioner roles has been identified as a method to ease demand on more traditional healthcare services. These have additional benefits for the wider healthcare system, including reduced waiting times and better integration between primary and secondary health services. Specialization in medicine is quite advanced. For example, in the field of surgery alone, we have specialists in orthopedic surgery, cosmetic surgery, cardiothoracic surgery, and neurosurgery. Various medical scientists have made significant contributions in highly specialized areas such as genetics, molecular biology, and the study of abnormal genes found in genetic disorders. This allows for further sub-specialization as well. The law is another area for great specialization. With the increasing globalization and commercialization of today’s world economies, it is inevitable that lawyers have been willing to specialize in a career in international business or trade law. In education, teachers have shown to become better skilled in their subject areas when they are given professional development in a particular area of the curriculum. Resistance to move away from old belief systems. The process of specialization requires individuals to give up the familiarity of general knowledge in a particular area in favor of seeking expertise in a smaller subfield. However, many may be afraid to give up that general knowledge around which their personal identity and professional work revolves. This is especially true when their employment requires versatility, such as a general practitioner in the medical field or a family attorney. Also, there is the understanding that the process of specialization comes with the appeal of prestige, recognition, and even financial incentives. However, it is difficult for individuals to avoid being influenced by these potential benefits and seek specialization even where it may not be necessary or productive.

1.1 Definition of Specialization

Specialization can be better understood by first defining what general practice is. General practice refers to a standard or routine practice and views things in a broad perspective. In medicine, for instance, general practitioners treat all acute and chronic illnesses, and provide preventive care and health education for all ages and both sexes. On the other hand, specialists focus on a specific disease and treatment, such as cardiologists who only treat heart-related illnesses, and provide a high level of patient care. Advanced practice nurses, as mentioned, are more specialized in a certain area. They should have the expertise in research and theory, and clinical and technical knowledge in their specialized area of practice such as psychiatric, adult health, oncology, pediatrics, or family health. Any nurses who want to gain specialization in a certain area need to acquire accredited post-basic programs for the specialty and pass the examination recognized by their respective professional groups. Such programs will train students to become specialists and to supervise nursing activities in both hospitals and the community and also to consult in their area of specialization. Ongoing clinical management by authority and continuous supervision to practice are required to ensure graduates’ safe practice. Specialized nurses are capable of performing many more complicated diagnostic and invasive procedures than a general nurse. For example, a nurse specialized in oncology – the study of cancer – can not only provide day-to-day care but also can perform a range of cancer treatments including chemotherapy. Advanced practice nurses can work as primary care providers and assist them in domestic health and health promotion, disease prevention, and management of chronic diseases. Focusing on the patient being “at the center of care” is the key to the success of nurses in advanced practice. By doing so, the patient can get the most personalized, comprehensive, and cost-effective care. By providing greater access to advanced practice nurses, a wealth of opportunity exists in contributing to patient-centered care in a range of professional specialties. The shift from physician-centered to patient-centered care also allows advanced practice nurses to practice a fuller scope of care and allows them to demonstrate “evidence-based practice” and “professional performance and quality” set by the respective accrediting body. With the concern about healthcare cost on the rise, the cost-effective nature of advanced practice nursing for specialized care is a genuine solution for sustainable quality healthcare provision. The emphasis and effect imparted by advanced practice nurses to the healthcare system would be enhanced further if the rest of the patient population could take advantage of having advanced practice nurses as primary care providers on a periodic basis. The impact of technology and globalization might have brought about the overall complexity of today’s healthcare environment, but this is allowing nurses to integrate different innovative discoveries in their specialized practices for the benefits of not only the patient but as well as the nurses themselves. However, it would be a greater transformation for nurses in advanced practice to take on and fully utilize the tremendous synergistic opportunities presented nowadays in healthcare transformation.

1.2 Importance of Advanced Practice

With the change in the healthcare system and progress in medical education, we have an opportunity now and the expectation of making greater improvements with further support for clinical educators’ specialty practice.

On July 23, 2015, the Secretary’s Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD) approved a set of recommendations for increasing flexibility in faculty work effort at medical education programs, focused on building sustainable residency training “capacity in community-based ambulatory settings.” This is proposed “to improve access to comprehensive, coordinated, and longitudinal care for patients and communities,” per the ACTPCMD letter to the then Secretary of Health and Human Services.

The importance of clinical educators’ focus on specialty clinical practice has been recognized for the third educational objective – increased faculty flexibilities in work effort allocation. Such a general focus has been a common theme during the feedback from various national organizations over the past years as well. For example, in 2005, the Institute of Medicine identified the need for a “reproved focus on patients and their ability to access the healthcare system and its resources.” It was suggested in the report that medical education programs and teaching hospitals should adopt a more “candidate-centered approach that focuses on patients’ needs, expectations, and preferences” in order to advance the quality of medical education and patient care.The fourth important educational objective is to give clinical educators the time and resources necessary to become experts in their areas of specialization, often through advanced degrees in health-related fields. This would create an environment where all members of the healthcare team, including physicians, nurses, pharmacists, and other professionals, would benefit from more highly specialized clinical educators who would have the time and opportunity to provide even greater levels of clinical education. In turn, students and residents in these programs would be exposed to higher levels of expertise in a cycle of continuous improvement of clinical education and patient care.

1.3 Evolution of Specialization in Various Fields

The trend of advanced practice roles and specialization has already been shaped and implemented in many countries and across a variety of industries. It is clear that the support for new and ever-changing fields and specialties, with additional uptake in the near future, will provide these industries with the tools and knowledge they need to excel and to contribute to economical and social reform.

With the advance of technology and globalization, education has also witnessed the influence of specialization in various career options. Special education teachers may receive specific training in emotionally disturbed, developmentally delayed, or autistic students. In higher education, deans and academic administrators are primarily responsible for managing and leading the institution and they play a critical role in successfully advancing the organization. However, a dean will need to have an in-depth knowledge of a large range of subjects including course provisions, students affairs, faculties, and finance.

In the field of law, the American Bar Association recognizes not only specific legal specialties such as admiralty law and intellectual property law, but also non-legal careers such as education and business that law graduates may elect to pursue. The accreditation process for law schools and bar examinations are consistent with the adequate preparation requirement for profession expectations.

In engineering, the transition from a master builder model to multidisciplinary design teams has created new fields such as aerospace engineering, computer engineering, and biotechnology. Aerospace engineering focuses on the design, manufacture, and testing of aircraft and spacecraft, as well as satellites and missiles. Computer engineering emphasizes the development of computer hardware and software. Biotechnology is a broad field of biology and technology, encompassing biomedical research and innovative medical processes.

2. Benefits of Specialization

2.1 Enhanced Expertise and Knowledge

2.2 Improved Quality of Services

2.3 Increased Efficiency and Productivity

2.4 Better Patient Outcomes

3. Challenges in Specialization

3.1 Narrow Focus and Limited Scope

3.2 Potential for Professional Isolation

3.3 Continuous Learning and Skill Development

3.4 Balancing Specialization with General Practice

4. Advanced Practice Roles

4.1 Nurse Practitioners

4.2 Physician Assistants

4.3 Certified Registered Nurse Anesthetists

4.4 Clinical Nurse Specialists

4.5 Pharmacists with Prescriptive Authority

5. Specialization in Medicine

5.1 Surgeons and Surgical Specialties

5.2 Cardiologists and Cardiovascular Specialties

5.3 Oncologists and Cancer Specialties

5.4 Psychiatrists and Mental Health Specialties

5.5 Dermatologists and Skin Specialties

6. Specialization in Law

6.1 Criminal Law Specialists

6.2 Corporate Lawyers and Business Specialties

6.3 Intellectual Property Attorneys

6.4 Family Law and Divorce Specialists

6.5 Environmental Lawyers and Sustainability Specialties

7. Specialization in Education

7.1 Special Education Teachers

7.2 Early Childhood Education Specialists

7.3 Educational Psychologists

7.4 Curriculum and Instruction Specialists

7.5 Higher Education Administrators