Subspecialty internal medicine in the United States: in and outside the hospital.
Subspecialty internal medicine in the United States: in and outside the hospital.
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发表时间：
1999
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通讯作者：
L. Langdon
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作者：
L. Langdon
在美国，内科的亚专科很好地融入了内科的整体学科，而且每个亚专科都是独特的。美国内科医学委员会目前认证了16个独特的分支学科，从大到小依次为：心脏病学（14,000名认证心脏病专家），胃肠病学（10,000名认证），肺病（9,000名认证），重症医学（6500名认证），血液学，肿瘤学，肾脏病学，传染病，过敏和免疫学，内分泌学，风湿病学，老年病学，运动医学，青少年医学。普通内科是经过三年培训后的第一级认证：上述专科是第二级认证（再经过2 - 3年的培训）。有些专科属于第三层次或“第三层次”。在心脏病学领域，“第三级”认证认可临床心脏电生理学和介入心脏病学。这些学科需要额外的，第四年的心脏训练和心脏病学的预先认证。在内科科室和亚专科科室之间，由于亚专科对科室的财政贡献不可避免地不公平，常常存在一种“健康的紧张关系”。目前，由于多种因素的共同作用，专业化率有所下降，其中包括直接接触hmo专家的机会受到限制，以及住院医生运动的发展：全职住院医生比其他全科医生更不可能需要亚专科医生咨询。
In the U.S. the subspecialties of internal medicine are well integrated in the overall discipline of internal medicine and each one is also unique. The American Board of Internal Medicine at present certifies 16 unique subdisciplines, which are, in order from the largest to the smallest: cardiology (14,000 certified cardiologists), gastroenterology (10,000 certified), pulmonary disease (9000 certified), critical care medicine (6500 certified), hematology, oncology, nephrology, infectious diseases, allergy and immunology, endocrinology, rheumatology, geriatrics, sport medicine, adolescent medicine. General internal medicine is the first level of certification after three years of training: the above-mentioned subspecialties are the second level (after an additional 2 to 3 years of training). Some subspecialties are at a third level or "third tier". Within cardiology, "third tier" certification recognizes clinical cardiac electrophysiology and interventional cardiology. These disciplines require an additional, fourth year of cardiac training and prior certification in cardiology. Between the departments of internal medicine and the subspecialty divisions there is often a "healthy tension" stemming from unavoidable inequities in the financial contributions of the subspecialties to the department. Currently, there is a decline in specialization rate due to a variety of converging factors, among them restricted direct access to specialists in HMOs, and the developing hospitalist movement: full-time hospitalists are less likely to need subspecialist consultation than other generalists.