Dear Atila.

This is absolutely modern and interesting.

As a medical professional, and also as a universitary teacher of Medicine, I have my strong doubts on the question of medical overspecialization.

With the recent galopping increase of Medical knowledge, we may find it virtually impossible to gather all the knowledge in one single medical human mind. This is the current context of overspecialties and subspecialties. (You need to overspecialize, if you want to be good or «the best» in medical terms...) 

But from the patients point of view, I do agree that everybody needs a good comprehensive general practitioner. One to come back to, to coordinate and for best advise in health.)

This adds to the responsability and enormous difficulty of good general practise.

I have confidence that, in the near future, GP will one of the most valued specialties in the world of Medicine. 

Dear DR. Karaalp,

I agree with you that " focusing on only one piece of puzzle block the total picture" In general, the best is a gold average and something OVER means switching to negative side. In my own opinion GP represenrs solution a health coverage for the big population, but it will be better in case of enough medical practioners that the patient will be examinated by narrow specialists - therapeutics, ophthalmologist, ENT, etc., but not by specialist on " Right hand' or "Left hand"

Given the complexity of the human body and the steep growth in therapies, it would be impossible for a single practitioner to cover the entire array of skills necessary to manage all patients' needs - thus the need for specialists. 

That said, there is probably too much specialization! This is particularly true in radiology where you will find those who specialize in knees and others in hips and still others in shoulders!

All the three levels of health care are crucial for obtaining good health of the population, but when we talked about the specialization, it is mostly dealing with the secondary & tertiary health care, overspecialization causes lack/ ignorance of primary health care. No doubt specialist services are important but it raises the cost of treatment, even the patients which are not required specialization services, they undergo costly diagnostic and treatment, procedures. And such procedures raise the out of pocket expenditure. High medical cost becomes the catastrophe for poor or even middle income population. Developing countries where a large population is of low socioeconomic status overspecialization should be discouraged, but more responsibility regarding health care should be given to general duty medical officers which are trained for treating minor ailments and diagnosing & referring to a higher level of services. However, these General Duty Medical officers should be trained and follow the standard treatment guidelines, so that they can provide treatment at primary level if required special services then refer through a strong referral system.

First I ask for the definition of "overspecialisation" - and then think of epidemiology. As you always should start with a diagnoses specialists are not the best point of service to start at - the population is presenting a low pretest probability and so specialized services or test cannot reach a good performance. By categorizing and filtering patients you then should reach a point where it makes sense to switch to specialized services.

I assume the same as true for interventions. As long as the certainty of diagnoses is low you start with broader interventions. Good guidelines take that into account - and are usually made not only by specialists.

Mohan has referred to the point of view of a health care system. There you have to balance free choice /accessibility for patients against managed pathways as well as low numbers of specialists needed against comprehensive geographical coverage.

Does it make sense that gastroenterologists specialise on liver diseases and then the liver specialist narrows his focus on viral hepatitis? To become the best in the field of science it may make sense. If the "service area" provides enough cases of viral hepatitis to keep him busy and provide a living it may make sense. But if you get 5 and would only need one - according to epidemiology / burden of disease in the service-population - its a waste and you decrease quality. 

In the "modern era" of Medicine where the all is based on result and evidence based orientation, it is inevitable that there will be super-specialisation of the practitioners. These are not the majority, but the few to whom the "generalists" will be able to  refer the patients. This is considered the safest way to treat patients and has the least of complications for their treatment. These doctors are the specialists who the patients themselves will ask to be referred to, as patients do their own research too.