DEFINED: Twenty Medical Specialties

Dr. David Edward Marcinko; MBA MEd

SPONSOR: http://www.HealthDictionarySeries.org

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A Comprehensive Overview

Medicine is an extraordinarily diverse field, shaped by centuries of scientific discovery and the evolving needs of human health. As knowledge has expanded, so too has the need for physicians to specialize in particular systems, diseases, or patient populations. Today’s medical landscape includes a wide range of specialties, each with its own philosophy, diagnostic approach, and therapeutic focus. Understanding these specialties not only clarifies how modern healthcare functions but also highlights the complexity of caring for the human body. The following essay explores twenty major medical specialties, defining their core purposes and illustrating how each contributes to the broader practice of medicine.

1. Internal Medicine

Internal medicine is the foundation of adult medical care. Internists specialize in diagnosing, treating, and preventing diseases that affect adults, particularly complex or chronic conditions. Their work spans multiple organ systems, requiring a broad understanding of physiology and pathology. Internists often serve as primary care physicians, coordinating care among subspecialists and managing long‑term health issues such as hypertension, diabetes, and heart disease.

2. Family Medicine

Family medicine emphasizes comprehensive, continuous care for individuals and families across all ages, genders, and health conditions. Unlike internal medicine, which focuses on adults, family physicians treat children, adolescents, adults, and older adults. Their holistic approach integrates preventive care, acute illness management, and chronic disease monitoring. Family medicine values long‑term relationships and community‑based practice.

3. Pediatrics

Pediatrics is dedicated to the health of infants, children, and adolescents. Pediatricians address developmental milestones, childhood illnesses, congenital disorders, and preventive care such as vaccinations. They must understand not only the physiology of growing bodies but also the emotional and social needs of young patients. Pediatricians often collaborate closely with families to support healthy development.

4. Obstetrics and Gynecology (OB/GYN)

OB/GYN combines two related fields: obstetrics, which focuses on pregnancy, childbirth, and postpartum care, and gynecology, which addresses the health of the female reproductive system. Specialists in this field manage prenatal care, deliver babies, perform reproductive surgeries, and treat conditions such as endometriosis, infertility, and menstrual disorders. OB/GYN physicians balance surgical skill with long‑term patient care.

5. Surgery

Surgery is one of the oldest and most technically demanding medical specialties. Surgeons diagnose and treat diseases, injuries, and deformities through operative procedures. General surgeons handle a wide range of abdominal, breast, and soft‑tissue conditions, while many pursue subspecialties such as vascular, colorectal, or trauma surgery. Surgical practice requires precision, decisiveness, and the ability to manage perioperative care.

6. Orthopedic Surgery

Orthopedic surgery focuses on the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles. Orthopedic surgeons treat fractures, sports injuries, degenerative diseases like arthritis, and congenital deformities. Their work often involves reconstructive procedures, joint replacements, and minimally invasive techniques. This specialty blends mechanical understanding with surgical expertise.

7. Cardiology

Cardiology is the study and treatment of diseases of the heart and blood vessels. Cardiologists manage conditions such as coronary artery disease, arrhythmias, heart failure, and hypertension. They use diagnostic tools like electrocardiograms, echocardiograms, and stress tests to evaluate cardiovascular function. Some cardiologists specialize further in interventional procedures, electrophysiology, or advanced heart failure management.

8. Neurology

Neurology focuses on disorders of the nervous system, including the brain, spinal cord, and peripheral nerves. Neurologists diagnose and treat conditions such as epilepsy, stroke, multiple sclerosis, migraines, and neurodegenerative diseases. Their work requires careful clinical examination and interpretation of imaging and electrophysiological tests. Neurology often intersects with psychiatry, rehabilitation, and neurosurgery.

9. Psychiatry

Psychiatry is the medical specialty devoted to mental, emotional, and behavioral health. Psychiatrists evaluate and treat conditions such as depression, anxiety disorders, bipolar disorder, schizophrenia, and substance‑related disorders. They use a combination of psychotherapy, behavioral interventions, and medication management. Psychiatry uniquely bridges biological and psychological perspectives on human health.

10. Dermatology

Dermatology addresses diseases of the skin, hair, and nails. Dermatologists diagnose and treat conditions such as eczema, psoriasis, acne, skin infections, and skin cancers. They perform procedures including biopsies, excisions, and cosmetic treatments. Because the skin reflects both internal and external influences, dermatologists often collaborate with other specialists to identify systemic causes of dermatologic symptoms.

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11. Ophthalmology

Ophthalmology is the medical and surgical care of the eyes and visual system. Ophthalmologists treat conditions such as cataracts, glaucoma, macular degeneration, and retinal disorders. They perform delicate microsurgeries and use advanced imaging to assess ocular health. Vision is central to daily life, making ophthalmology essential for preserving quality of life.

12. Otolaryngology (ENT)

Otolaryngology—often called ENT—focuses on disorders of the ear, nose, throat, head, and neck. ENT specialists treat hearing loss, sinus disease, voice disorders, sleep apnea, and head‑and‑neck cancers. Their work includes both medical management and surgical procedures, ranging from tonsillectomies to complex reconstructive surgeries.

13. Emergency Medicine

Emergency medicine physicians provide immediate care for acute illnesses and injuries. They work in fast‑paced environments where rapid assessment and stabilization are critical. Emergency physicians treat trauma, heart attacks, strokes, infections, and a wide range of urgent conditions. Their broad training allows them to manage patients of all ages and coordinate care with specialists.

14. Anesthesiology

Anesthesiology centers on pain management and the safe administration of anesthesia during surgical and medical procedures. Anesthesiologists monitor vital functions, manage airway and breathing, and ensure patient comfort. They also provide critical care, acute pain services, and chronic pain management. Their role is essential for modern surgery and intensive care.

15. Radiology

Radiology involves the use of imaging technologies to diagnose and sometimes treat disease. Radiologists interpret X‑rays, CT scans, MRIs, ultrasounds, and nuclear medicine studies. Interventional radiologists perform minimally invasive procedures guided by imaging, such as angioplasty or tumor ablation. Radiology is central to accurate diagnosis across nearly all medical specialties.

16. Pathology

Pathology is the study of disease at the microscopic and molecular levels. Pathologists analyze tissue samples, blood, and bodily fluids to identify abnormalities and provide definitive diagnoses. Their work includes surgical pathology, cytology, and laboratory medicine. Although they often work behind the scenes, pathologists are essential for confirming diagnoses and guiding treatment decisions.

17. Oncology

Oncology focuses on the diagnosis and treatment of cancer. Oncologists manage chemotherapy, immunotherapy, targeted therapy, and palliative care. They work closely with surgeons, radiologists, and pathologists to develop comprehensive treatment plans. Oncology requires not only scientific expertise but also compassionate communication, as patients often face life‑altering diagnoses.

18. Endocrinology

Endocrinology addresses disorders of the endocrine system, which regulates hormones. Endocrinologists treat conditions such as diabetes, thyroid disease, adrenal disorders, and metabolic bone disease. Because hormones influence nearly every bodily function, endocrinologists must understand complex physiological interactions and long‑term disease management.

19. Gastroenterology

Gastroenterology focuses on the digestive system, including the esophagus, stomach, intestines, liver, pancreas, and gallbladder. Gastroenterologists diagnose and treat conditions such as inflammatory bowel disease, liver disease, ulcers, and gastrointestinal cancers. They perform endoscopic procedures to visualize and treat internal structures. Digestive health plays a crucial role in overall well‑being, making this specialty vital.

20. Nephrology

Nephrology is the study and treatment of kidney diseases. Nephrologists manage chronic kidney disease, electrolyte imbalances, hypertension related to kidney dysfunction, and dialysis care. They play a central role in preventing kidney failure and supporting patients who require renal replacement therapy. Because the kidneys influence many bodily systems, nephrology often overlaps with cardiology, endocrinology, and critical care.

Conclusion

The diversity of medical specialties reflects the complexity of human health. Each specialty contributes a unique perspective, set of skills, and body of knowledge, yet all share the common goal of improving patient well‑being. From the precision of surgery to the holistic approach of family medicine, from the microscopic focus of pathology to the emotional insight of psychiatry, these twenty specialties illustrate the breadth of modern medicine. Understanding them not only clarifies how healthcare is organized but also highlights the collaborative nature of caring for patients in an increasingly specialized world.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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PASSIVE-AGGRESSIVE: Patients

By Dr. David Edward Marcinko MBA MEd

Professor Eugene Schmuckler PhD MBA MEd CTS

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Navigating the Challenges of Passive-Aggressive Patients in Healthcare

In the complex landscape of healthcare, effective communication between providers and patients is essential for accurate diagnosis, treatment adherence, and overall patient satisfaction. However, passive-aggressive behavior—characterized by indirect resistance, subtle obstruction, and veiled hostility—can significantly hinder this process. Passive-aggressive patients present unique challenges that require emotional intelligence, patience, and strategic communication skills from healthcare professionals.

Passive-aggressive behavior often stems from underlying feelings of fear, resentment, or a perceived lack of control. Patients may feel overwhelmed by their diagnosis, skeptical of medical advice, or frustrated by systemic issues such as long wait times or insurance complications. Rather than expressing these concerns openly, they may resort to behaviors such as missed appointments, vague complaints, sarcasm, or noncompliance with treatment plans. These actions, though subtle, can disrupt care continuity and erode trust between patient and provider.

One of the most difficult aspects of managing passive-aggressive patients is identifying the behavior early. Unlike overt aggression, passive-aggression is cloaked in ambiguity. A patient might nod in agreement during a consultation but later ignore medical instructions. They may offer compliments laced with sarcasm or express dissatisfaction through third parties rather than directly. These indirect signals can leave providers confused and uncertain about the patient’s true feelings or intentions.

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Addressing passive-aggressive behavior requires a nuanced approach. First, providers must cultivate a nonjudgmental environment where patients feel safe expressing concerns. Active listening, empathy, and validation can encourage more direct communication. For example, acknowledging a patient’s frustration with wait times or side effects can open the door to honest dialogue. Providers should also be mindful of their own reactions, avoiding defensiveness or dismissiveness, which can exacerbate the behavior.

Setting clear boundaries and expectations is another key strategy. Passive-aggressive patients often test limits subtly, so it’s important to reinforce the importance of mutual respect and accountability. Documenting interactions, treatment plans, and patient responses can help track patterns and ensure consistency. In some cases, involving mental health professionals may be beneficial, especially if the behavior is rooted in deeper psychological issues.

Ultimately, the goal is to transform passive-aggressive dynamics into constructive partnerships. This requires time, effort, and a willingness to engage with patients beyond surface-level interactions. When successful, it can lead to improved outcomes, greater patient satisfaction, and a more harmonious clinical environment.

In conclusion, passive-aggressive patients pose a unique challenge in healthcare, but they also offer an opportunity for providers to refine their communication skills and deepen their understanding of patient psychology. By fostering openness, setting boundaries, and responding with empathy, healthcare professionals can navigate these interactions effectively and promote better health outcomes for all.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com 

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SOCIAL DETERMINANTS OF HEALTH

By Dr. David Edward Marcinko MBA MEd

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Shaping Well-being Beyond Medicine

Health is often thought of as the result of medical care, but in reality, it is deeply influenced by the conditions in which people are born, grow, live, work, and age. These conditions, known as social determinants of health, include a wide range of social, economic, and environmental factors that shape health outcomes. They are responsible for many of the differences in health status between individuals and communities. Understanding these determinants is essential for promoting fairness in health and designing policies that reduce disparities.

Economic Stability

Economic stability is one of the most powerful determinants of health. Individuals with steady income can afford nutritious food, safe housing, and preventive healthcare. Conversely, poverty increases vulnerability to chronic diseases, mental health challenges, and limited access to medical services. Families with fewer financial resources may struggle to afford medications or healthy diets, leading to higher rates of obesity, diabetes, and cardiovascular disease. Unemployment or unstable work further exacerbates stress, which itself is linked to poor health outcomes. Economic inequality directly translates into health inequality.

Education

Education shapes health both directly and indirectly. Higher educational attainment is associated with better employment opportunities, higher income, and improved health literacy. People with more education are more likely to understand medical information, adopt healthy behaviors, and navigate healthcare systems effectively. Limited education can perpetuate cycles of poverty and poor health. For instance, children who grow up in underfunded schools may face restricted opportunities, leading to lower lifetime earnings and poorer health outcomes. Education is therefore a critical lever for breaking intergenerational cycles of disadvantage.

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Neighborhood and Physical Environment

The environment in which individuals live plays a crucial role in determining health. Safe neighborhoods with clean air, accessible parks, and reliable transportation promote physical activity and reduce exposure to pollutants. In contrast, communities with high crime rates, poor housing, and environmental hazards contribute to stress, injury, and illness. Food deserts—areas with limited access to affordable, healthy food—are a striking example of how environment shapes health. Residents in these areas often rely on processed foods, increasing risks of obesity and related diseases. Housing quality also matters: overcrowding, mold, or lead exposure can lead to respiratory illnesses and developmental delays.

Healthcare Access and Quality

Access to healthcare is a fundamental determinant, but it is shaped by social and economic factors. Insurance coverage, affordability, and cultural competence of providers influence whether individuals receive timely and effective care. Marginalized groups often face barriers such as discrimination, language differences, or lack of nearby facilities. Even when healthcare is available, disparities in quality persist. For example, minority populations may receive less aggressive treatment for certain conditions compared to others. Addressing these inequities requires systemic reforms that prioritize inclusivity and affordability.

Social and Community Context

Social relationships and community support networks significantly affect health. Strong social ties provide emotional support, reduce stress, and encourage healthy behaviors. Communities with high levels of trust and civic engagement often experience better health outcomes. Conversely, discrimination, racism, and social exclusion undermine health by increasing stress and limiting opportunities. Social cohesion and equity are therefore vital for fostering healthier societies.

Conclusion

The social determinants of health highlight that medicine alone cannot ensure well-being. Economic stability, education, environment, healthcare access, and social context collectively shape health outcomes and drive disparities. Addressing these determinants requires a holistic approach that integrates public health, social policy, and community action. By investing in education, reducing poverty, improving neighborhoods, and ensuring equitable healthcare, societies can move closer to achieving health equity. Ultimately, health is not just about treating illness—it is about creating conditions in which everyone has the opportunity to thrive.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Understanding the Tele-Medicine Paradox in Healthcare

By Dr. David Edward Marcinko MBA MEd

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A paradox is a logically self-contradictory statement or a statement that runs contrary to one’s expectation. It is a statement that, despite apparently valid reasoning from true or apparently true premises, leads to a seemingly self-contradictory or a logically unacceptable conclusion. A paradox usually involves contradictory-yet-interrelated elements that exist simultaneously and persist over time. They result in “persistent contradiction between interdependent elements” leading to a lasting “unity of opposites”.

THE TELE-MEDICINE PARADOX

Classic Definition: Refers specifically to the treatment of various medical conditions without seeing the patient in person. Healthcare providers may use electronic and internet platforms like live video, audio, PCs, tablets, or instant messaging to address a patient’s concerns and diagnose their condition remotely.

Modern Circumstance: This may include giving medical advice, walking them through at-home exercises, or recommending them to a local provider or facility. Even more exciting is the emergence of telemedicine apps which give patients access to care right from their phones or computer screens.

Paradox Examples: Treating certain conditions remotely can be challenging. Tele-medicine is often used to treat common illnesses, manage chronic conditions, or provide specialist services. If a patient is dealing with an emergent or serious condition, the remote provider suggests they seek in-person medical care.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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HAPPY: Labor Day 2025

Dear Medical Executive-Post Readers and Subscribers

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HISTORY OF LABOR DAY

The first Labor Day holiday was celebrated on Sept. 5th, 1882, in New York City, in accordance with the plans of the Central Labor Union. President Grover Cleveland signed a law on June 28th, 1894, that made the first Monday in September of each year a national holiday, according to the Department of Labor.

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MY SEPTEMBER HEALTH RE-SET

To give my health a boost after Labor Day, I’m taking a complete break from alcohol, sugar, cookies, ice cream, coffee and tea for the entire month of September. Besides that, I’ll also prioritize sleep and increase my exercise from 7 to at least 10 times [hours] a week. This will allow me to focus on my diet and mental well-being. It’s essentially a month of health and wellness rejuvenation.

I’ve chosen to focus on alcohol and sugar because I want to challenge the idea that moderate drinking is part of a healthy lifestyle. In reality, only those who maintain a healthy lifestyle can afford to enjoy alcohol in moderation. But, sugar is everywhere and must be minimized for Type II diabetes and weight control.

Moreover, the long-term and excessive intake of sugary beverages and refined sugars can negatively impact your overall caloric intake and create a domino effect on your health. For example, excess sugar in the body can turn into fat deposits and lead to fatty liver disease.

A low sugar diet can help you lose weight and also help you manage and/or prevent diabetes, heart disease and stroke, reduce inflammation, and even improve your mood and the health of your skin. That’s why the low sugar approach is a key tenet of other well-known healthy eating patterns, such as the Mediterranean diet and the DASH diet.

QUESTION: And so, do you also commit to such “factory resets” now and then? Please comments.

Do, enjoy the Labor Day Weekend, Bar-B-Ques with friends, family and colleagues. And, I hope you continue to find the Medical Executive-Post useful!

Many thanks for your likes and referrals.
Dr. David Edward Marcinko MBA MEd CMP
[Editor and Chief]

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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PHYSICIAN BURNOUT: Causes and Conclusions

By Dr. David Edward Marcinko; MBA MEd

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Healthcare comes with its share of mental challenges, especially considering that clinicians often care for patients when they’re in difficult and sometimes tragic situations. New research shows that even the path to getting into the workforce can be a challenge, with some physicians burning out before they make it to graduation.

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American medicine is undergoing vast changes, placing the status of physicians in the medical industrial complex at great risk. Most physicians feel overwhelmed by increasing bureaucratic mandates from insurers, hospitals, and government. At the same time, physicians are the front line employees of healthcare and assume the majority of the risk for patient care. This has left many in the profession with increasing disillusionment. 

Samantha Meltzer-Brody a psychiatrist and director of, Taking Care of Our Own, University of North Carolina, Chapel Hill, NC states it best:

“Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.”

What causes physician burnout?

The “Big 4” factors known to contribute to stress and burnout include:

  1. Time pressure, especially in patient visits or documentation
  2. Lack of control over work environment
  3. Chaotic, fast-paced workplaces
  4. Culture of the organization, specifically a culture that does not emphasize communication, cohesion, trust, and alignment of values between clinicians and their leaders

In addition to burnout rates, these factors can be assessed to help direct interventions toward those drivers that are most likely to be contributing to burnout at your organization.

OK BURNOUT: https://medicalexecutivepost.com/2022/08/30/u-s-hospitals-feeling-the-pain-of-physician-burnout/

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The burned-out physician is exhausted — mentally and physically — and often no longer able to find empathy or connection with patients. The question of how to escape from what has become a highly unpleasant situation becomes a frequent one. Given the high demands of the profession and serious consequences of mistakes, the burned-out doctor is a potentially impaired one. And the impaired physician is not able to maintain the unflappable, perpetually cool under fire, always objective, professional and yet compassionate demeanor that is expected by society. Worst of all, the impaired physician is at great risk for developing depression, suicidal ideation, or a serious addiction.

The doctors who contact me report feeling beaten down by an increasingly hostile work environment. They say that they don’t have time to take care of patients the way they envisioned when they decided to apply to medical school. Many describe feeling betrayed by a system that they say seems focused on achieving the bottom line with little regard for the impact on both doctors and patients.

Most of these doctors report spending a significant amount of their time dealing with the electronic medical record and documentation. The ratio of time spent on doctor-patient

interactions compared to physician-computer ones appears so horribly skewed that it has reached the point of complete dysmorphia. These good physicians call me when they feel like they can’t continue any longer in the profession. They want to quit medicine. They report a loss of joy and meaning in their work. They describe the toll that the profession has had on their mental health, physical health, and personal lives. And most wrenchingly, they don’t see an end.

What can we do? There are no easy answers to the complex issues that threaten our profession.  “The Taking Care of Our Own Program…has had an over 200% rate of growth in the first year, reflecting the enormous need…”  

PHYSICIAN COACHING: https://medicalexecutivepost.com/coach/

Assessment

Burned out physicians will eventually be labeled as disruptive, impaired, an outlier or arrogant.  There’s a reason it’s difficult and extremely expensive for physicians to find disability insurance; psychiatric claims.  Burnout leads to depression, anxiety, PTSD, suicide, divorce, drug abuse, surly behaviors and interactions, etc.  It’s nothing new; it’s been occurring for a long time.  Go without routine sleep, eat erratically, work long hours, operate under constantly stressful situations and have no time for your family or self and most individuals will de-compensate physically and psychologically within weeks. 

Conclusion

Physicians operate within these parameters year after year. 

How are they to remain healthy, functional humans? They can’t.  Even a superhero couldn’t, yet physicians are expected to endure and thrive under such conditions. 

If a physician makes a single mistake, or snaps just one day, their entire career is on the line.

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COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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PHYSICIAN DIVORCE: Within the Medical Profession

By Dr. David Edward Marcinko MBA MEd

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SPONSOR: http://www.MarcinkoAssociates.com

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DIVORCE WITHIN THE MEDICAL PROFESSION

A Johns Hopkins University study, by Michael J. Klag MD in 1997, found that physicians in some specialties — chiefly psychiatry and surgery — are at higher risk for divorce than their medical brethren in other fields. But, the results did not support the common view that job-related anxiety and depression are linked to marital breakup. Alerting medical students to the risks of divorce in some specialties may influence their career choices and strengthen their marriages whatever field they choose. The study, supported by the National Institutes of Health [NIH], was published in the March 13th issue of The New England Journal of Medicine. Results also strongly suggested that the high divorce risk in some specialties may result from the inherent demands of the job as well as the emotional experiences of physicians who enter those fields.

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Divorce Prone Medical Specialties*

For example, the Hopkins team assessed the specialty choices, marriage histories, psychological characteristics, and other career and personal factors of 1,118 physicians who graduated from The Johns Hopkins University School of Medicine from 1948 through 1964. Over 30 years of follow-up, the divorce rate was 51 percent for psychiatrists, 33 percent for surgeons, 24 percent for internists, 22 percent for pediatricians and pathologists, and 31 percent for other specialties. The overall divorce rate was 29 percent after three decades of follow-up and 32 percent after nearly four decades of follow-up.

Physicians who married before medical school graduation had a higher divorce rate than those who waited until after graduation (33 percent versus 23 percent). The year of first marriage was linked with divorce rates: 11 percent for marriages before 1953, 17 percent for those from 1953 to 1957, 24 percent for those from 1958 to 1962 and 21 percent for those after 1962. Those who had a parent die before medical school graduation had a lower divorce rate.

Female physicians had a higher divorce rate (37 percent) than their male colleagues (28 percent). Physicians who were members of an academic honor society in medical school had a lower divorce rate, although there was no difference in divorce rates according to class rank. Religious affiliation, being an only child, having a parent who was a physician and having a divorced parent were not associated with divorce rates. Physicians who reported themselves to be less emotionally close to their parents and who expressed more anger under stress also had a significantly higher divorce rate, but anxiety and depression levels were not associated with divorce rates.

MEDIATION: https://medicalexecutivepost.com/2024/09/15/financially-egalitarian-dating-marriages-and-divorce-mediation-for-doctors/

*Cite: Co-authors of the study, which was part of the Johns Hopkins Precursors Study, an ongoing, prospective study of physicians from the Hopkins medical school graduating classes of 1948 through 1964, were lead author Bruce L. Rollman, M.D., Lucy A. Mead, Sc.M., and Nae-Yuh Wang, M.S.

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The Painful Truth

In their article “The Painful Truth: Physicians Are Not Invincible” [1] Miller and McGowen state that divorce rates among physicians have been reported to be 10% to 20% higher than those in the general population. They explain that for many years in pre-med college, medical school, and residency, physicians focus on getting through the next hurdle. They may postpone the pleasures of life that others enjoy.  Compulsive traits that allow them to postpone enjoyment may have the unwanted consequence of leading to more distant relationships., thus placing strain on intimate relationships.

A 2002 study looking at dual physician marriages found they have a relatively low divorce rate of 11%. “They’re a happily married cohort,” says Dr Wayne Sotile of the Sotile Cetner for Resilience (www.sotile.com). “They’re more compassionate about the passion for the career — they understand the calling because they share it.”

A study published in The New England Journal of Medicine in 1997 with Bruce L. Rollman as the lead researcher [2] found that physicians in some specialties — chiefly psychiatry and surgery — are at higher risk for divorce than their medical brethren in other fields. Alerting medical students to the risks of divorce in some specialties may influence their career choices and strengthen their marriages whatever field they choose.

The study suggested that the high divorce risk in some specialties may result from the inherent demands of the job as well as the emotional experiences of physicians who enter those fields. The divorce rate was 51 percent for psychiatrists, 33 percent for surgeons, 24 percent for internists, 22 percent for pediatricians and pathologists, and 31 percent for other specialties.

The overall divorce rate was 29 percent after three decades of follow-up and 32 percent after nearly four decades of follow-up. Physicians who married before medical school graduation had a higher divorce rate than those who waited until after graduation (33 percent versus 23 percent). Female physicians had a higher divorce rate (37 percent) than their male colleagues (28 percent).

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References:


  1. Miller, M. N., McGowen, R., 2000, “The painful truth: Physicians are not invincible,” Southern Medical Journal, 93: 966-973.
  2. Rollman BL, Mead LA, Wan NY, Klag MJ. Medical specialty and the incidence of divorce. N Engl J Med. 1997;336:800–3

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Gerontologist V. Geriatrician?

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FLEXNER REPORT: Medical Education

By Staff Reporters

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According to Wikipedia, the Flexner Report was a book-length landmark report of medical education in the United States and Canada, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Flexner not only described the state of medical education in North America, but he also gave detailed descriptions of the medical schools that were operating at the time. He provided both criticisms and recommendations for improvements of medical education in the United States.

Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath. While it had many positive impacts on American medical education, the Flexner report has been criticized for introducing policies that encouraged systemic racism and sexism.

The Report, also called Carnegie Foundation Bulletin Number Four, called on American medical schools to enact higher admission and graduation standards, and to adhere strictly to the protocols of mainstream science principles in their teaching and research. The report talked about the need for revamping and centralizing medical institutions. Many American medical schools fell short of the standard advocated in the Flexner Report and, subsequent to its publication, nearly half of such schools merged or were closed outright.

Colleges for the education of the various forms of alternative medicine, such as electro-therapy were closed. Homeopathy, traditional osteopathy, eclectic medicine, and physiomedicalism (botanical therapies that had not been tested scientifically) were derided.

The Report also concluded that there were too many medical schools in the United States, and that too many doctors were being trained. A repercussion of the Flexner Report, resulting from the closure or consolidation of university training, was the closure of all but two black medical schools and the reversion of American universities to male-only admittance programs to accommodate a smaller admission pool.

In Chapter 11, Flexner stressed that the success of medical education reform and the professionalization of medicine relied heavily on the effective legal and ethical functioning of state medical boards. However, he noted that these boards were failing in their mission, stalling progress and allowing substandard medical practices to continue, thereby jeopardizing public health. This problem persists as a significant issue in the current practice of medicine in the United States.

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