Word: patients
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...docs. I certainly wouldn't want anyone but a neurosurgeon dissecting a tumor out of my brain, or anyone but smart oncologist coming up with the drug cocktail that might save my life from a cancer. It's usually not that hard, though. The great bulk of patient visits are for really simple things - questions that a reasonably bright resident would get right. Most pneumonias, for example, are pretty easy to treat; the internist should have no trouble doing it himself. But sub-specialization is the trend.The reasons for this are tied up in ego, education and mostly economics...
...Education in medicine means residency and fellowship. Residency is, for some, very pleasant - a long continuation of at least some of the comforts of childhood. When you're a resident, the chairman is always right. You rotate off services - the worst disaster patient is somebody else's problem at the end of six weeks. There's no office to run, no payroll, insurance, rent etc. You only do the interesting part of the job: medicine. Long fellowships and residencies prolong this state. And produce a bunch of narrow specialists...
...general surgeon like my guest attending back in med school? Probably not. At least not anywhere they have running water. The training programs for different types of surgery have evolved too far apart. And, of course, the malpractice lawyers would take the guy's house the first time a patient didn't do well...
...real fun of our field is putting it all together and getting a happy human being out of one who came in disturbed by a problem. Keeping up one's interest level in treating only a narrow patient population can be a challenge. I do mostly shoulders (that's my sub-specialty), but also hands, knees, hips, various fractures, a few feet and, unavoidably, some backaches. Despite the backaches, general orthopedists are pretty lucky still to be able to have this run of the body. I couldn't imagine just putting in 10 total knees a week, 49 weeks...
...groaning cliché, but "Time will tell" is surprisingly useful here. The study suggests that time will change the Supreme Court even without new Justices. So if you don't like the current ideological tilt, just be patient...