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診療科

Revision as of 20:06, 19 February 2024 by Fire (talk | contribs) (Created page with "==北米の診療科一覧 ほか== {{Anchor|List of North American medical specialties and others}} この表では、多くの医療分野と同様に、診療科を以下のグループに分類している： * 外科専門分野は、病気を治療するための手作業による手術や器具を使った技術に重点を置いている。 * 医学の専門分野であり、病気の診断と非外科的治療に重点を置いて...")

Medical specialty/ja
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診療科とは、特定の患者、疾患、技術、または哲学に特化した診療分野のことである。例えば、小児（小児科）、がん（腫瘍学）、検査医学（病理学）、またはプライマリ・ケア（家庭医学）のみを扱う医学の一分野である。医師や外科医などの臨床医は、医学部やその他の基礎訓練を修了した後、通常、複数年のレジデンシーを修了して専門医になることで、特定の医学の専門分野でさらに医学教育を受ける。

医療の専門化の歴史

ある程度までは、医薬品を扱う医師は昔から専門化されていた。ガレノスによれば、ローマ時代の医師の間では専門化が一般的であった。現代の専門医制度は19世紀に徐々に発展した。正式な法制度よりも先に、医学の専門性に対する社会的な非公式な認識が発展したのである。医学を様々な専門分野に細分化することは、国によって異なり、やや恣意的である。

医療の専門性の分類

診療科はいくつかの軸で分類することができる。それらは以下の通りである：

  • 外科または内科
  • 患者の年齢層
  • 診断か治療か
  • 臓器別か手技別か

歴史上、最も重要なのは、外科専門医と内科専門医に分かれることであった。外科の専門分野とは、診断と治療の重要な部分が、主要な外科的技術によって達成される専門分野である。内科の専門分野とは、診断や治療の主体が決して大手術ではない専門分野である。ある国では、麻酔学は外科学に分類されている。これは、麻酔科医が自ら大手術を行うことはないが、手術の過程では不可欠だからである。

多くの専門分野は臓器別である。多くの症状や病気は特定の臓器に由来する。また、もともとはX線を中心とした放射線学のように、一連の技術を中心としたものもある。

どの専門医が診る患者の年齢層は、かなり幅がある。小児科医は、外科手術を必要としない小児の愁訴や疾患のほとんどを扱っており、小児科には、成人の臓器別専門科を模倣したいくつかの下位専門科（正式または非公式）がある。小児外科は、小児の外科的不定愁訴を扱う別個の専門分野である場合もあれば、そうでない場合もある。

さらに細分化すると、診断専門医と治療専門医がある。診断プロセスはすべての専門分野で非常に重要であるが、病理学、臨床神経生理学、放射線学など、主に診断検査のみを行う専門家もいる。この境界線は、インターベンショナル・ラジオロジーという、画像の専門知識を駆使して低侵襲の手技を行う発展途上の分野によって、やや曖昧になりつつある。

世界共通の専門分野

専門分野 サブスペシャリティであってもよい 年齢層
患者数 		診断 (D) あるいは
治療 (T)
専門 		外科手術 (S) あるいは
内科 (I)
専門 		臓器別 (O)
あるいは 技術に基づく (T)
アレルギー・免疫学 内科
小児科 		All Both I O
Adolescent medicine/ja 小児科
家庭医学 		小児 Both I T
Anesthesiology/ja None All T Both Both
航空宇宙医学 家庭医学 All Both Neither Both
Bariatrics/ja Several All Both Both Both
循環器学 内科 成人 T I O
Cardiothoracic surgery/ja 一般外科 成人 T S O
児童思春期精神医学 精神医学 小児 T I T
Clinical neurophysiology/ja 神経学 All D I Both
Colorectal surgery/ja 一般外科 All Both S O
Dermatology/ja None All T I O
発達小児科 小児科 小児 T I Neither
Emergency medicine/ja 家庭医学 All Both Both Both
内分泌学 内科 成人 Both I 学際的
Family Medicine/ja None All Both Both 学際的
Forensic pathology/ja 病理学 All D Neither T
Forensic psychiatry/ja 精神医学 All D I T
Gastroenterology/ja 内科 成人 T I O
General surgery/ja None 成人 T S T
一般外科腫瘍学 一般外科 成人 T S T
Geriatrics/ja 家庭医学
内科 		老人 T I 学際的
Geriatric psychiatry/ja 老年医学
精神医学 		老人 T I Neither
Gynecologic oncology/ja 産婦人科 All T S O
Hematology/ja 内科
病理学 		成人 D I Neither
血液病理学 血液学
病理学 		All D Neither T
感染症 内科
小児科 		All Both I Neither
内科 None 成人 Both I Neither
Interventional radiology/ja 放射線学 All Both - 学際的
Intensive care medicine/ja 麻酔科学
救急医療
内科 		All T Both Both
Maternal-fetal medicine/ja 産婦人科 成人 T S Both
Medical biochemistry/ja 内科 All D I Neither
Medical genetics/ja None All D I Neither
Medical oncology/ja 内科 成人 D I Neither
Neonatology/ja 小児科 新生児 T I Neither
Nephrology/ja 内科 All T I O
Neurology/ja 内科 All Both I O
Neuropathology/ja 病理学 All D Neither T
Neurosurgery/ja None All T S O
核医学 None All Both I T
Obstetrics and gynecology/ja 家庭医学 All T S O
Occupational medicine/ja 家庭医学
内科 		成人 T I 学際的
Ophthalmology/ja None All T S O
Orthopedic surgery/ja None All T S O
Oral and maxillofacial surgery/ja None All T S O
Otorhinolaryngology/ja None All T S O
Palliative care/ja 家庭医学
内科
小児科 		All Both Neither Neither
Pathology/ja None All D Neither T
Pediatrics/ja None 小児 Both I Neither
小児アレルギー・免疫学 小児科 小児 T I O
小児循環器科 小児科 小児 T I O
Pediatric emergency medicine/ja 小児科 小児 Both Both Both
小児内分泌学 小児科 小児 Both I Multidisciplinary
小児消化器病学 小児科 小児 T I O
小児血液・腫瘍学 小児科 小児 T I O
小児感染症 小児科 小児 T I O
小児腎臓学 小児科 小児 T I O
小児呼吸器内科 小児科 小児 T I O
小児リウマチ科 小児科 小児 T I O
Pediatric surgery/ja 一般外科 小児 T S O
Physical medicine and rehabilitation/ja None All T I 学際的
形成外科、再建外科、美容外科 一般外科 All T S O
Psychiatry/ja 家庭医学 All Both I T
Public health/ja 家庭医学 All Neither Neither T
Radiation oncology/ja None All T Neither T
Radiology/ja None All Both I T
生殖内分泌学と不妊症 産婦人科 成人 T S T
呼吸器科、あるいは呼吸器内科 内科 成人 T I O
Rheumatology/ja 内科 成人 T I Neither
Sports medicine/ja 家庭医学 All Both Neither 学際的
Thoracic surgery/ja 一般外科 成人 T S T
Toxicology/ja 救急医学 All Both Neither O
Transfusion Medicine/ja None All Both Neither Both
Neuroradiology/ja 放射線学 All Both I Both
Urology/ja None All T S O
Vascular surgery/ja 一般外科 All T S O

欧州連合（EU）および欧州経済地域（EEA）で認められている専門医のリスト

欧州連合は、欧州連合、ひいては欧州経済領域で認められている専門分野のリストを公表している。いくつかの専門分野間にはかなりの重複があり、例えば「臨床放射線学」と「放射線学」は、欧州全域で同じ診療パターンを大なり小なり指していると思われる。

北米の診療科一覧 ほか

この表では、多くの医療分野と同様に、診療科を以下のグループに分類している：

  • 外科専門分野は、病気を治療するための手作業による手術や器具を使った技術に重点を置いている。
  • 医学の専門分野であり、病気の診断と非外科的治療に重点を置いている。
  • 診断専門は、より純粋に障害の診断に重点を置いている。
専門分野 コード グループ 副専門分野 フォーカス
Allergy/jaとimmunology/ja アレルギー反応、喘息、免疫システム
Anesthesiology/ja AN, PAN 外科 Anesthesia/ja
Bariatrics/ja 肥満の原因、予防、治療を扱う
循環器学 医学 循環器系の疾患
Cardiovascular surgery/ja Surgery/ja 心臓と胸部の主要な血管を操作すること。
臨床検査科学 診断 検体分析、顕微鏡分析など、医学研究所における診断技術の応用。
Dermatology/ja D, DS 医学 皮膚科、モース手術 皮膚とその付属器官（毛髪、nail、汗腺など）
Dietetics/ja RD 食品と栄養
Emergency medicine/ja EM 医学 The initial management of emergent medical conditions, often in hospital emergency departments or the field.
Endocrinology Medicine The endocrine system (i.e., endocrine glands and hormones) and its diseases, including diabetes and thyroid diseases.
Family medicine FM Medicine
  • Addiction medicine
  • Adolescent medicine
  • Anesthesia
  • Emergency medicine
  • Care of the elderly (geriatric medicine)
  • Clinical environmental health
  • Global health
  • HIV care
  • Hospital medicine
  • Indigenous health
  • Low-risk obstetrics
  • Medical education
  • Medical oncology
  • Medical simulation
  • Pain medicine
  • Palliative care
  • Point of Care Ultrasound (POCUS)
  • Research
  • Sleep medicine
  • Sports and exercise medicine
  • Women's health
 Continuing, comprehensive healthcare for the individual and family, integrating the biological, clinical and behavioral sciences to treat patients of all ages, sexes, organ systems, and diseases.
Forensic medicine Medicine
Gastroenterology GI Medicine The alimentary tract
General surgery GS Surgery
  • Colorectal surgery
  • Gastrointestinal surgery
  • Transplant surgery
  • Trauma surgery
Geriatrics IMG Medicine Elderly patients
Gynecology Female reproductive health
Hepatology Medicine The liver and biliary tract, usually a part of gastroenterology.
Hospital medicine Medicine
Infectious disease ID Medicine Diseases caused by biological agents.
Intensive care medicine Medicine Life support and management of critically ill patients, often in an ICU.
Internal medicine Medicine
Medical research Anatomy, Biochemistry, Embryology, Genetics, Pharmacology, Toxicology Care of hospitalized patients
Nephrology Medicine Kidney diseases
Neurology N Medicine Diseases involving the central, peripheral, and autonomic nervous systems.
Neurosurgery NS Surgery Disease of the central nervous system, peripheral nervous system, and spinal column.
Obstetrics and gynecology OB/GYN Surgery
Oncology ON Medicine Cancer and other malignant diseases, often grouped with hematology.
Ophthalmology OPH Surgery Diseases of the visual pathways, including the eyes, brain, etc.
Oral and maxillofacial surgery Maxfacs, OMS Surgery
  • Oral and Craniofacial surgery (Head and neck)
  • Facial cosmetic surgery
  • Craniomaxillofacial trauma
 Disease of the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region.
Orthopedic surgery ORS Surgery Hand surgery, surgical sports medicine, adult reconstruction, spine surgery, foot and ankle, musculoskeletal oncology, orthopedic trauma surgery, pediatric orthopedic surgery Injury and disease of the musculoskeletal system.
Otorhinolaryngology, or ENT ORL, ENT Surgery Head and neck, facial cosmetic surgery, Neurotology, Laryngology Treatment of ear, nose, and throat disorders. The term head and neck surgery defines a closely related specialty that is concerned mainly with the surgical management of cancer of the same anatomical structures.
Palliative care PLM Medicine A relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
Pathology PTH Diagnostic Understanding disease through examination of molecules, cells, tissues and organs. The term encompasses both the medical specialty that uses tissues and body fluids to obtain clinically useful information and the related scientific study of disease processes.
Pediatrics PD Medicine Children. Like internal medicine, pediatrics has many sub-specialties for specific age ranges, organ systems, disease classes, and sites of care delivery. Most sub-specialties of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, pediatric oncology, pediatric ophthalmology, and neonatology. Deals with the medical care of infants, children, and adolescents (from newborn to age 16–21, depending on the country).
Pediatric surgery Surgery Treats a wide variety of thoracic and abdominal (and sometimes urologic) diseases of childhood.
Physical medicine and rehabilitation Or Physiatry PM&R Medicine
  • Cancer Rehabilitation
  • Pain Management
  • Traumatic Brain Injury
  • Spinal Cord Injury
  • Sports Medicine
  • Pediatrics
  • Hospice & Palliative Medicine
 Concerned with functional improvement after injury, illness, or congenital disorders.
Plastic surgery PS Surgery
  • Cosmetic surgery
  • Burn
  • Microsurgery
  • Hand surgery
  • Craniofacial surgery
 Elective cosmetic surgery as well as reconstructive surgery after traumatic or operative mutilation.
Podiatry POD Surgery
  • Forefoot surgery
  • Midfoot surgery
  • Rearfoot surgery
  • Ankle surgery
  • Soft tissue leg surgery
 Elective podiatric surgery of the foot and ankle, lower limb diabetic wound and salvation, peripheral vascular disease limb preservation, lower limb mononeuropathy conditions. Reconstructive foot & ankle surgery.
Proctology PRO Medicine (or Colorectal Surgery) Treats disease in the rectum, anus, and colon.
Psychiatry P Medicine The bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related fields include psychotherapy and clinical psychology.
Pulmonology Medicine The lungs and respiratory system. Pulmonology is generally considered a branch of internal medicine, although it is closely related to intensive care medicine when dealing with patients requiring mechanical ventilation.
Public Health Public health focuses on the health of populations. Physicians employed in this field work in policy, research or health promotion, taking a broad view of health that encompasses the social determinants of health.
Radiology R, DR Diagnostic and Therapeutic
  • Interventional radiology is concerned with using expert imaging of the human body, usually via CT, ultrasound, fluoroscopy, or MRI to perform a breadth of intravascular procedures (angioplasty, arterial stenting, thrombolysis, uterine fibroid embolization), biopsies and minimally invasive oncologic procedures (radiofrequency and cryoablation of tumors & transarterial chemoembolization)
  • Nuclear medicine uses radioactive substances for in vivo and in vitro diagnosis either using imaging of the location of radioactive substances placed into a patient or using in vitro diagnostic tests utilizing radioactive substances.
 The use of expertise in radiation in the context of medical imaging for diagnosis or image guided minimally invasive therapy. X-rays, etc.
Rheumatology RHU Medicine Autoimmune and inflammatory diseases of the joints and other organ systems, such as arthritis and other rheumatic diseases.
Surgical oncology SO Surgery Curative and palliative surgical approaches to cancer treatment.
Thoracic surgery TS Surgery Surgery of the organs of the thoracic cavity: the heart, lungs, and great vessels.
Transplant surgery TTS Surgery Transplantation of organs from one body to another.
Toxicology Diagnostic and Therapeutic
  • Environmental
  • Forensic
  • Occupational
  • Pediatric
 Poisonings, Overdoses; Environmental, and Occupational Exposures
Urgent Care Medicine UCM Medicine Immediate medical care offering outpatient care for the treatment of acute and chronic illness and injury.
Urology U Surgery Urinary tracts of males and females, and the male reproductive system. It is often practiced together with andrology ("men's health").
Vascular surgery VS Surgery The peripheral blood vessels – those outside the chest (usually operated on by cardiovascular surgeons) and outside the central nervous system (treated by neurosurgery).

Salaries

According to the 2022 Medscape Physician Compensation Report, physicians on average earn $339K annually. Primary care physicians earn $260K annually while specialists earned $368K annually.

The table below details the average range of salaries for physicians in the US of medical specialties:

Specialty Average salary (USD) Average hours

work/week

Average salary/hour (USD)
Allergy & Immunology $298K
Anesthesiology $405K 59
Dermatology $438K 44 103
Emergency medicine $373K 44 180
Endocrinology $257K
Cardiac Surgery 218,684 to $500,000
Cardiology $490K 55
Critical care $369K
Infectious disease $260K
Internal medicine $264K 55 58
Family medicine $255K 51 58
Nephrology $329K
Neurology $301K 54 93
Obstetrics and Gynecology $336K 59 83
Oncology $411K
Ophthalmology $417K 45
Orthopedic surgery $557K 56
Otolaryngology $469K 52
Oral and Maxillofacial Surgery 360,000 to $625,210 53
Pathology $334K 44
Pediatrics 244K 52 69
Rheumatology $289K
Physical Medicine & Rehabiliation $322K
Podiatry 170,800 to $315,150 45 80
Preventative medicine $243K
Pulmonary medicine $353K 55
Psychiatry $287K 46 72
Radiology (diagnostic) $437K 56
Surgery (general) $402K 58
Urology $461K 59
Neurosurgery 350,000 to $705,000 132
Plastic surgery $576K 114
Gastroenterology $453K 55 93

Specialties by country

Australia and New Zealand

There are 15 recognised specialty medical Colleges in Australia. The majority of these are Australasian Colleges and therefore also oversee New Zealand specialist doctors. These Colleges are:

Specialist College Major Subspecialties Approximate number of specialist doctors/trainees
Australasian College for Emergency Medicine Paediatric emergency medicine 5,000
Australasian College of Dermatologists 700
Australasian College of Sport and Exercise Physicians Exercise medicine 350
Australian and New Zealand College of Anaesthetists Pain medicine 7,000
Australian College of Rural and Remote Medicine 4,500
College of Intensive Care Medicine Paediatric Intensive care 1,200
Royal Australasian College of Medical Administrators 800
Royal Australasian College of Physicians Addiction medicine, Adolescent and young adult medicine, Cardiology, Clinical Genetics, Clinical haematology, Clinical pharmacology, Community child health, Endocrinology, Gastroenterology, General and acute care medicine, General paediatrics Geriatric medicine, Haematology, Infectious diseases, Immunology and allergy, Neonatal and perinatal medicine, Nephrology, Neurology, Nuclear medicine, Occupational medicine, Oncology, Paediatric emergency medicine, Palliative medicine, Public health, Rehabilitation, Respiratory and sleep medicine, Rheumatology, Sexual Health 28,000
Royal Australasian College of Surgeons Cardiothoracic, General surgery, Head & neck, Neurosurgery, Orthopaedics, Paediatric surgery, Plastics, Urology, Vascular 9,000
Royal Australian and New Zealand College of Obstetricians and Gynaecologists Obstetrics, Gynaecology, Fertility medicine, Obstetric ultrasound, Gynaecological oncology, Urogynaecology 2,500
Royal Australian and New Zealand College of Ophthalmologists 1,100
Royal Australian and New Zealand College of Psychiatrists 5,000
Royal Australian and New Zealand College of Radiologists Diagnostic, Interventional, Ultrasound, Nuclear medicine 3,500
Royal Australian College of General Practitioners 40,000
Royal College of Pathologists of Australasia Anatomical, Chemical, Clinical, Forensic, Genetic, Haematological, Immunological, Microbiological Pathology 1,000

In addition, the Royal Australasian College of Dental Surgeons supervises training of specialist medical practitioners specializing in Oral and Maxillofacial Surgery in addition to its role in the training of dentists. There are approximately 260 faciomaxillary surgeons in Australia.

The Royal New Zealand College of General Practitioners is a distinct body from the Australian Royal Australian College of General Practitioners. There are approximately 5100 members of the RNZCGP.

Within some of the larger Colleges, there are sub-faculties, such as: Australasian Faculty of Rehabilitation Medicine Archived 2014-12-11 at the Wayback Machine within the Royal Australasian College of Physicians

There are some collegiate bodies in Australia that are not officially recognised as specialities by the Australian Medical Council but have a college structure for members, such as: Australasian College of Physical Medicine

There are some collegiate bodies in Australia of Allied Health non-medical practitioners with specialisation. They are not recognised as medical specialists, but can be treated as such by private health insurers, such as: Australasian College of Podiatric Surgeons

Canada

Specialty training in Canada is overseen by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. For specialists working in the province of Quebec, the Collège des médecins du Québec also oversees the process.

Germany

In Germany these doctors use the term Facharzt.

India

Specialty training in India is overseen by the Medical Council of India, responsible for recognition of post graduate training and by the National Board of Examinations. Education of Ayurveda in overseen by Central Council of Indian Medicine (CCIM), the council conducts UG and PG courses all over India, while Central Council of Homoeopathy does the same in the field of Homeopathy.

Sweden

In Sweden, a medical license is required before commencing specialty training. Those graduating from Swedish medical schools are first required to do a rotational internship of about 1.5 to 2 years in various specialties before attaining a medical license. The specialist training lasts 5 years.

United States

There are three agencies or organizations in the United States that collectively oversee physician board certification of MD and DO physicians in the United States in the 26 approved medical specialties recognized in the country. These organizations are the American Board of Medical Specialties (ABMS) and the American Medical Association (AMA); the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) and the American Osteopathic Association; the American Board of Physician Specialties (ABPS) and the American Association of Physician Specialists (AAPS). Each of these agencies and their associated national medical organization functions as its various specialty academies, colleges and societies.

Certifying board National organization Physician type
ABMS AMA MD and DO
ABPS AAPS MD and DO
AOABOS AOA DO only

All boards of certification now require that medical practitioners demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years.

In the United States there are hierarchies of medical specialties in the cities of a region. Small towns and cities have primary care, middle sized cities offer secondary care, and metropolitan cities have tertiary care. Income, size of population, population demographics, distance to the doctor, all influence the numbers and kinds of specialists and physicians located in a city.

Demography

A population's income level determines whether sufficient physicians can practice in an area and whether public subsidy is needed to maintain the health of the population. Developing countries and poor areas usually have shortages of physicians and specialties, and those in practice usually locate in larger cities. For some underlying theory regarding physician location, see central place theory.

The proportion of men and women in different medical specialties varies greatly.

Satisfaction and burnout

A survey of physicians in the United States came to the result that dermatologists are most satisfied with their choice of specialty followed by radiologists, oncologists, plastic surgeons, and gastroenterologists. In contrast, primary care physicians were the least satisfied, followed by nephrologists, obstetricians/gynecologists, and pulmonologists. Surveys have also revealed high levels of depression among medical students (25 - 30%) as well as among physicians in training (22 - 43%), which for many specialties, continue into regular practice. A UK survey conducted of cancer-related specialties in 1994 and 2002 found higher job satisfaction in those specialties with more patient contact. Rates of burnout also varied by specialty.

See also

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