Fragmentation and Specialization

Arch Surg. 1987;122(6):639. doi:10.1001/archsurg.1987.01400180021003.
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The concerns registered by Dr Roe in this issue of the Archives continue a dialogue that has existed since 1945. The decibels have been raised to a new level since 1980. Much of this is reflected in recent policy statements from the American College of Surgeons, the American Board of Surgery, and the American Surgical Association. Many surgeons not currently on the "organizational firing line" may not be aware of changes implemented by the Residency Review Committee and The American Board of Surgery.

The branches and leaves of any tree grow and function only if there is vitality in the trunk. A nonviable tree cannot continue to pioneer the development of new specialties and techniques if the newly developed specialties become more parasitic than physiologic. I know of no division or subsystem in any biologic preparation that is larger than the original trunk. The very best of peripheral arterial vessels


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