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Fragmentation in General Surgery The Case of Head and Neck Surgery

Arch Surg. 1989;124(9):1013-1014. doi:10.1001/archsurg.1989.01410090019001.
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Fragmentation of the specialty of general surgery has become a source of serious concern and alarm for the community of general surgeons. Part of the fragmentation stems from the burgeoning of technological interventionists, usually based in the nonsurgical specialties. Radiologists, gastroenterologists, and cardiologists, among others, have been aggressively pushing their specialties into surgical realms. Another part of the problem, however, is based on schisms between and among surgical disciplines.

A particular case in point is the controversy that has been swirling around the attempts of the specialty of otolaryngology to become designated as otolaryngology–head and neck surgery. These attempts have caused serious conflicts at the board and residency review committee levels of the two specialties. The outcome of the conflicts is not clear. What is clear is that there are enormous implications for clinical practice, board certification, and residency training in both fields, no matter what the outcome may


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