ما بين الشمولية.. والتخصصية الطبية..!

Several years ago, during a scientific meeting, one of the attendees introduced himself and his specialty, adding: "So-and-so, consultant in right nasal surgery." Perhaps I would have believed what he said, had he not indicated that it was a meaningful joke in his mind, criticizing the phenomenon of mandatory specialties and their complexities, and the reduction of healthcare services to the specific without considering the general specialty at times, which ignited a long debate between supporters and opponents. Here arises the question: What is the balanced equation between the availability of specialized medical services and the provision of comprehensive medical care? Is it better for a doctor to offer a little of everything or a lot of one thing? Or is it about balancing both?
Observing the timeline of the existence of medical specialties, we find that the beginning of the presence of doctors in the Kingdom in the early twentieth century was through the recruitment of general practitioners, who perhaps were found only in major cities at a rate of one doctor in some cities, and the limited services at that time forced them to receive and treat all types of cases without exception. Things evolved after that, starting from the mid-century to its end, where the concept of specialization began, coinciding with the launch of scholarships, so many Saudi doctors obtained general specialties, such as internal medicine, general surgery, pediatrics, and obstetrics... etc. Their situation was similar to that of general practitioners in the past; they were compelled to expand their range of services even if it included aspects outside their specialty at times. By the end of the twentieth century, the concept of precise specialties developed significantly, benefiting medical services and leading many Saudi medical institutions to excel on a global level.
On the other hand, this was accompanied by increased competition and the desire for students and trainee doctors to study more years for the sake of distinction and obtaining better job opportunities. Looking at the history of the evolution of the concept, we find that the need to enter the medical job market and practice medicine required 7 years of study in 1950; in contrast, it now requires between 13 to 16 years in 2025, which is equivalent to an increase of one year every ten years. The question remains: Will these rates continue to grow? Is it time to change the structure of medical curricula and pathways?
Looking at some global examples, we find that seats in precise specialties in America, Canada, and Europe are not always the first choice for the children of those countries, due to their view that it may restrict their practice in one field, and that they do not need an additional qualification to do what they want precisely. This thought is similar in some European countries like Germany, while we find the opposite in some distinguished centers that require precise specialization in a specific field.
There is no doubt that I am a supporter of specialization, due to its positive effects related to providing the latest technologies in line with scientific advancement, and opening the field for precise scientific research that contributes directly and indirectly to beneficiaries and scientific institutions, while ensuring that it must represent a balanced ratio between general practitioners and specialists, in both general and precise specialties, and perhaps maintaining the practice of precise specialists in their general specialties and preserving that culture. As for the negative effects of drifting away from practicing general specialties, they are divided into effects on the healthcare practitioner and the patient. Regarding the practitioner: 1- Delayed adaptation to the sciences of their general specialty, 2- Loss of clinical and surgical skills in their general specialty, 3- Lack of risk diversification by practicing a precise specialty that may disappear due to innovation or technology. And the negative effects on the patient: 1- Deterioration of institutional efficiency (for example: the patient having to seek services from 3 doctors in the same department due to the differences in their precise specialties despite the similarity in their general specialty). 2- Increased costs since the service is provided by several individuals, each separately, which indirectly reflects on insurance prices.
There is no doubt that the topic needs more in-depth studies; however, it is essential to work on the concept, thought, and culture associated with precise specialization, by enhancing the importance of everyone's role without exception in the healthcare system, whether general or specialized, and finding an equation between (the practitioner's passion, the community's needs, the number of beneficiaries, and the service orientation of the healthcare institution).