EDITORIAL

Time for
subspecialisation '?
Steve 8eningfield

MBChB(UCT), FFRad(D)SA

Head: Department of Radiology,
University of Cape Town

I am unsure who coined the description of Radiology as being "the
general practice of the specialties", but the expression appears to be
becoming less true in the USA and other leading countries as sub-
specialisation occurs. For some time, the trend toward organ-specific
imaging has dominated over the technique-specific approach. In the USA
the diagnostic and interventive radiologists have effectively parted
company, with separate subspecialties being registered. Even within
interventive radiology, for example, the interventive neuroradiologist, the
interventive vascular radiologist and the interventive hepatobiliary
radiologist have little in common. Similar trends are found in other
radiological groupings such as paediatric radiology and ultrasonography.

In South Africa a number of other medical, disciplines already have or
are contemplating subspecialty registration for their special interest groups.
Previously general surgeons now concentrate on specific areas of interest
such as vascular, colorectal, .gastric, hepatopancreatobiliary, endocrine,
oncological, or breast surgery. Legislated certification is becoming more
commonplace as the various groups crystallise.

The difficulty in South Africa is that in almost all private and most
full-time practices, diverse demands are placed on radiologists who are
called upon to be all things to all men. Is this sustainable, when one is
competing with highly skilled colleagues who have an exclusive focus
that includes the relevant imaging in their field? Is there a prospect for
subspecialisation in South African radiology, and if so, how should this be
orchestrated? Should formal fellowship programs be developed? Should
a "grandfather" clause be allowed?

As the turf wars flare, the need for a more specialised radiologist may
become unavoidable. It appears likely that in the same way as the do-it-
all general practitioner is a vanishing breed, the generalist radiologist may
become a scarce resource.

3 SAJOURNAL OF RADIOLOGY· November 1998