The way I see it, and you have to understand that this is purely how I see it, there are 4 kinds of specialties.
Systems based specialties: are just what they sound like, specialties based around one system of the body, cardiology, neurosurgery, gastroenterology, endocrinology etc etc. These specialties seem to deal with all kinds of patients in all kinds of settings but with a very narrow range of diseases. I decided fairly quickly in my first year I didn't want to do one of these systems based specialties. Why? To be honest I found the idea boring and frustrating. Restricting yourself to one system of the body didn't seem right for me. The first reason was that I found all body systems interesting, to exclude heart conditions just because I was a neurologist seemed like it would be frustrating and limiting. The other was that these specialists unlike the other two categories seem to have almost comprehensive knowledge in their chosen field, and it seems to me that once you know everything about something it gets boring, after all there are only so many different kinds of glomerulonephritis and once you know them well... then what? I want a specialty where you never know completly what's going on where knew stuff comes out every day.
Patient Based Specialties: These are the kinds of specialties based around who your patients are, paediatrics, geriatrics, paediatric surgery, refugee medicine etc. These specialties seem to deal with all kinds of diseases in all kinds of settings but with a very narrow range of patients. These always seemed slightly less restrictive than the systems based specialties. these always held an interest for me as they seemed to define a field of practice for a practitioner rather than restricting them to one. I like kids and old people too so these both seem like legitimate choices. To be honest paediatrics was what I first thought about doing when I applied for medicine
Setting Based Specialties: This is probably the smallest group of specialties, those based around the setting in which the patient presents, including Rural and remote medicine, General practice and emergency medicine. These allow for a broad range of diseases and presentations, as well as demanding a pretty good knowledge base with a pretty good capacity for independent learning. Sounds good right? Right. I could see myself doing all these specialties. Each has a downside though, emergency medicine is not a lifestyle friendly specialty and is possibly one of the most high stress environments available, GPs are essentially running a buisness something I don't look forward to and Rural and Remote medicine tends to be, well, remote and I'm a city boy.
Technique Based Specialties These include all specialties defined by a particular approach rather than a particular type of patient or body system or setting, things like radiation oncology, public health, medical geneticists and medical oncology. These are a pretty heterogenous group of specialties some deal with many diseases, some deal with only cancer, some operate on a population level, some on individual cells. The defining feature of these specialties is a mastery of technology or technique, either using whatever it is radiation oncologists use, or drafting a good whatever it is population health people draft, these specialties display a level of technical mastery related to an interventional technique rather than an individual body system or patient type.
The reason I say this is that I thought up until this rotation that I wouldn't find a systems based specialty that would be interesting enough to do my whole career. I was quite certain I'd end up in the second or third category, paediatrics, geriatrics, GP, emergency medicine, the broadness of these specialties appealed to me and I thought that's where my future lay. That is until we stared neurology. After I'd mentioned that I wanted to do neurology to a tutor of mine from last year he said "I could really see you doing that Kyle". Maybe I will be a system specialist after all.
Hm, that's true, I guess I haven't really thought about them because we haven't had much contact yet. What do you define as a procedure? Is an xray a procedure? a CT scan? an MRI? Taking blood?
Interesting viewpoint. What about service specialties which don't 'own' patients such as radiology, anaesthetics and pathology. They rely on referral from other doctors, but without them the medical system as we know it would certainly not work. I think there's many ways to characterise a specialty, for example procedural specialties compared to those with fewer procedures...