Physicians' reports of focused expertise in clinical practice

Little is known about the prevalence of focused expertise (special areas of expertise within a clinical field) among physicians, yet such expertise ma y influence how care is delivered. We surveyed general internists, pediatri cians, cardiologists, infectious disease specialists, and orthopedic surgeo ns to describe the prevalence of focused expertise and identify associated physician and practice characteristics. About one quarter of generalists an d three quarters of specialists reported a focused expertise within their p rimary specialty. Hospital-based physicians more often reported such expert ise, and physicians reimbursed by capitation less often reported expertise. Learning how focused expertise affects processes and outcomes of care will contribute to decisions about physician training and staffing of medical g roups.