Subspecialization: Commercialism or Professionalism?

Otolaryngologyhas come a long way in the 35 years that I have been associated with it. When I chose this specialty I was counseled by many of my respected teachers to avoid what they considered to be a "second rate" specialty. This has certainly changed, in large part because of the aggressive efforts of the American Board of Otolaryngology. The Board's demand for excellence in training, the elimination of marginal training programs, and the support of the expansion of otolaryngology into major new areas of expertise has been heroic and monumental. We face significant challenges that focus on the practice of medicine, the cost of delivering medical care, and the need to provide high quality care to all of our citizens. This challenge demands that we aggressively and honestly consider changes that may be painful to us all. I do not believe that there can be any argument that