Shirah Vollmer MD

The Musings of Dr. Vollmer

What Does It Mean To Specialize?

Posted by Dr. Vollmer on September 18, 2015


I am a child psychiatrist. I added two years of training, took both an oral and written examination, with the resulting distinction that I am a board certified child psychiatrist. I also did psychoanalytic training, a process which took me 8 years, involved 3 supervised psychoanalytic cases and 4 years of 4 hours per week of classes. Those are two recognized distinctions within the field of psychiatry. Yet, there is a push to specify  a niche, perhaps to improve what advertisers call branding. Suppose, for example, that I “specialize” in divorce. Does this mean I only see divorced people? Does this mean I am divorced, so I have personal experience to bring to the table? Does this mean I attend a study group on divorce, and together we have discussed divorced cases in some depth? Or, does it mean that I think that focusing on divorce can increase my business, and in so doing, I need to carve out this corner of the market. The unaware consumer feels comforted by going to a person who “specializes” in their problem, even if drilling down, “specializing” has little practical meaning. Is the skill set different, treating people going through or suffering from divorce, or am I using my old skills, but applying them to a very particular stressor? This dilemma between accurate representation and marketing getting hazier as the world moves toward electronic searches which require key words, and tags which bring you to certain websites.

For years, I have taken the opposite approach. I have emphasized both my breath and depth, focusing on the notion that my training, rather than narrowing my focus, has allowed me to see people from a variety of vantage points, and as such, I am able to handle a variety of problems which present to me in my office. My “wider and deeper” tool box has been my signature, and yet, with the focusing of treatment programs, such as addiction and eating disorders, there is a push to find “addiction specialists,” eating disorder specialists,” etc. I still give push-back to this notion. Eating disorders, like all disorders, involve a person “with” an eating disorder, and it is the person who needs the attention, along with the symptoms, the eating, which accompany the individual who presents. In certain fields, such as oncology, I can certainly see how the patient is wise to want a “specialist,” someone who sees a lot of their particular kind of cancer, because the treatments are changing rapidly, and there is a need to be able to distinguish the nuances of treatment. However, to continue with the example of eating disorders, the patient needs someone who understand them, who can think like them, and feel like them, as all psychiatric patients need this. Through this understanding the patient will want to take better care of him or herself. Eating disorders, like addiction, and like the majority of psychiatric issues, are yet another example of self-sabotage. As such, patients need help understanding why they would ruin their own lives. The specialization should be in human motivation, not the symptoms which are downstream from that. I never tire from making this point, and so my blog continues.

2 Responses to “What Does It Mean To Specialize?”

  1. Shelly said

    I respect all of the hard word you’ve put in to specialize, do your fellowships, do psychoanalytic training and your many, many years of practice. And I do believe that there is that push to find a niche, that sub-specialty that will bring in the pack. Where I live, people sub-specialize within the specialty, and then they are known throughout the country as “the specialist.” You are right, then, that they only see those kinds of cases. And I’m sure that gets very, very boring because they ONLY see those kinds of cases. On the other hand, being known as “the specialist” has its merits too.

    • Yes, it is a dilemma in terms of building a practice versus having job satisfaction. What the public thinks it wants, may not necessarily have merit, but it may bring a pool of patients which can then be educated about what psychiatry can do for them. Thanks.

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