Specialization in medicine developed in response to the ever-increasing volume and complexity of scientific knowledge. While diverse factors may have contributed to improved health of people in the United States, the medical profession undoubtedly played an important role. Despite this achievement our profession is held in low esteem probably because of the high cost of medical care and unsubstantiated charges in the United States that some surgery is performed unnecessarily. In contemplating the future we must guard against the establishment of unrealistic small areas of specialization. Specialty groups must refrain from treatment of disease entities or anatomical regions. Such claims indicate self-aggrandizement and lead to acrimonious, destructive disputes within the profession.