Jack of all trades, master of none is the unfortunate default state. The beauty of specialization is that one can get better products and services for less time invested. Complete ignorance is discouraged as a cursory knowledge of what exists is required for productivity and establishing oneself within a relevant context. Furthermore, knowing the place or the people to whom one would go for help, to learn more on any given topic, is of course hugely beneficial. It is difficult to collaborate on a project or to seek help with a particular problem or question if one is unsure what technology exists and is available. One pitfall after realizing that something exists is the perceived need to become competent in a particular piece of technology or a particular skill. Exerting excess time and energy to gain unnecessary competence unfortunately negates the benefits of specialization and either decreases the quality of the product or service or increases the time and price at which the result is achieved. One may have a working knowledge of computer programming which may aid in communication, project design, and the selection of the team with which one works, however one would be foolish to spend one’s time attempting to learn, then perfect and implement the coding themselves.
Success in the near future depends on the ability to identify opportunities and then work well with other team members from different backgrounds in order to achieve the goal. Being able to communicate well with members of other fields in order to harness the unique expertise and perspective from each individual field is vital. The list of hospital tasks in which a physician does not have expertise far outstretches the list of tasks for which a physician does have competency. For example, swallow evaluations, starting parenteral nutrition, determining the range of mobility and assist devices which would most benefit a patient, and compounding specific medications for administration are all outside the physician’s wheelhouse. And that is okay. Recently on rounds in the ICU the team outnumbered the patients by a significant margin. The rounding team was about 15 strong- enough to start a couple of basketball teams. The goal of any member of the team is not to become proficient in all the tasks and all the aspects of patient care, but rather to have expertise within their one area with enough knowledge and appreciation of the other aspects that they are able to work amicably and synergistically with all other members. Dietitians are not asked to interpret EKGs, start central lines, or declare patient’s deceased. Physician’s are not asked to perform swallow evaluations or conduct strengthening exercises although are certainly expected to recognize the general theory and importance of each discipline and identify patients who would benefit from such interventions. The goal is not to do the every job- that is simply wasteful redundancy. The goal then is to be able to understand the overarching principles of each job to enable teamwork and enhance productivity. Ultimately, the competency goal must be “Works with all trades, Master of one”.