The End of Silo Medicine: A Case for Disease-Centered Subspecialization.

Modern medical subspecialization was organized around organs, age groups and procedures during an era when diseases were viewed as isolated processes. Contemporary biology instead reveals illnesses that arise across systems and evolve across the life span. Yet clinical care remains fragmented among multiple specialties with no single physician accountable for the integrated whole. We propose disease-centred subspecialization, in which expertise for a complex condition is unified within a single clinical domain and supported by advanced clinical intelligence systems. Fetoneonatology, integrating foetal and neonatal medicine across the continuum of pregnancy and early life, illustrates this model. Similar integration is urgently needed for metabolic syndrome and ischaemic heart disease, conditions whose pathophysiology spans multiple organs and specialties. Evidence increasingly shows that fragmented care contributes to medical error, contradictory treatment plans, rehospitalization and poor long-term outcomes. We outline a framework for training, certification and AI augmented practice, organized around diseases rather than anatomy alone.