The implementation of medical specialization in Brasil has been relatively free of constraints. There has thus been a progressive fragmentation of medical work. The so-called root specialities are losing both their strength and clinical problem-solving capacity. Two operational concepts are proposed for achieving better administration of medical responsibilities and the role of medical professionals: 1) field of competence and 2) core competence. General goals are suggested for reforming specialized training and integration of specialists into the Unified National Health System.