backend: add per-clinic staff specialty (Care Team -> patient sheet)

New staff_profile table (org + user, unique) holding a clinician's clinical
specialty. GET /api/staff and /api/staff/providers now include specialty; new
PATCH /api/staff/:userId (member:update) upserts it. Migration 0023.

Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>

backend/drizzle/0023_panoramic_punisher.sql

@@ -0,0 +1,10 @@
+CREATE TABLE "staff_profile" (
+	"organization_id" text NOT NULL,
+	"user_id" text NOT NULL,
+	"specialty" text,
+	"updated_at" timestamp DEFAULT now() NOT NULL
+);
+--> statement-breakpoint
+ALTER TABLE "staff_profile" ADD CONSTRAINT "staff_profile_organization_id_organization_id_fk" FOREIGN KEY ("organization_id") REFERENCES "public"."organization"("id") ON DELETE cascade ON UPDATE no action;--> statement-breakpoint
+ALTER TABLE "staff_profile" ADD CONSTRAINT "staff_profile_user_id_user_id_fk" FOREIGN KEY ("user_id") REFERENCES "public"."user"("id") ON DELETE cascade ON UPDATE no action;--> statement-breakpoint
+CREATE UNIQUE INDEX "staff_profile_org_user_idx" ON "staff_profile" USING btree ("organization_id","user_id");

backend/drizzle/meta/_journal.json

@@ -162,6 +162,13 @@
       "when": 1781802557475,
       "tag": "0022_damp_synch",
       "breakpoints": true
+    },
+    {
+      "idx": 23,
+      "version": "7",
+      "when": 1781889806890,
+      "tag": "0023_panoramic_punisher",
+      "breakpoints": true
     }
   ]
 }

backend/src/db/schema/index.ts

@@ -16,3 +16,4 @@ export * from "./ai-chat.js";
 export * from "./org-ai-policy.js";
 export * from "./attachments.js";
 export * from "./integrations.js";
+export * from "./staff-profile.js";

backend/src/db/schema/staff-profile.ts

@@ -0,0 +1,31 @@
+import { pgTable, text, timestamp, uniqueIndex } from "drizzle-orm/pg-core";
+
+import { organization, user } from "./auth.js";
+
+// Per-member, per-clinic profile extras that Better Auth's member row doesn't
+// hold. Currently just a doctor's clinical specialty (e.g. "Orthopedist",
+// "Dentist") which the admin sets in Care Team and surfaces on the patient
+// sheet for the patient's primary provider. Unique on (org, user) so each
+// member has at most one profile per clinic.
+export const staffProfile = pgTable(
+  "staff_profile",
+  {
+    organizationId: text("organization_id")
+      .notNull()
+      .references(() => organization.id, { onDelete: "cascade" }),
+    userId: text("user_id")
+      .notNull()
+      .references(() => user.id, { onDelete: "cascade" }),
+    specialty: text("specialty"),
+    updatedAt: timestamp("updated_at")
+      .defaultNow()
+      .$onUpdate(() => new Date())
+      .notNull(),
+  },
+  (table) => [
+    uniqueIndex("staff_profile_org_user_idx").on(
+      table.organizationId,
+      table.userId,
+    ),
+  ],
+);

backend/src/routes/staff.ts

@@ -5,6 +5,7 @@ import { z } from "zod";
 import { auth } from "../auth.js";
 import { db } from "../db/index.js";
 import { member, organization, user } from "../db/schema/auth.js";
+import { staffProfile } from "../db/schema/staff-profile.js";
 import { HttpError } from "../lib/http-error.js";
 import { requireAuth, requireOrg, requirePermission } from "../middleware/auth.js";
 
@@ -65,9 +66,17 @@ staffRouter.get("/providers", async (req, res, next) => {
         userId: member.userId,
         name: user.name,
         role: member.role,
+        specialty: staffProfile.specialty,
       })
       .from(member)
       .innerJoin(user, eq(user.id, member.userId))
+      .leftJoin(
+        staffProfile,
+        and(
+          eq(staffProfile.userId, member.userId),
+          eq(staffProfile.organizationId, member.organizationId),
+        ),
+      )
       .where(
         and(
           eq(member.organizationId, req.organizationId!),
@@ -96,9 +105,17 @@ staffRouter.get(
           name: user.name,
           email: user.email,
           username: user.username,
+          specialty: staffProfile.specialty,
         })
         .from(member)
         .innerJoin(user, eq(user.id, member.userId))
+        .leftJoin(
+          staffProfile,
+          and(
+            eq(staffProfile.userId, member.userId),
+            eq(staffProfile.organizationId, member.organizationId),
+          ),
+        )
         .where(eq(member.organizationId, req.organizationId!))
         .orderBy(asc(user.name));
       res.json(rows);
@@ -168,3 +185,48 @@ staffRouter.post(
     }
   },
 );
+
+// Update a member's clinical specialty. Empty string clears it. Owner/admin
+// only. Upserts the per-clinic staff_profile row.
+const specialtyInputSchema = z.object({
+  specialty: z.preprocess(
+    (v) => (typeof v === "string" && v.trim() === "" ? null : v),
+    z.string().trim().max(60).nullable(),
+  ),
+});
+
+staffRouter.patch(
+  "/:userId",
+  requirePermission({ member: ["update"] }),
+  async (req, res, next) => {
+    try {
+      const userId = String(req.params.userId ?? "");
+      const { specialty } = specialtyInputSchema.parse(req.body);
+      const organizationId = req.organizationId!;
+
+      // The target must be a member of this clinic.
+      const [target] = await db
+        .select({ id: member.id })
+        .from(member)
+        .where(
+          and(
+            eq(member.organizationId, organizationId),
+            eq(member.userId, userId),
+          ),
+        );
+      if (!target) throw new HttpError(404, "Member not found.");
+
+      await db
+        .insert(staffProfile)
+        .values({ organizationId, userId, specialty })
+        .onConflictDoUpdate({
+          target: [staffProfile.organizationId, staffProfile.userId],
+          set: { specialty },
+        });
+
+      res.json({ userId, specialty });
+    } catch (err) {
+      next(err);
+    }
+  },
+);

frontend/components/messages/messages-view.tsx

@@ -626,11 +626,11 @@ export function MessagesView() {
             </div>
 
             <form
-              className="flex flex-col gap-2 rounded-2xl border bg-card/30 p-2"
+              className="flex flex-col rounded-3xl border border-input bg-background shadow-sm transition-colors focus-within:border-ring/60 focus-within:ring-2 focus-within:ring-ring/20"
               onSubmit={send}
             >
               {pending.length > 0 && (
-                <div className="flex flex-wrap items-center gap-1.5 px-1 pt-1">
+                <div className="flex flex-wrap items-center gap-1.5 px-3 pt-3">
                   {pending.map((att, i) => (
                     <span
                       className="flex items-center gap-1.5 rounded-lg bg-muted px-2 py-1 text-foreground text-xs"
@@ -658,52 +658,64 @@ export function MessagesView() {
                   ))}
                 </div>
               )}
-              <div className="flex items-center gap-2">
-                {/* The attach control is a native <label> wrapping the file
-                    input, so the browser opens the picker on a trusted click.
-                    A programmatic `inputRef.click()` (the old menu item) gets
-                    dropped by user-activation gating once the menu closes —
-                    which is why attaching silently failed and no chip appeared. */}
-                <label
-                  aria-label={t("messages.attach.file")}
-                  className={cn(
-                    "inline-flex size-9 shrink-0 cursor-pointer items-center justify-center rounded-md text-muted-foreground transition-colors hover:bg-accent hover:text-foreground",
-                    uploading && "pointer-events-none opacity-50",
-                  )}
-                >
-                  <Paperclip className="size-4" />
-                  <input
-                    aria-label={t("messages.attach.file")}
-                    className="sr-only"
-                    multiple
-                    onChange={onPickFiles}
-                    ref={fileInputRef}
-                    type="file"
-                  />
-                </label>
-                <Button
-                  aria-label={t("messages.attach.appointment")}
-                  disabled={uploading}
-                  onClick={openApptPicker}
-                  size="icon"
-                  type="button"
-                  variant="ghost"
-                >
-                  <CalendarClock className="size-4" />
-                </Button>
-                <Input
-                  aria-label={t("messages.newMessage")}
-                  className="border-0 bg-transparent shadow-none before:hidden"
-                  onChange={(e) => setDraft(e.target.value)}
-                  placeholder={
-                    uploading
-                      ? t("messages.attach.uploading")
-                      : t("messages.messagePlaceholder", { name: selected.name })
+              <textarea
+                aria-label={t("messages.newMessage")}
+                className="field-sizing-content block max-h-40 min-h-11 w-full resize-none bg-transparent px-4 pt-3 pb-1 text-sm outline-none placeholder:text-muted-foreground"
+                onChange={(e) => setDraft(e.target.value)}
+                onKeyDown={(e) => {
+                  // Enter sends; Shift+Enter inserts a newline.
+                  if (e.key === "Enter" && !e.shiftKey) {
+                    e.preventDefault();
+                    e.currentTarget.form?.requestSubmit();
                   }
-                  value={draft}
-                />
+                }}
+                placeholder={
+                  uploading
+                    ? t("messages.attach.uploading")
+                    : t("messages.messagePlaceholder", { name: selected.name })
+                }
+                rows={1}
+                value={draft}
+              />
+              <div className="flex items-center justify-between gap-2 px-2 pb-2">
+                <div className="flex items-center gap-0.5">
+                  {/* The attach control is a native <label> wrapping the file
+                      input, so the browser opens the picker on a trusted click.
+                      A programmatic `inputRef.click()` (the old menu item) gets
+                      dropped by user-activation gating once the menu closes —
+                      which is why attaching silently failed and no chip appeared. */}
+                  <label
+                    aria-label={t("messages.attach.file")}
+                    className={cn(
+                      "inline-flex size-9 shrink-0 cursor-pointer items-center justify-center rounded-full text-muted-foreground transition-colors hover:bg-accent hover:text-foreground",
+                      uploading && "pointer-events-none opacity-50",
+                    )}
+                  >
+                    <Paperclip className="size-4" />
+                    <input
+                      aria-label={t("messages.attach.file")}
+                      className="sr-only"
+                      multiple
+                      onChange={onPickFiles}
+                      ref={fileInputRef}
+                      type="file"
+                    />
+                  </label>
+                  <Button
+                    aria-label={t("messages.attach.appointment")}
+                    className="rounded-full"
+                    disabled={uploading}
+                    onClick={openApptPicker}
+                    size="icon"
+                    type="button"
+                    variant="ghost"
+                  >
+                    <CalendarClock className="size-4" />
+                  </Button>
+                </div>
                 <Button
                   aria-label={t("messages.send")}
+                  className="size-9 shrink-0 rounded-full"
                   disabled={!draft.trim() && pending.length === 0}
                   size="icon"
                   type="submit"

frontend/components/patients/patient-detail.tsx

@@ -1,7 +1,7 @@
 "use client";
 
 import { ArrowLeftRight, Network, Pencil, Trash2 } from "lucide-react";
-import { type ReactNode, useState } from "react";
+import { type ReactNode, useEffect, useState } from "react";
 import { useTranslation } from "react-i18next";
 
 import { Sparkline } from "@/components/chat/sparkline";
@@ -27,6 +27,7 @@ import {
 } from "@/lib/invoices";
 import type { AllergySeverity, LabFlag, Patient, Trend } from "@/lib/patients";
 import type { Prescription } from "@/lib/prescriptions";
+import { listProviders, type Provider, specialtyLabel } from "@/lib/staff";
 import { cn } from "@/lib/utils";
 
 // A record "file" surfaced both in the graph and the sheet's clickable list.
@@ -132,6 +133,24 @@ export function PatientDetail({
   // The record "file" opened in a detail dialog from the records list.
   const [openFile, setOpenFile] = useState<RecordFile | null>(null);
 
+  // Resolve the responsible clinician's specialty (set by an admin in Care
+  // Team) to show alongside the primary-care provider.
+  const [providers, setProviders] = useState<Provider[]>([]);
+  useEffect(() => {
+    if (!patient.primaryProviderId) return;
+    let active = true;
+    listProviders()
+      .then((p) => active && setProviders(p))
+      .catch(() => {});
+    return () => {
+      active = false;
+    };
+  }, [patient.primaryProviderId]);
+  const providerSpecialty = specialtyLabel(
+    t,
+    providers.find((p) => p.userId === patient.primaryProviderId)?.specialty,
+  );
+
   // The same problems + visits the graph plots, as a clickable list.
   const files: RecordFile[] = [
     ...patient.problems.map((p, i) => ({
@@ -216,7 +235,9 @@ export function PatientDetail({
         <div className="grid grid-cols-2 gap-x-4 gap-y-3">
           <Stat
             label={t("patientCard.summary.primaryCare")}
-            value={patient.pcp}
+            value={
+              providerSpecialty ? `${patient.pcp} · ${providerSpecialty}` : patient.pcp
+            }
           />
           <Stat
             label={t("patientCard.summary.lastSeen")}

frontend/components/settings/employee-detail-dialog.tsx

@@ -34,8 +34,12 @@ import {
 import { ROLE_LABELS } from "@/lib/access";
 import { authClient } from "@/lib/auth-client";
 import { PROVISIONABLE_ROLES, rolePermissionSummary } from "@/lib/roles";
+import { SPECIALTIES, specialtyLabel, updateStaffSpecialty } from "@/lib/staff";
 import { notify } from "@/lib/toast";
 
+// Roles that can carry a clinical specialty (i.e. treat patients).
+const PROVIDER_ROLES = new Set(["owner", "admin", "doctor", "member"]);
+
 // Icon shown next to each permission resource row.
 const RESOURCE_ICONS: Record<string, React.ReactNode> = {
   patient: <Users className="size-4" />,
@@ -53,6 +57,7 @@ export type StaffMember = {
   name: string | null;
   email: string | null;
   username: string | null;
+  specialty: string | null;
 };
 
 function roleLabel(role?: string | null): string {
@@ -98,10 +103,13 @@ export function EmployeeDetailDialog({
   const { t } = useTranslation();
   const [role, setRole] = useState<string>(member?.role ?? "");
   const [saving, setSaving] = useState(false);
+  const [specialty, setSpecialty] = useState<string>(member?.specialty ?? "");
+  const [savingSpecialty, setSavingSpecialty] = useState(false);
 
   useEffect(() => {
     setRole(member?.role ?? "");
-  }, [member?.id, member?.role]);
+    setSpecialty(member?.specialty ?? "");
+  }, [member?.id, member?.role, member?.specialty]);
 
   const summary = rolePermissionSummary(member?.role);
   const secondary = member?.username ? `@${member.username}` : member?.email;
@@ -137,6 +145,39 @@ export function EmployeeDetailDialog({
     onOpenChange(false);
   };
 
+  const saveSpecialty = async () => {
+    if (!member || savingSpecialty) return;
+    const next = specialty || null;
+    if (next === (member.specialty ?? null)) return;
+    setSavingSpecialty(true);
+    try {
+      await updateStaffSpecialty(member.userId, next);
+      notify.success(
+        t("settings.careTeam.employee.specialtyUpdatedTitle"),
+        t("settings.careTeam.employee.specialtyUpdatedBody", {
+          name: member.name ?? member.email ?? "",
+        }),
+      );
+      onChanged();
+    } catch {
+      notify.error(
+        t("settings.careTeam.employee.specialtyFailedTitle"),
+        t("settings.careTeam.employee.specialtyFailedBody"),
+      );
+    } finally {
+      setSavingSpecialty(false);
+    }
+  };
+
+  const showSpecialty = PROVIDER_ROLES.has(member?.role ?? "");
+  const specialtyOptions = [
+    { value: "", label: t("settings.careTeam.employee.noSpecialty") },
+    ...SPECIALTIES.map((s) => ({
+      value: s,
+      label: t(`settings.careTeam.specialties.${s}`),
+    })),
+  ];
+
   return (
     <Dialog onOpenChange={onOpenChange} open={open}>
       <DialogPopup className="sm:max-w-md">
@@ -163,6 +204,11 @@ export function EmployeeDetailDialog({
                   {secondary}
                 </p>
               )}
+              {showSpecialty && specialtyLabel(t, member?.specialty) && (
+                <p className="truncate text-primary text-xs">
+                  {specialtyLabel(t, member?.specialty)}
+                </p>
+              )}
             </div>
             <Badge className="capitalize" variant="secondary">
               {roleLabel(member?.role)}
@@ -246,6 +292,47 @@ export function EmployeeDetailDialog({
               </div>
             </div>
           )}
+
+          {editable && showSpecialty && (
+            <div className="flex flex-col gap-2">
+              <span className="text-xs font-medium tracking-wide text-muted-foreground uppercase">
+                {t("settings.careTeam.employee.specialty")}
+              </span>
+              <div className="flex items-center gap-2">
+                <Select
+                  items={specialtyOptions}
+                  onValueChange={(value) => setSpecialty(value as string)}
+                  value={specialty}
+                >
+                  <SelectTrigger
+                    aria-label={t("settings.careTeam.employee.specialty")}
+                    className="flex-1"
+                  >
+                    <SelectValue />
+                  </SelectTrigger>
+                  <SelectPopup>
+                    {specialtyOptions.map((o) => (
+                      <SelectItem key={o.value} value={o.value}>
+                        {o.label}
+                      </SelectItem>
+                    ))}
+                  </SelectPopup>
+                </Select>
+                <Button
+                  disabled={
+                    savingSpecialty ||
+                    (specialty || null) === (member?.specialty ?? null)
+                  }
+                  onClick={saveSpecialty}
+                  type="button"
+                >
+                  {savingSpecialty
+                    ? t("settings.careTeam.employee.saving")
+                    : t("settings.careTeam.employee.save")}
+                </Button>
+              </div>
+            </div>
+          )}
         </DialogPanel>
 
         <DialogFooter>

frontend/components/settings/settings-care-team.tsx

@@ -9,6 +9,7 @@ import {
   EmployeeDetailDialog,
   type StaffMember,
 } from "@/components/settings/employee-detail-dialog";
+import { specialtyLabel } from "@/lib/staff";
 import {
   SettingsCard,
   SettingsSection,
@@ -162,6 +163,11 @@ export function CareTeamPanel() {
                     </p>
                   )}
                 </div>
+                {specialtyLabel(t, m.specialty) && (
+                  <Badge variant="outline">
+                    {specialtyLabel(t, m.specialty)}
+                  </Badge>
+                )}
                 <Badge className="capitalize" variant="secondary">
                   {roleLabel(m.role)}
                 </Badge>

frontend/lib/i18n/locales/en/translation.json

@@ -1506,6 +1506,22 @@
       "clickHint": "Tip: click a team member to see their permissions and manage their role.",
       "addMember": "Add team member",
       "removeMember": "Remove member",
+      "specialties": {
+        "general": "General practitioner",
+        "orthopedics": "Orthopedist",
+        "dentistry": "Dentist",
+        "cardiology": "Cardiologist",
+        "pediatrics": "Pediatrician",
+        "dermatology": "Dermatologist",
+        "neurology": "Neurologist",
+        "obgyn": "OB-GYN",
+        "ophthalmology": "Ophthalmologist",
+        "ent": "ENT specialist",
+        "psychiatry": "Psychiatrist",
+        "radiology": "Radiologist",
+        "anesthesiology": "Anesthesiologist",
+        "surgery": "Surgeon"
+      },
       "employee": {
         "title": "Team member",
         "description": "View this member's access, change their role, or remove them.",
@@ -1520,6 +1536,12 @@
         "roleUpdatedBody": "{{name}} is now {{role}}.",
         "roleFailedTitle": "Couldn't update role",
         "roleFailedBody": "Please try again.",
+        "specialty": "Specialty",
+        "noSpecialty": "No specialty",
+        "specialtyUpdatedTitle": "Specialty updated",
+        "specialtyUpdatedBody": "Updated {{name}}'s specialty.",
+        "specialtyFailedTitle": "Couldn't update specialty",
+        "specialtyFailedBody": "Please try again.",
         "resources": {
           "patient": "Patients",
           "appointment": "Appointments",

frontend/lib/staff.ts

@@ -7,8 +7,54 @@ export type Provider = {
   userId: string;
   name: string;
   role: string;
+  // Admin-set clinical specialty (e.g. "Orthopedist"); null when unset.
+  specialty?: string | null;
 };
 
 export function listProviders(): Promise<Provider[]> {
   return apiFetch<Provider[]>("/api/staff/providers");
 }
+
+// Update a member's clinical specialty (owner/admin only). Pass null to clear.
+export function updateStaffSpecialty(
+  userId: string,
+  specialty: string | null,
+): Promise<{ userId: string; specialty: string | null }> {
+  return apiFetch(`/api/staff/${encodeURIComponent(userId)}`, {
+    method: "PATCH",
+    body: JSON.stringify({ specialty }),
+  });
+}
+
+// Curated list of clinical specialties an admin can assign to a doctor. Stored
+// as the plain string; values double as the i18n key suffix
+// (settings.careTeam.specialties.*).
+// Human label for a stored specialty key (settings.careTeam.specialties.*),
+// falling back to the raw value for any legacy/free-text entries.
+export function specialtyLabel(
+  t: (key: string) => string,
+  specialty?: string | null,
+): string | null {
+  if (!specialty) return null;
+  const key = `settings.careTeam.specialties.${specialty}`;
+  const label = t(key);
+  return label === key ? specialty : label;
+}
+
+export const SPECIALTIES = [
+  "general",
+  "orthopedics",
+  "dentistry",
+  "cardiology",
+  "pediatrics",
+  "dermatology",
+  "neurology",
+  "obgyn",
+  "ophthalmology",
+  "ent",
+  "psychiatry",
+  "radiology",
+  "anesthesiology",
+  "surgery",
+] as const;
+export type Specialty = (typeof SPECIALTIES)[number];