TRENDS
By JOHN P. HUBBARD, M.D., Contributing Editor
This and subsequent descriptions of events and trends are intended to be unbiased and factual, pre.
senting both sides of controversial matters so that conclusions may be formed from critical appraisal
of things as they are. These statements do not necessarily reflect the opinion of the writer nor are
they to be interpreted as official opinion of the Academy.
REGIONAL
PLANNING
IN
DISTRICT
III
TTENTION has frequently been called to the two most prominent needs revealed
by the Academy’s Study. The first calls for a better distribution of pediatric
services ; the second calls for more attention in undergraduate and graduate training to the health supervision of normal children and the practical aspects of pediatric practice. To meet this two-fold need, the Academy has emphasized the importance of regional planning, or decentralization, if this latter term is preferred. In order to serve as a
testing ground, a program has been instituted in Pennsylvania, New Jersey and
Dela-ware, District III of the Academy. One aspect of this program has been provision for a
resident to spend a three month period serving two community hospitals which are
located reasonably close together. The Montgomery Hospital at Norristown and the
Phoenixville Hospital in the town of the same name were selected for this purpose.
These two hospitals are both about 25 miles from Philadelphia and about eight miles from each other. A pediatric resident, Dr. Ronald M. Bernardin, who had already com-pleted his residency training for Board Certification, was given the first appointment in
this part of the program. The following two letters, one from Norristown and the other
from Phoenixville, are an indication of the program’s value from the point of view of
two communities:
DEAR DR. HUBBARD:
On behalf of the pediatric staff and the general staff at the Montgomery Hospital, I wish to express my appreciation of the District III program for supplying us a pediatric
resident during these last three months. The resident, Dr. Bernardin, whose services we have shared with the Phoenixville Hospital, had been well trained in all branches of
pediatrics. He was well liked and accepted by all the men of the entire staff in our
hospital and I have been told the same holds true for the Phoenixville Hospital. Everyone is enthusiastic about continuing this type of service.
The amount of time spent in each hospital varied depending on which had the cases
requiring the most attention. However, since Montgomery Hospital is the larger of the
two, more time was probably spent there.
The two hospitals agreed as to the financial responsibilities, a salary plus some travel-ling expenses being paid by both hospitals.
Both hospitals are approximately a 45 minute drive from the center of Philadelphia,
but the parents of our patients prefer to have their children as near to home as possible
when they are ill so they can more readily be visited. Many of these patients required intravenous therapy or other technical procedures which could not be done by the usual
TRENDS 567
In the past, since it is impossible for the chief of service to handle both a busy practice
and the duties of a resident, these patients who require special care were usually sent
immediately to the larger teaching hospitals in Philadelphia. Now that we have the
services of a resident, these cases were kept in our hospital with gratifying results.
Many of these cases were presented by the resident and discussed at regular pediatric
conferences attended by the interns, nurses and visiting men. The interns were particularly
grateful to Dr. Bernardin for his instruction. Usually the visiting chief has a limited
time to spend making rounds so that not as much time could be given to instructing the
interns as was desired.
The general practitioner also benefited by having this trained resident care for his
private pediatric cases in the hospital.
The consulting staff as well as the laboratory and x-ray departments in both of these
hospitals are excellent so that the majority of cases can be studied satisfactorily. Of
course, there are some unusual studies that can only be done in the teaching institutions.
Our equipment, particularly in the Montgomery Hospital, is better than in many of the
large city hospitals and I am told we have better nursing care with more nurses available
than in many of the city hospitals.
At Montgomery Hospital there are 20 pediatric beds and 40 bassinets. At Phoenixville
there are 8 pediatric beds and 25 bassinets.
This year we had a late polio epidemic with an equal number of adult and child cases
admitted to our isolation section. Since Dr. Bernardin had been well trained in the care
of these cases while at the Municipal Hospital, he was put in charge of all cases.
Everyone was well pleased with the successful coordination that resulted.
All newborn infants were examined by the resident regardless if private or ward
patients. We all know this should be routine but in our hospital, as in many others
where interns are now limited in number and most of the babies are delivered by general
practitioners,
.
many of the babies are never examined during their stay in the hospital.Thus far it sounds as if only the hospital has benefited from the resident’s presence.
But I believe that he learned a great deal while working with us. His eyes were opened
by the great variety of cases on our service. He had to accept more responsibility and
had a closer contact with the parents. I think he realizes how important it is to have
ade-quately trained pediatricians in the smaller towns where people are now becoming more
specialist minded. Most parents don’t want to take their children into the city tb see their
pediatrician and when they are ill they want the same physician caring for them in their
local hospital. Many times this can be done without the aid of a resident but we all
realize how much easier and better it can be done when there is a trained resident on
hand to carry out the necessary technical procedures.
Unfortunately at present no credit toward certification by the specialty board has been
given to this man for his excellent work. But I know he has seen just as many interesting
and unusual cases and has learned just as much in his three months with us as he would
have learned in any of the teaching institutions in the United States.
568 JOHN P. HUBBARD
intern to carry out common pediatric technical procedures. As a result these cases are
sent into the teaching institutions, causing over-crowding.
I believe a system with a resident servicing at least two and possibly three small
hospitals in short distances of each other would improve the general pediatric care of
patients, keep the visiting men informed as to the latest developments in the larger
institutions and prepare the resident for going out into practice for himself.
I would like to see the resident receive credit toward his board certification and, if at
all possible, the continuation of this type of service in our hospital. Everyone feels it has
been a great success.
(signed) THOMAS T. KOCHENDERFER, M.D.
Norristown, Pa.
DEAR DR. BROOKS:
With the departure of Dr. Bernardin last week, we finished the first three months’ trial
of the shared pediatric residency. I thought you might be interested in some of the
impressions the program has made.
We had the first pediatric conference which has been held here in some years. At its
close the hospital staff requested that at least one of our monthly staff meetings here-after be devoted to pediatrics.
We have revised the routines and procedures in the newborn nursery. Dr. Bernardin attended our Nursery Committee meetings and offered a number of excellent suggestions.
In the daily hospital care of our pediatric patients, the resident carried out all treat-ments ; did history and physical examinations ; took charge of all house cases, both
new-born and pediatric ward ; and gave to the staff members the benefits of his more recent
training.
I, personally, have greatly appreciated Dr. Bernardin’s help at Well-Baby Clinic. We have each spent two hours a week as compared to the one hour weekly previously and have almost doubled the number of infants and preschool children attending.
There has been an up-surge of interest in pediatrics. The medical staff is heartily in
favor of continuing the program and was delighted to hear that Dr. Eister would be with
us for the next few months.
My personal thanks to you for making all this possible.
(signed) LOLA S. REED, M.D.
