PROCEEDINGS
THE PRACTICEOF PEDIATRICS
A Panel Discussion
Early in 1959 an editorial in PEDIATRICS(23:253, 1959) entitled “¿Canthe new pediatrics be practiced?― referred to some obstacles facing pediatricians now entering general practice. It seemed that the scope of pediatrics and the knowledge of children had been extended enough in recent years to justify the term new pediatrics, and that these advances were becoming diffi cult to apply in a hurried general pediatric practice. The question was raised as to whether it was not somewhat urgent to take more deliberate steps to make it easier and more inviting to practice pediatrics as a truly sophisticated specialty—to take cognizance of the improved capa biities of pediatricians and to foster recognition of the comprehensive service they can render when the working conditions are favorable. Furthermore, it was emphasized that tl*re appeared to be need for concern about the future appeal of the practice of pediatrics rather than with the fate of pediatrics as a branch of medical science, and that this distinction was fundamental to intelligent discussion.
Now we have an opportunity to consider the opinions of leaders within the American Academy of Pediatrics in the following series of papers. These were presented at the 1960 Spring Session of the Academy in a panel discussion organized by a prominent official of the Academy to deal with the question posed by the editorial a year previously.
Some of the participants took serious exception to the term new pediatrics. Less seriously, one gains the impression they might have preferred Ye Olde Pediatrics to describe the prevailing practice, to go with their suggestion it simply needs to be made “¿better.―The distinction be tween “¿better―and “¿new―pediatrics does not seem clear or consequential at first glance, except that the present potential of pediatrics may include some new elements which were not part of pediatric practice of yesteryear. Of course a dynamic progressive enterprise will be ever new, and we hope better.
The reader can skip the semantic quibbling and see what this group of practitioners has to say that promises to make pediatric practice “¿better―and of maximum service to children and an appealing career for able physicians, in the years to come.
THE EDITOR
INTRODUCTORY
Carl C. Fischer, M.D.
Hahnemann Medical College and Hospital, Philadelphia
I N A FINAL act of what I can only inter pret as retribution for the tasks im posed upon them, your Program Committee drafted its chairman to set up the conclud ing program of this session in a form of a panel on the topic, “¿Canthe New Pediatrics be Practiced?―
Fortunately, no restrictions as to content or participantswere given and for this,at least, my thanks to the committee.
Periodic episodes of self-examination by
various segments of the medical profession have been among the more salutary ad vances of Medicine for generations, but in creasing emphasis upon the change in pedi atric practice seems to date back only about 3 yearstoa Letterto theEditoroftheJour nal of Pediatrics by Dr. Frank L. Tabrah in December, 1957.This letterquoting an article of the November, 1956 issue of Medical Economics, stated among other things that “¿1/3of the pediatricians in prac
ADDRESS: (C.C.F.) Girard College, Philadelphia 21, Pennsylvania.
PEDIATRICS, November 1960
AMERICAN ACADEMY OF PEDIATRICS—PROCEEDINGS 873
tice were dissatisfied― and contained such challenging statements as, “¿well-babiesstill frequent the pediatrists' office, but it is in conceivable that any physician with intel ligence and interest in the unusual, can long survive the routine of playing grandmother for years on end in a well-baby practice. Few men will knowingly accept such a career—in time the specialty may lose the top quality men it has attracted in past years, pediatric medical office practice is not enough; there are too many private pediatric practices being started today that will be abandoned from sheer boredom.― Dr. Tabrah's letter was followed by a reply by one of our panelists, Dr. Lee Hill, and in the same issue by an article entitled “¿Pedia tric Rewards― by Dr. A. H. Parmellee, Sr.
Adding fuel to the fire was a stimulating editorial on the topic of “¿Canthe New Pe diatrics be Practiced?― written by our own Editor, Dr. Charles May, for the February, 1959 issue of PEDIATRIcs, which concluded with an invitation for comments by readers, many of whom responded in defense of the specialty.
Even more recently, the 36th Ross Pedi atric Conference was held on the topic “¿Careersin Pediatrics― under the co-chair manship of Dr. Robert Aldrich and Dr. Robert Lawson. In preparation for this con ference Dr. Aldrich, with the assistance of Dr. Richard Spitz and Mr. Gil Martinez of the Ross Laboratories, conducted a national survey covering many aspects of pediatrics and its practice, and with their kind permission I will use a few of the re sults of this survey to introduce our discus sion.
At this time perhaps it would be appro priate to try to define what we mean by “¿TheNew Pediatrics.― I am sure that each and every one of us would have a different definition but that in essence they would mean essentially the same thing. In order that we might start on some common ground, I would suggest that we adopt for our definition here today “¿thecomprehen sive practice of pediatrics, which would in clude all presently known methods of in
suring the normal growth and development of the children and youth.―
To further clear the atmosphere, I think that we can also assume by the mere fact that there are so many of you here today and that the number of pediatricians apply ing to the American Board of Pediatrics for examinations has shown no tendency to de crease in recent years, that the answer to our question is certainly believed by the vast majority of us to be in the affirmative. The real question is then. “¿Howbest can the New Pediatrics be practiced?― and this will be what our panel will try to out line for you today.
874 PRACTICE OF PEDIATRICS
and 3% the need to share the load with a partner—making a total of 40% complaining about the time factor. Next in importance came income, about which 20 to 25% corn plained, 17% on the basis that the income was poor compared to the long hours, years of training, and degree of specialization and 9.8% that too many patients must be seen to make a living.
With this introduction may I then turn the discussion over to our panelists and ask Dr. Hill to first give us his answer to our questions. Each of the panelists will then present his views.
[A morecomplete
account
of theresults
of Dr. Aldrich's survey, along with an anal ysis of the results, will be published as a report of the 36th Ross Pediatric Research Conference, “¿Careersin Pediatrics,― Ross Laboratories, Columbus 16, Ohio.]
rics can be done better than we're doing it now. If what we're talking about is bet ter pediatrics rather than new, the sooner we abandon “¿new―thebetter.
But it is my impression that the term “¿new―pediatrics, as was indicated by Dr. Fischer,arosein responseto the criticisms voiced by a few, that pediatrics no longer affords a satisfying professional career. The reasons cited were long hours, hard work, low pay as compared with otherspecialties, and the monotony of practiceas compared to the glamour of residency training. The young pediatrician, it was maintained, who enters practice fresh from his exciting resi dency becomes frustrated and disillusioned when he findshimself,for economic rea sons,unable to dispensethe high qualityof
comprehensivemedicalcarehe isprepared to offerand which he believeshe should. He sacrificesqualityfor quantityin order to make possiblethe income he feelsen statistics that Dr. Aldrich and his group
collected, revealing that 16% of the board certified pediatricians practiced some sub specialty with allergy, cardiology, psychia try and neurology, and hematology heading the list in that order.
Finally, it is hoped that our panelists will touch upon the questions that seem to be the main source of dissatisfaction among those who are unhappy about present day pediatric practice. Here again, we might quote from Dr. Aldrich's survey and note that of the board-certified group: 12% felt that there were no problems of note; 20.2% complained that they had no time for families, friends, etc.; 9.7% that they were too busy, the hours were too long and ex hausting; 9.8% that too many patients had to be seen to make a living; 9.1% that there was an inadequate time for each patient;
D R. FIscHER has asked us to comment on threetopics:(1)the “¿newpediatrics,― (2) residency training requirements and (3) pediatric practice—in the space of 10 min utes. I can dispose of the first topic very quickly. I don't know what is meant by “¿new―pediatrics. Even after our chairman has supplied us with a nicely-worded defi nition, I still don't know what the “¿new― means. It seems to me that his definition has been applicable as the objective and goal for pediatriciansever sincepediatrics was established.If the questionbeforeus was “¿canbetterpediatricsbe practiced?― I would have a much clearerconcept of
what the concern is about.To that ques tion my answer would be “¿sure,it can―and then we could go on to a discussionof
methods of improving teachingof pedia tricsatalllevels,medicalschool,internship and residencyin preparationfor pediatric practice,and of how the practiceof pediat
SOLO PRACTICE
Lee Forrest Hill, M.D.
1960;26;872
Pediatrics
Carl C. Fischer
INTRODUCTORY
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1960;26;872
Pediatrics
Carl C. Fischer
INTRODUCTORY
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