I think it’s safe to say that health care in America bears little resemblance to health care a generation or two ago. College students today seem to me to have a better understanding of the commitment it takes to pursue a career in medicine. They seem more motivated to find meaningful research and service experiences before applying to medical school. Students entering medical school seem to have clearer goals of what they want from their careers, including professional considerations regarding their fields of training (I didn’t know I wanted to be a pediatrician until I was a third-year medical student), as well as their personal goals (making sure they’ll have enough time for family and important hobbies that help define who they are). There also seems to be a greater focus on educating and training nurses and, to use an unfortunate euphemism, “physician extenders” (nurse practitioners and physician assistants) — no doubt in recognition of the fact that highly trained and qualified NP’s and PA’s can do a lot of patient care just as well as those MD’s and DO’s who supervise them (and for a lot less cost).
All of these things improve the quality of health care by improving the quality of the provider pool. All these things, I believe, are good for patients as much as they are good for providers.
Of course there are headaches associated with hospitals, insurance companies, electronic health records, pharmaceutical companies, and more that physicians complain about ad nauseam. But doctors have always complained about these things in one form or another. My father was a salaried, hospital-based radiologist for more than 30 years before he finally earned his income from “fee-for-service.” That achievement was hard-earned and deserved, but a change in how the hospital and insurance companies compensated him didn’t end his complaining. Fortunately (for both of us), my dad never soured on the intellectual challenge and personal satisfaction that a career in medicine offers to discourage me from becoming a doctor.
My dad had the utmost respect for all his colleagues, but none more than the pediatricians. He felt pediatrics was the most academic of the primary care fields, where the important, pioneering research was happening. I think that’s still true. Me graduating medical school was thrilling for him, I’m sure; committing to a residency program in pediatrics (in Pittsburgh!) was more than icing on his cake.
I bring this all up because even though health care has changed a lot, pediatrics hasn’t. The American Academy of Pediatrics recently published a policy statement providing definitions for pediatrics and the pediatrician. I don’t know why I find it curious that the AAP would devote an entire policy statement to these definitions — I thought everyone knew:
Pediatrics is the specialty of medical science concerned with the physical, mental, and social health of children from birth to young adulthood. Pediatric care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases.
Pediatrics is a discipline that deals with biological, social, and environmental influences on the developing child and with the impact of disease and dysfunction on development. Children differ from adults anatomically, physiologically, immunologically, psychologically, developmentally, and metabolically.
A pediatrician, then, is a physician who practices pediatrics. That means:
…A pediatrician is a physician who is concerned primarily with the health, welfare, and development of children and is uniquely qualified for these endeavors by virtue of interest and initial training. This training includes 4 years of medical school education, plus an additional year or years (usually at least 3) of intensive training devoted solely to all aspects of medical care for children, adolescents, and young adults. Maintenance of these competencies is achieved by experience, training, continuous education, self-assessment, and practice improvement.
A pediatrician is able to define accurately the child’s health status and to serve as a consultant and make use of other specialists as consultants as needed, ideally in the context of, or in conjunction with, the physician-led medical home. Because the child’s welfare is heavily dependent on the home and family, the pediatrician supports efforts to create a nurturing environment. Such support includes education about healthful living and anticipatory guidance for both patients and parents.
A pediatrician participates at the community level in preventing or solving problems in child health care and publicly advocates the causes of children.
That’s what we do. It’s what makes us proud to be pediatricians!