I am responding to the article by Camp et al1 published in the January 1997 ARCHIVES. I completed my internship (at Children's Hospital, Boston, Mass) and residency (at Children's Hospital of Philadelphia in Pennsylvania) in 1990 and have been involved in the primary care practice of pediatrics in rural north central Pennsylvania since then. The closest tertiary care medical center for children is approximately 3 hours away. As did many of the graduates surveyed in this study, I too felt inadequately prepared to handle issues in developmental and behavioral pediatrics, learning disabilities, and orthopedics early in my practice experience. However, I have found that the past 7 years have been a continuing learning experience for me; through reading, telephone consultation, referral of patients to specialists, working with the local school system, and simple experience—seeing several patients with the same presentation or clinical course—I have come to feel much more comfortable with many of these "new morbidity" areas. On the other hand, when I am occasionally called on to perform certain acute care skills that I felt very comfortable with on leaving residency (such as intubation of premature newborns, placement of umbilical lines, resuscitation of near-drowning or trauma victims), I am grateful that I did master these skills with a certain degree of proficiency. It seems important that we not shift the emphasis of residency training too far in the direction of the new morbidity areas, in which we can continue to gain proficiency during our practice careers, at the expense of the acute care fields of neonatology, emergency pediatrics, and critical care pediatrics, which we pediatricians who practice in remote areas will continue to need (but will be unable to gain extensive experience in) during the remainder of our careers.
Rigas MAP. Preparation for Pediatric Primary Care. Arch Pediatr Adolesc Med. 1998;152(2):209–210. doi: