Our study found that rates of referral to specialists among children in the United States are 2 to 3 times higher than in the UK. The challenge of accounting for this large difference was taken up by Dr Weinberg, who suggested that the scope of practice among pediatricians might be decreasing in the United States. We agree that this could be an explanation for our findings. The burgeoning supply of specialists in this country may contribute to a more narrowly defined scope of practice both through changes in pediatric education, as Weinberg suggests, and through supply-side forces that minimize barriers to referral.
Forrest CB, Majeed A, Weiner J, Bindman A. Pediatric Referral Patterns—Reply. Arch Pediatr Adolesc Med. 2003;157(10):1033-1034. doi:10.1001/archpedi.157.10.1033-a