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Sir.—Dr Heifer's editorial "Primary Care: Does It Belong in Pediatrics?"1 was indeed thought provoking and very much to the point. As a faculty member of a university division of general pediatrics (pediatric generalist with subspecialty in developmental pediatrics), I can readily agree with Dr Helfer on most of his points.
However, I all too often am privy to the confessions of pediatric residents who explain their decisions to pursue one of the more lucrative tertiary subspecialties because they have decided they "simply cannot afford to practice primary care." I believe Dr Helfer was in error when he compared the pediatrician's otoscope to the plumber's roto-rooter. Recently, I was grateful when the plumber's assistant relieved the impaction in our bathtub drain with the help of his "hi-tech gimmick," but my gratitude was somewhat short of ecstatic when this young high school dropout presented me with a bill for $60
CRAIN LS. Primary Care and Pediatrics. Am J Dis Child. 1986;140(4):322. doi:10.1001/archpedi.1986.02140180055005