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Comment & Response
December 21, 2018

Consumerism and Innovation in Pediatric Primary Care

Author Affiliations
  • 1Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
JAMA Pediatr. 2019;173(2):197-198. doi:10.1001/jamapediatrics.2018.4634

To the Editor In their Viewpoint, Fiks et al1 propose “divergent thinking” as the ideal response to the “innovator’s dilemma” attributed to consumerism. But the dilemma, as defined by Clayton Christensen in his seminal business book,2 is that good management simply cannot pursue divergent strategies simultaneously. As the authors note, “pediatric primary care is thriving,” thanks to near-universal funding, required by the Affordable Care Act, of its core business of well-child care. It would be a tall order to look beyond the predictable revenue of these physician-driven, visit-based services to adopt lower-cost models with uncertain margins, particularly because medical practice is so highly regulated toward the former. We therefore suggest a nondivergent increased focus on children with medical complexity and other special health care needs as a more successful response.