The availability of pediatric subspecialty care is critically important to the health and well-being of infants, children, and adolescents. Moreover, timely collaboration with pediatric subspecialists is an essential element of the standard of care for children: the community-based medical home. The medical home model of care, with a generalist physician as the leader, has been shown to produce considerable economic1 and patient-level benefits.2,3 In this model, primary care practice teams coordinate all care for a patient, including subspecialty care. Unfortunately, lack of access to pediatric subspecialty care within the medical home has reached crisis proportions in the United States owing to several interrelated factors: an insufficient number of pediatric subspecialists, dramatically increasing demand for pediatric subspecialty care, a fragmented system of pediatric primary and specialty care, and inadequate financing of medical education and collaborative primary and specialty pediatric care through the medical home.
Margaret McManus, Harriette Fox, Stephanie Limb, Polly Arango, Peter Armstrong, Richard Azizkhan, Richard Behrman, Russell Chesney, Atul Grover, Vidya Bhushan Gupta, Ethan Jewett, M. Douglas Jones, Wun Jung Kim, John Lewy, Donald Lighter, Holly Mulvey, Richard Pan, Robert Schwartz, Calvin Sia, Christopher Stille, James Stockman, Vera Tait, Thomas Tonniges, Peters Willson. New Workforce, Practice, and Payment Reforms Essential for Improving Access to Pediatric Subspecialty Care Within the Medical Home. Arch Pediatr Adolesc Med. 2009;163(3):200–202. doi:10.1001/archpediatrics.2009.8