The article by Forrest et al,1 and the commentary by Ferris,2 do not mention the main reason for the disparity in subspecialty consultations. The reason is a shift in the training philosophy of the pediatric resident. Years ago, pediatric house officers were taught: "You will be a specialist in the care of children." Today's pediatric resident, however, receives a different, double message: "You will be a specialist in the care of children but you will not be good enough to care for complex problems in infectious disease, neurology, cardiology, gastroenterology, developmental medicine, and so on. Complicated (interesting) patients must be referred for diagnosis and care to the pertinent subspecialist."
Horst D. Weinberg. Pediatric Referral Patterns. Arch Pediatr Adolesc Med. 2003;157(10):1033. doi:10.1001/archpedi.157.10.1033-a