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June 1993

Resolved: The Proliferation of Subspecialties Is Not in the Best Interests of General Pediatrics: Ambulatory Pediatric Association Debate

Author Affiliations

Dr Nelson is president of the Ambulatory Pediatric Association, Birmingham, Ala, and is affiliated with the University of Alabama School of Medicine, Birmingham; Dr Alpert is chairman of the Department of Pediatrics, Boston (Mass) University School of Medicine; Dr Chesney is chairman of the Department of Pediatrics, University of Tennessee School of Medicine, Memphis; Dr McAnarney is professor of pediatrics, Department of Pediatrics, University of Rochester (NY) School of Medicine; and Dr Simmons is chairman of the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.

Am J Dis Child. 1993;147(6):672-679. doi:10.1001/archpedi.1993.02160300078028

Dr Nelson: The topic for the annual Ambulatory Pediatric Association debate is resolved: that the proliferation of new subspecialties is not in the best interests of general pediatrics.

Dr Chesney: Let me review a few historical perspectives about pediatrics. For many years, about 9% of graduates of medical schools have gone into pediatrics and have done a variety of things as pediatricians. It turns out that about 10 schools, or 7% of our schools, have produced more than 350 pediatricians over those years, and not surprisingly, these are the largest schools, such as the University of Illinois, the University of Indiana, and the oldest schools, such as Harvard. These schools have tended to produce a larger number of pediatricians than other schools. The residents of our pediatric programs tend to settle in the state in which they took their residency or in a contiguous state in more than 65% of the cases. We come from a tradition of a relatively small number of schools producing a large number of pediatricians and a tradition of pediatricians remaining near home.

The supply of pediatricians has been relatively stable for the past 12 years, at roughly 1350, plus or minus 50, residents per year, and of those 1350 American graduates, 47% immediately go into general pediatric practice, another third go into fellowships, and the remainder do other things, including chief residencies. Many of those trainees subsequently go into general pediatrics. Of the 33% of trainees who do fellowships, fully 50% go into neonatology, which is a very well-established subspecialty.

One of the important things to recognize is that there is an established need for hospital-based services, which is,

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