As long as births on this continent increase faster than the proportionate output of medical graduates, there will never be a sufficient number of trained pediatricians, "comprehensive" or otherwise, to attend the entire childhood population—even if this situation were ideal, and there are arguments against it being so—unless, of course, the proportion of pediatricians among total practitioners increases tremendously, which is improbable. The pediatrician-to-child population ratio is estimated to be 1 to 7000.1 In 1957, the United States had approximately one Board Certified pediatrician for every 40 physicians of all categories, and there appears to be no breaking of ranks by the generalists. The more comprehensively a pediatrician practices (that is, with close supervision of the child and extensive counselling of the family) the fewer patients will he be able to see and the more expensive will his services become. (It could be that this mode of pediatric candidate, as others have suggested.) Thus for practical reasons of availability and economy the less trained general practitioner must continue to assume the greatest share of the work, and he would still turn to the specialist pediatrician for particular help, as seems to be indicated from the foregoing presentation. If improved quality of child care is the aim of medical educators, then that emphasis should be placed as much on the training of the general practitioner as on that of the pediatrician,7 and the latter should look more to the field of consultation for his contribution to the nation's health.

The author readily admits that his way of practice is not without shortcomings and difficulties, part of which derive from the fact that he holds a minority view among his peers. Some of the problems can be surmised from between the lines of the material presented, but they need not be dwelt upon because they do not detract from the main theses of the study. A specialist with referrals justifies his status; without them his valuable knowledge and skills tend to rust from disuse. That the pediatrician consultant must minimize the scope of his counselling work need not mean that he stands unconcerned about general well-being of children and other pertinent issues; in such matters he can and should participate at the voluntary community level and thus play his distinctive part on the wider scene. By interposing himself between the grass roots and the ivory towers he becomes a key link in the chain of medical services to the child, and at the same time he assures himself of a satisfying professional existence.

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