To the Editor.—

In the article "Primary Care: The Future of Pediatric Education"1 Dr Alpert addresses many issues facing pediatrics. I agree with his list of problems. However, I doubt that the social, economic, and cultural changes he describes will ever occur.

My informal survey of pediatricians in practice is a song of frustration and boredom. The ringing telephone provides the rhythm. How does a patient-physician relationship develop in an environment of missed appointments, 3 AM emergency department visits, and managed care? Many families change physicians whenever employers change health benefits packages.

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