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My title is adapted from that used by Professor Sir Stanley Peart in a personal paper published in 1970.1 His argument was that general internal medicine had differentiated sufficiently for there to be no place for a general physician in an academic department. There would be physicians specialising in the various body systems, relying on general practitioners (GPs) to choose the most suitable for their patients. Similar developments are taking place in UK paediatrics but I will argue that (a) there will remain an important place for the general paediatrician and (b) the specialty of general paediatrics should be recognised as one alongside others such as paediatric gastroenterology and carrying comparable esteem.
Why the debate?
Developments in medical knowledge and consumer preference mean that the traditional authority of doctors to determine the content and style of their practice is being challenged.2 3 Other physicians and professionals may claim that they could do a general paediatrician’s job more effectively or cheaply. Paediatrics is not the only specialty where stock might be taken of its content and purpose.4-6 However the establishment of the Royal College of Paediatrics and Child Health, closer integration with Europe, and changes in primary and tertiary care in paediatrics all justify questioning the future of the generalist paediatrician.
Definition
What is general paediatrics? In the UK it is secondary care paediatrics practised by up to half a dozen specialist consultants serving a population of approximately 250 000. The position is different in most of the rest of the world. Here the general paediatrician may be a primary care physician providing services to a population similar to a UK primary care GP but seeing only children and having greater paediatric expertise. In some parts of the world the traditional primary care paediatrician is under threat, particularly from the development of family …