Carving a Niche—The General Academic Pediatrician as Consultant

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Abstract
The role of the general pediatrician as a specialist is often unclear to the majority of physicians and patients. The role of the general academic pediatrician (GAP) as a consulting subspecialist also is in need of definition. We surveyed a consultation service staffed primarily by three GAPs in our tertiary care children's hospital. During the 12-month survey, 275 patients with a mean age of 5.6 years were evaluated. The mean duration of the chief complaint prior to the initial visit was 12.3 months. A total of 254 (92%) were evaluated initially as outpatients; of these, 20 (8%) were eventually hospitalized. Only 29 percent of the patients were referred to pediatric subspecialists. GAPs acting as consultants in a tertiary care setting most often see patients with long-standing complaints that do not require hospitalization or subspecialist referral, but their role at times is expanded to include more acute and more complex problems. Referrals may come from primary care physicians or from tertiary care subspecialists, particulary surgeons, or by self-referral from the patients' families.