The pediatrician's role--shrinking and shrinking!

The article entitled "Physician Experience With Pediatric Inpatient Care in Washington State" that appeared in the January 1996 issue of Pediatrics disturbs me. The trend toward the deemphasis of the primary care pediatrician in the care of hospitalized children is one with which I disagree for the following reasons. First, as the article acknowledges, pediatricians who practice in a rural setting need to know how to care for a critically ill child. If we elect to teach pediatric residents only the skills necessary for outpatient care, we will either be sending incompletely trained pediatricians to rural areas, or we will be worsening the trend toward pediatrician and physician geographical maldistribution by training pediatricians who will not feel comfortable practicing in rural areas, thereby virtually ensuring their choice of an urban area in which to practice.