President's address--the politics of pediatrics

It took a long time for pediatrics to be recognized as a separate specialty, and it was only after World War II that medical schools and teaching institutions gave this area a recognizable identity in their programs. The "baby boom" of the postwar era gave the pediatrician a busy practice, limited only by the large amount of "well-baby care" that caused him to have little time for difficult cases. The end of that same baby boom in the late sixties, however, along with the regionalization of care, the involvement of closed panel health programs at contract rates, and the use of public health clinics for routine procedures, forced the pediatrician to reassess once again his changing and, in many cases, diminishing practice. The question still remains: What must the pediatrician do now to convince others that he or she is, indeed, the specialist to handle children's problems, be they physical, developmental, mental, or behavioral? How can pediatricians present their role as preventionists and ambulatory care specialists so that they will be recognized among colleagues and by community agencies as the center of comprehensive care and the spokespersons for the child in our society? By an overview of the nature of the changes in our population and practice since World War II, and an evaluation of where the pediatrician now stands in relation to other professionals who handle the health and well-being of the child, I believe we can once again answer the question so often posed by presidential addresses to the pediatric societies in the early 1960s: "Whither pediatrics?"