A community-wide pediatric program: a beginning and a blueprint for the future

IN DECEMBER OF 1963 a communication by Robert M. Sigmond, Director of the Hospital Council of Western Pennsylvania, appeared in Pediatrics. It examined in detail the existing facts concerning the quality of pediatric care and residency training in the community hospitals of Pittsburgh and its environs and came to some definite conclusions. Excerpts of these conclusions follow: "Planning for children's inpatient services should encourage grouping of small segregated pediatric units in which most children receive care today. . . . Small units interfere with provision of high quality, comprehensive care and are wasteful of scarce personnel and dollars. . . . Most general hospitals should affiliate with major general hospitals or children's medical centers at which their pediatric inpatient facilities could be grouped into a few large units. . . . Failure of children's medical centers to develop such affiliations may have dire consequences in the long run." By the time this article appeared Drs. Robert E. Cooke (Professor of Pediatrics), Russell A. Nelson (President of The Johns Hopkins Hospital), Thomas B. Turner (Dean of The Johns Hopkins University School of Medicine), and I were deep in discussions about this very topic. For many years, while I had been heavily engaged in the problems of the pediatric department of the Sinai Hospital and the nursery service of the Hospital for the Women of Maryland, the manifest deficiencies of these services as they were then constituted, and the difficulty of overcoming them had been much on my mind. Chief of these was our inability to develop a training program which would attract the house staff so necessary in modern times to provide ideal patient care.