Sir.—Dr Hoekelman's article "Well-Child Visits Revisited" (Journal 1983; 137:17-20) raises important issues in today's economy. Pediatricians undertake an extensive three-year residency (mostly hospital based) that stresses the care of critically ill neonates and young children. Many of us are poorly trained to do what the general practitioner of pediatrics does, ie, mostly treat children who are not ill. The child health associate whom I employ was better trained in behavioral pediatrics than I, and we both trained at the same institution. To continue to be competent in taking care of critically ill children, I have to attend and teach.
Unless insurance carriers recognize benefits from well-child care and begin paying for these services, I fear those of us in general pediatric practice will see things change. This change may not be in the best interest of children. I love the preventive aspects of pediatrics. I think it pays to