Sir.—As a primary care pediatrician faced with the conflicts Dr Helfer so nicely outlined in his editorial in AJDC,1 I want to thank him for submitting his thoughts. Pediatricians in general continue to be undervalued by society and our medical colleagues, and this is increasingly clear in the cognitive vs procedural reimbursement of health maintenance organizations.
There seems to be a stigma about being a plain, ordinary primary care physician. For those of us who have appointments at the University of Michigan Medical Center, Ann Arbor, the only way we can be promoted above the assistant clinical professor level is to have a national reputation. I will continue to remain dedicated to the fact that we are specialists for children and that our work is important.
Again, I want to thank Dr Helfer for using his position as a respected academic pediatrician to support those of us who