In THE CURRENT, sometimes heated, discussions concerning the influence of residency programs in determining the proportion of generalist or primary care physicians, pediatric programs are often grouped with those in internal medicine. In fact, the outcomes are very different. The two specialties (generalist and subspecialist entities exist in both programs) have found different niches and different philosophies for their development owing to the differing demographics of their patients and their own spheres of expertise. As is often the case, economic issues play a major role in determining the pattern of collective choices.
Pediatrics, as a discipline concerned with the interaction of disease and disorder on growth and development and vice versa, has a defined upper-age limit. Essentially, this is the point at which growth ceases and aging begins. In practical terms, this is about age 18 or 21 years, albeit when the birth rate falls, our societies are tempted to