Boning up

If a physician focuses on his patients and their responses to illness rather than the illness itself, he is less likely find the practice of general pediatrics boring. However, there are days when a steady diet of runny noses, ear infections, depressed teenagers, and rule-out-attention-deficit/hyperactivity disorder can numb the senses of even the most patient-centered pediatrician.

Half a century ago, pediatricians saw a wider variety of illnesses and injuries in their offices than they do now. For various reasons, the scope of practice for most pediatricians has narrowed. Residency programs churned out subspecialists, who then moved into communities that had previously been "underserved." Alert parents interested in the "best" care options could now bypass the general pediatrician and self-refer for problems that he had been successfully managing himself.

Newly trained pediatricians accustomed to having easy access to subspecialists during their residency may become more likely to reach for the phone and a quick-and-easy referral instead of tackling a problem that their older colleagues would have managed on their own. While necessity was once the mother of invention, an abundance of subspecialists eager to market their skills has fathered a generation of physicians hesitant to venture beyond a narrow comfort zone. Of course, the perceived threat of malpractice suits has amplified this shift toward specialty dependence.

Twenty-five years ago, hospitals and pharmacy chains began to realize that opening urgent care centers and walk-in clinics could be profitable or at least function as attractive portals to their other income streams. Some physicians welcomed these new kids on the block. But even pediatricians who encouraged families with minor emergencies to come to their offices, and who offered extended office hours, faced stiff competition from hospital walk-in clinics with hefty advertising budgets.

The end result of these forces of competition and short-sighted self-pruning is that many families no longer think of their pediatrician’s office as the place to go for minor injuries. With less exposure, a physician and his staff can become increasingly uncomfortable with these simple problems.

A report in the Journal of Pediatric Orthopedics (2012;32:732-6) documents how far this trend to avoidance has gone. Of more than 500 new referrals to a hospital-based orthopedic clinic, the investigators determined that nearly half of the patients had a problem that a health care provider with "basic musculoskeletal education and experience can manage." The list of conditions included undisplaced finger fractures, displaced single bone upper extremity fractures, femoral anteversion, and radial buckle fractures.

I was lucky enough to have been trained by physicians who assumed that I wouldn’t have ready access to orthopedists. This left me with some very basic skills that have allowed me to enjoy a more balanced diet of presenting complaints in the office. Primary care orthopedics is not rocket science or neurosurgery. Children’s bones heal quickly. Splinting and casting is hands-on fun with rewarding results. And parents appreciate the convenience of one-stop shopping.

If you want to build a medical home that provides you with a more stimulating variety of chief complaints and offers families an attractive place to get good care, it’s time to bone up on your basic musculoskeletal education.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@frontlinemedcom.com.

If a physician focuses on his patients and their responses to illness rather than the illness itself, he is less likely find the practice of general pediatrics boring. However, there are days when a steady diet of runny noses, ear infections, depressed teenagers, and rule-out-attention-deficit/hyperactivity disorder can numb the senses of even the most patient-centered pediatrician.

Half a century ago, pediatricians saw a wider variety of illnesses and injuries in their offices than they do now. For various reasons, the scope of practice for most pediatricians has narrowed. Residency programs churned out subspecialists, who then moved into communities that had previously been "underserved." Alert parents interested in the "best" care options could now bypass the general pediatrician and self-refer for problems that he had been successfully managing himself.

Newly trained pediatricians accustomed to having easy access to subspecialists during their residency may become more likely to reach for the phone and a quick-and-easy referral instead of tackling a problem that their older colleagues would have managed on their own. While necessity was once the mother of invention, an abundance of subspecialists eager to market their skills has fathered a generation of physicians hesitant to venture beyond a narrow comfort zone. Of course, the perceived threat of malpractice suits has amplified this shift toward specialty dependence.

Twenty-five years ago, hospitals and pharmacy chains began to realize that opening urgent care centers and walk-in clinics could be profitable or at least function as attractive portals to their other income streams. Some physicians welcomed these new kids on the block. But even pediatricians who encouraged families with minor emergencies to come to their offices, and who offered extended office hours, faced stiff competition from hospital walk-in clinics with hefty advertising budgets.

The end result of these forces of competition and short-sighted self-pruning is that many families no longer think of their pediatrician’s office as the place to go for minor injuries. With less exposure, a physician and his staff can become increasingly uncomfortable with these simple problems.

A report in the Journal of Pediatric Orthopedics (2012;32:732-6) documents how far this trend to avoidance has gone. Of more than 500 new referrals to a hospital-based orthopedic clinic, the investigators determined that nearly half of the patients had a problem that a health care provider with "basic musculoskeletal education and experience can manage." The list of conditions included undisplaced finger fractures, displaced single bone upper extremity fractures, femoral anteversion, and radial buckle fractures.

I was lucky enough to have been trained by physicians who assumed that I wouldn’t have ready access to orthopedists. This left me with some very basic skills that have allowed me to enjoy a more balanced diet of presenting complaints in the office. Primary care orthopedics is not rocket science or neurosurgery. Children’s bones heal quickly. Splinting and casting is hands-on fun with rewarding results. And parents appreciate the convenience of one-stop shopping.

If you want to build a medical home that provides you with a more stimulating variety of chief complaints and offers families an attractive place to get good care, it’s time to bone up on your basic musculoskeletal education.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@frontlinemedcom.com.

If a physician focuses on his patients and their responses to illness rather than the illness itself, he is less likely find the practice of general pediatrics boring. However, there are days when a steady diet of runny noses, ear infections, depressed teenagers, and rule-out-attention-deficit/hyperactivity disorder can numb the senses of even the most patient-centered pediatrician.

Half a century ago, pediatricians saw a wider variety of illnesses and injuries in their offices than they do now. For various reasons, the scope of practice for most pediatricians has narrowed. Residency programs churned out subspecialists, who then moved into communities that had previously been "underserved." Alert parents interested in the "best" care options could now bypass the general pediatrician and self-refer for problems that he had been successfully managing himself.

Newly trained pediatricians accustomed to having easy access to subspecialists during their residency may become more likely to reach for the phone and a quick-and-easy referral instead of tackling a problem that their older colleagues would have managed on their own. While necessity was once the mother of invention, an abundance of subspecialists eager to market their skills has fathered a generation of physicians hesitant to venture beyond a narrow comfort zone. Of course, the perceived threat of malpractice suits has amplified this shift toward specialty dependence.

Twenty-five years ago, hospitals and pharmacy chains began to realize that opening urgent care centers and walk-in clinics could be profitable or at least function as attractive portals to their other income streams. Some physicians welcomed these new kids on the block. But even pediatricians who encouraged families with minor emergencies to come to their offices, and who offered extended office hours, faced stiff competition from hospital walk-in clinics with hefty advertising budgets.

The end result of these forces of competition and short-sighted self-pruning is that many families no longer think of their pediatrician’s office as the place to go for minor injuries. With less exposure, a physician and his staff can become increasingly uncomfortable with these simple problems.

A report in the Journal of Pediatric Orthopedics (2012;32:732-6) documents how far this trend to avoidance has gone. Of more than 500 new referrals to a hospital-based orthopedic clinic, the investigators determined that nearly half of the patients had a problem that a health care provider with "basic musculoskeletal education and experience can manage." The list of conditions included undisplaced finger fractures, displaced single bone upper extremity fractures, femoral anteversion, and radial buckle fractures.

I was lucky enough to have been trained by physicians who assumed that I wouldn’t have ready access to orthopedists. This left me with some very basic skills that have allowed me to enjoy a more balanced diet of presenting complaints in the office. Primary care orthopedics is not rocket science or neurosurgery. Children’s bones heal quickly. Splinting and casting is hands-on fun with rewarding results. And parents appreciate the convenience of one-stop shopping.

If you want to build a medical home that provides you with a more stimulating variety of chief complaints and offers families an attractive place to get good care, it’s time to bone up on your basic musculoskeletal education.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@frontlinemedcom.com.