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Paediatr Child Health. 1998 Mar-Apr; 3(2): 93–94.
PMCID: PMC2851276

The practice of paediatrics in the 21st century: A voice from a rural community paediatrician

Sandra Woods, MD FRCPC

Hospitals with no paediatric beds or very few paediatric beds are rapidly becoming a reality in our society. In response, paediatricians will need to play a role in preventive medicine, a role that will begin even before conception. Folic acid supplements for all women of childbearing years are becoming automatic with the addition of this vitamin to our flour and pasta. The prevention of adolescent pregnancy, with easily available confidential family planning, in an attempt to offset the rise in premature births and the increase in adolescent pregnancy seen in Quebec must concern us.

Education about the danger of smoking has not prevented a rise in this addictive habit, which afflicted 34.2% of Quebec’s population age 15 years and over in 1991/92 (1). Awareness regarding the effects of nicotine on the fetus must be increased because mothers will often make sacrifices to save their children that they could never make for their own well-being. Alcohol and drug use in teenagers and pregnant women are unfortunate problems that must be addressed if we are to improve the health of our young population.

Because of the increased survival rates of premature babies, more children need to be followed for developmental delay and, subsequently, for behaviour problems at school where fewer resources will be available. Thus paediatricians need to develop skills to advise parents regarding the optimal use of the health and educational services to ensure that these young people achieve their full potential.

With out-patient treatment for asthma and diabetes the order of the day, information for parents must be readily available at specialty clinics established in community hospitals for this purpose. Education of parents will prevent neglect of chronic conditions to the point where hospitalization is inevitable.

Because injuries are now the most common cause of death in children, we must ensure that paediatricans’ offices are able to handle paediatric emergencies (2). An emergency equipment list for the paediatric office may be found in the APLS: The Pediatric Emergency Medicine Course Manual (3) of the American Academy of Pediatrics.

We, the paediatricians of Canada, are faced with a rapidly changing work situation. Across Canada, the number of residents in training for the practice of general paediatrics has been reduced considerably, for example, in Quebec that number has been cut to zero for the next four years. With early retirement packages being offered to those in practice, we will be fewer in number with increasingly complicated patients to follow. Staff paediatricians in subspecialty areas at teaching hospitals are often called in to see patients whose initial management used to be the responsibility of our ever-diminishing numbers of fellows in training.

Despite media coverage to suggest that doctors are among the highest paid citizens of Canada, paediatricians will be expected to do more with less financial incentives. Licencing restrictions and limitation of billing numbers render us less mobile than before. We will need to ensure that each province avoids developing an insular mentality. More frequent continuing education courses involving paediatricians from across Canada can help us exchange ideas and experience in different areas of practice.

Combining reasonably priced vacation packages with conferences that correspond with school vacation time, eg, March break, could help paediatricans to remain up to date in their practice of paediatrics.

Paediatricians are people too. Many of us are parents, spouses and grandparents. In an age where single parent families are all too common, where reconstituted families cause stress for adults and children alike, we must ensure that we keep time for ourselves to develop and maintain healthy family relationships.

Paternity and maternity leave for residents should be promoted (4). Obsessive compulsive work habits that result in neglect of other important areas of our lives must be guarded against if we are to function effectively as competent efficient paediatricians in the 21st century.

In the years to come, parents will be asked to assume more responsibility for their children’s well-being. Protection from the sun will reduce the risk of skin cancer. Iron-fortified formulas and breastfeeding should eliminate iron deficiency anemia. Regarding cigarettes as an addictive drug that can cripple the lives of our young people will encourage smoking to become a practice restricted to consenting adults in private.

Paediatricians will be asked to concentrate their energy in areas where new advances in technology and treatments are saving lives. Children with cystic fibrosis and complex congenital heart disease often live to adulthood and need to be followed carefully. As family doctors take more responsibility for the first-line care, paediatricans will be relied on to provide support and make decisions regarding the diagnosis, treatment and follow-up of diseases of children whose only wish is to live normal happy healthy lives. We must be ready to assume the challenging responsibility that this commitment involves.


1. Charest A. Priorités de santé publique 1997–2002, L’Actualité médicale [23 avril] 1997;18:2.
2. Richardson K. We have failed children miserably. Medical Post. 1997 May;27:6.
3. American Academy of Pediatrics . APLS: The Pediatric Emergency Medicine Course Manual. Elk Grove Village: American Academy of Pediatrics; 1993.
4. American Academy of Pediatrics Parental leave for residents and pediatric training programs. Pediatrics. 1995;96:972–3. [PubMed]

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