Pediatrics in the community hospital

The subject of the community hospital's pediatric service-its mission, organization and staff-is ripe for critical study and innovative implementation. The centripetal force of medical education which has kept the best medical school graduates within the tertiary hospital walls during medical school, residency, fellowship, and subspecialty practice has had a perhaps unintended though real inhibiting effect on the community hospital. Those who practice in the community environment may well be less equipped to study and change their world than are their academic counterparts. They often lack the training to do so, and lack time that can be taken from busy practice commitments. Those most capable of critical study are unfamiliar with or at least not always empathic to the community's problems. We suggest that there are many clinical questions and many organizational issues that are legitimate matter for study within community hospitals, in which a majority of the nation's children are cared for. The increasing number of affiliations between university and community hospitals may allow a true academic bond to develop and learning to occur at both ends. The community hospital has both the need and potential for important growth in the 1980s.