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Arch Pediatr Adolesc Med. 2003;157:1033-1034.

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Our study found that rates of referral to specialists among children in the United States are 2 to 3 times higher than in the UK. The challenge of accounting for this large difference was taken up by Dr Weinberg, who suggested that the scope of practice among pediatricians might be decreasing in the United States. We agree that this could be an explanation for our findings. The burgeoning supply of specialists in this country may contribute to a more narrowly defined scope of practice both through changes in pediatric education, as Weinberg suggests, and through supply-side forces that minimize barriers to referral.

Another explanation for the referral rate differences is a sicker population of children in the United States. Our study found the opposite effect, although Michelle Mayer suggests that restricted access to specialists may explain the greater burden of morbidity that we observed in the UK compared . . . [Full Text of this Article]

Christopher B. Forrest, MD, PhD
Department of Health Policy and Management
Johns Hopkins School of Public Health
624 N Broadway, Room 689
Baltimore, MD 21205

Azeem Majeed, MD, MRCGP
London, England

Jonathan Weiner, DrPH
Baltimore

Andrew Bindman, MD
San Francisco, Calif

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Arch Pediatr Adolesc Med. 2003;157(10):1033.
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