PEDIATRICS Vol. 10 No. 5 November 1952, pp. 612-618
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THE PEDIATRICIAN AND THE PUBLIC

Editors: PAUL A. HARPER, M.D..

THIS description of medical practice in Lynchburg, Virginia, is offered because it presents an unusual pattern for a small city wherein most of the citizens' medical needs are met by specialists rather than by general practitioners. Furthermore, it is remarkable that this pattern has developed spontaneously without any master plan and without any central clinic or hospital or other type of group practice. The great majority of physicians practice independently but in an atmosphere of cooperation. There are now 78 physicians in active practice in the city and some 20 in the adjacent trading area.

Since 1930, 59 new doctors have come to the city and remained. Of these men, 50 limit their practice to a specialty, while 9 are in general practice.

At the present time one might safely estimate that over 75% of the total volume of medical work in the city is performed by specialists and less than 25% by men in general practice. A check of admissions to the Lynchburg General Hospital shows that in 1951 only 13% were patients of general practitioners, even though all physicians in town are on one of the staffs of this hospital. In 1951 general men delivered 471 out of 2,453 live births in the city or 23.8%. Only four mothers were attended by midwives.

Two reasons that are responsible for this situation are the fact that basic minimum fees are the same for specialists and general men and that the public has educated itself to prefer the services of a specialist whenever available.