Published online May 2, 2005
PEDIATRICS
Vol. 115
No. 5
May 2005, pp.
1449-1450
(doi:10.1542/peds.2005-0275)
Health Care Transition
Tom Melgar, MD
Past President, Medicine-Pediatrics Program Directors Association
Departments of Internal Medicine and Pediatrics and Human Development
Michigan State University
Kalamazoo Center for Medical Studies
Kalamazoo, MI 49008
Chad Brands, MD
Co-chair, Medicine-Pediatrics Program Directors Association Committee on Transitional Care
Departments of Internal Medicine and Pediatrics
Mayo Clinic College of Medicine
Rochester, MN 55905
Niraj Sharma, MD
Co-chair, Medicine-Pediatrics Program Directors Association Committee on Transitional Care
President-Elect, Medicine-Pediatrics Program Directors Association
Departments of Internal Medicine and Pediatrics
University of Miami School of Medicine
Miami, FL 33136
To the Editor.—
We read the article by Reiss et al1 on health care transition (in the January 2005 issue of Pediatrics) with great interest. The authors discuss the practical perspectives of patients, their families, and their pediatric care providers. Their work and discussion astutely identify obstacles that limit successful transition to providers of adult medical care. However, we were disappointed to note that there was no identifiable inclusion of combined internal medicine-pediatrics (med-peds) trained physicians in the study. Today in the United States 1 of every 8 pediatricians graduates from a combined med-peds residency program. Med-peds physicians are a logical part of the solution to successfully transitioning children, adolescents, and young adults with chronic conditions to adult care providers and settings. The benefits of med-peds training as it pertains to health care transition has been recognized in the Future of Pediatric Education II.2 Their training includes extensive pediatric and adult subspecialty experience and promotes expertise in the care of patients with multiple chronic medical problems. Recent survey data on graduates of med-peds programs demonstrates that the vast majority are confident in their ability to care for children, adolescents, and young adults with special health care needs, making them ideal candidates for transition care.3
A tremendous number of survivors of congenital and chronic conditions are entering and surviving further into adulthood. Although rapidly growing in number, there are only 4000 med-peds physicians currently practicing in the country. It is unlikely that the med-peds physician workforce will be able to shoulder the bulk of the medical care of the growing populations of patients transitioning in the near future. New models and approaches are required, and national attention is being focused on these issues.2,4
Given these patient and provider demographics and tremendous opportunities and challenges in transitional care, the Medicine-Pediatrics Program Directors Association formed its Committee on Transition Care in 2003. The committee is dedicated to the advancement of the field of transitional care and is pursuing a national agenda that includes networking, resource development, and transformation of the transition process for both patients and physicians. We hope that our experience, expertise, and enthusiasm in this area will enable our colleagues to gain confidence and competence in the provision of care for adults with chronic congenital or acquired conditions from childhood. As we partner with other professional organizations, we believe that our strategy will enable students, residents, and practitioners of pediatrics, medicine-pediatrics, internal medicine, and family medicine to promote successful transitions to adult medical care.
REFERENCES
- Reiss JG, Gibson RW, Walker LR. Health care transition: youth, family, and provider perspectives.
Pediatrics. 2005;115
:112
–120[Abstract/Free Full Text]
- The Future of Pediatric Education II. Organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century. A collaborative project of the pediatric community. Task Force on the Future of Pediatric Education.
Pediatrics. 2000;105(1 pt 2)
:157
–212
- Cull W, Melgar T, Kaelber DC, Kan BD, Chamberlain JK. Training experiences of combined internal medicine-pediatrics residents. Presented at: Pediatric Academic Societies Annual Meeting; May 3, 2004; San Francisco, CA. Available at: www.pas-meeting.org/2004SanFran/Abstracts/Abstracts.htm. Accessed February 6 2005
- Gesensway D. Internists wanted for complex adolescent care: a growing number of childhood disease survivors need to transition from pediatric care.
ACP Observer. 2004. Available at: www.acponline.org/journals/news/dec04/adolescents.htm. Accessed February 6, 2005
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics
