The case study of a 16-year-old with diskitis ("Cough and achiness in an adolescent: The boy's back again," Pediatric Puzzler, October 2002) was very good and reminds us how indolent this process can be. But I want to comment on the statement that "only specialists can order [an MRI] scan" under the regulations of the independent physicians association (IPA) to which the authors belong. I guess pediatrics is not a specialty. This is appalling and insulting, but probably only the tip of the iceberg. These physicians' IPA does not appear to represent the pediatrician very well.
Pediatricians should wake up and not tolerate this nonsense. Why would anyone want to choose general pediatrics as a specialty if they are going to be reduced to a glorified, very expensive nurse practitioner? General pediatrics may well be an endangered species. These pediatricians are being pushed out at one end by pediatric subspecialists and at the other end by lower level health providers. Some of this has been externally driven, but some of it has been driven by pediatricians abdicating their rolefor example, turning all newborn care over to a neonatologist, sending their patients to emergency rooms to be seen by "emergency medicine physicians," and not taking care of their hospitalized patients but referring them to a "hospitalist" instead.
The author replies: I completely agree with Dr. Cimino's concerns about pediatrics being considered a specialty. The issue here may be one of terminology. Within our IPA (in which I serve as a member of the Board of Directors) the physicians are generally referred to as primary care phy- sicians or specialists, and the primary care physicians must be board-certified or board-eligible in pediatrics, family practice, or internal medicine.
The policy on MRI ordering was the result of perceived overuse of this imaging modality by primary care physicians in the IPA. However, as in our case, this policy did not result in decreased utilization of MRI scans and has since been discontinued.
Readers' Forum. Contemporary Pediatrics 2002;12:16.