TRAINING PEDIATRICIANS FOR THE EVOLVING GENERALIST-SPECIALIST INTERFACE IN THE MANAGED CARE ERA

Managed care involves the linkage of service delivery and financing. O ne of the outgrowths of the rapid expansion of managed care over the p ast decade has been an increasing consensus that the generalist of the future will need to manage more of the patients traditionally cared f or by subspecialists. Subspecialty education for pediatric residents b ecomes increasingly important as the role of the pediatric generalist enlarges to include independent outpatient management of some less com plex but traditional subspecialty patients as well as collaborative ma nagement of more complex patients. To prepare for this role, a balance d exposure to subspecialty problems in outpatient as well as inpatient settings is required. At the same time, however, the growth of manage d care has led to certain barriers for providing this enhanced trainin g. This article describes the effects of managed care on the role and scope of the pediatric subspecialist as well as on educational strateg ies for coping with these changes while reshaping the roles of both ge neralists and subspecialists for maximal effectiveness in meeting the health care needs of children.