The paediatrician’s role in ambulatory health care of the older child in Switzerland

Objective Data selected from a larger study, ‘Schoolchildren in the Paediatric Practice’, were analysed to examine the role of the practising paediatrician in providing care to the older child/adolescent. Design For the base study, paediatricians in private practice collected data on schoolchildren during two year-long research segments. At the end of the study, each paediatrician was interviewed. To assist the focused analysis of this paper, statistics on physician utilization patterns and diagnoses were obtained from two external sources. Setting and Sample Thirty-four paediatricians practising in the canton of Bern, Switzerland received a sample of 5971 schoolchildren, aged 6–16. Results The paediatricians saw a decreasing number of children with increasing ages. Other medical specialities showed no comparable decline. The length of time a paediatrician had been practising was related to having more older patients. The paediatricians expressed mixed opinions about the decline in older patients, with 59% stating this to be normal or not a problem. A minority felt the situation was a serious threat to the profession. Issues concerning the paediatricians included the image of the profession, the medical and administrative management of adolescent visits, and inadequate reimbursement. Implications for practice To take the lead in assuring adequate care for the country’s older children, Swiss paediatricians need to clarify their desired role and address the questions of competence, training needs, personal barriers to offering services, and manpower coverage.