Pediatric Annals

GUEST EDITORIAL 

A Pediatricians View: Community Pediatrics and One Community Pediatrician

Michael Weitzman, MD

Abstract

This is the last issue of Peoiotric Annals for which Robert A. Hoekelman, MD, will serve as editor-inchief; and it is devoted to community pediatrics. Community pediatrics is the focus because of its importance, especially during this time of health-care reform, and because Dr Hoekelman began his career as a community pediatrician and has always maintained the perspective of a generalist with a community orientation in all of his many efforts on behalf of children.

This issue contains contributions from six individuals who have been in the forefront of community pediatrics since its inception. Each of these articles are based on presentations made at the Robert A. Hoekelman Symposium held at the University of Rochester in August 1993 to honor Dr Hoekelman on his stepping down as the chairman of its pediatrics department. Three of the key individuals who developed community pediatrics and who conducted the seminal Rochester Child Health Studies are contributors to this issue - Robert Haggerty, Evan Chamey, and Barry Pless. The volume begins with Dr Haggerty's article entitled "Community Pediatrics: Past and Present," in which he provides a historical overview of community pediatrics in Rochester, a definition of this field, and a compelling argument as to its importance. Dr Charney's article is titled "Medical Education in the Community: The Primary Care Setting as Laboratory and Training Site" and is of great topical importance as innovative community-based pediatrie education will be a key ingrethent in the health professional training reform that is likely to accompany health-care reform. Barry Pless, one of the major forces in community pediatrics1 research, has written an article on "The Future of Community Pediatric Research."

James Perrin, who was a resident and fellow with Drs Hoekelman, Haggerty, Charney, and Pless, writes about regional variations in children's hospitalization rates, a vitally important topic in times of cost containment and increasing emphasis on the outcomes of medical efforts. Vince Hutchins, who was at the head of federal efforts to implement a community pediatrics service, education, and research agenda for much of the last 20 years writes on "Community Pediatrics from the Federal Government's Perspective." Joel J. Alpert, who has spent his career championing community pediatrics and the care of America's children living in urban poverty, writes on "The Future and Primary Care."

Each of these anieles deals with a subject that is germane to contemporary community pediatrics and touches on some aspect of Dr Hoekelman's work. I would like to chronicle just some of these aspects and some of the landmarks in his career to date because of the influence he has had not just on the readership of Pediatric Annals, but on all of pediatric education.

Dr Hoekelman received his BA degree from Dartmouth College and his MD degree from Columbia University College of Physicians and Surgeons. He then did a rotating internship and 1 year of pediatric residency training at Mary Hitchcock Memorial Hospital, completing his pediatric training at Babies Hospital, Columbia-Presbyterian Medical Center. After serving in the US Navy for 2 years, Dr Hoekelman was in private pediatric practice in Canandaigua, New York from 1955 to 1967. His effectiveness in this endeavor is attested to by his being named "Mr Canandaigua" (Canandaigua's Citizen of the Year Award) by the Canandaigua Chamber of Commerce in 1968. In 1967, he was recruited out of practice by Robert J. Haggerty, MD, to join the full-time faculty of the pediatrics department at the University of Rochester where he has served ever since.

In the more than 25 years that Dr Hoekelman has been a faculty member at the University of Rochester, he has made countless pediatrie…

This is the last issue of Peoiotric Annals for which Robert A. Hoekelman, MD, will serve as editor-inchief; and it is devoted to community pediatrics. Community pediatrics is the focus because of its importance, especially during this time of health-care reform, and because Dr Hoekelman began his career as a community pediatrician and has always maintained the perspective of a generalist with a community orientation in all of his many efforts on behalf of children.

This issue contains contributions from six individuals who have been in the forefront of community pediatrics since its inception. Each of these articles are based on presentations made at the Robert A. Hoekelman Symposium held at the University of Rochester in August 1993 to honor Dr Hoekelman on his stepping down as the chairman of its pediatrics department. Three of the key individuals who developed community pediatrics and who conducted the seminal Rochester Child Health Studies are contributors to this issue - Robert Haggerty, Evan Chamey, and Barry Pless. The volume begins with Dr Haggerty's article entitled "Community Pediatrics: Past and Present," in which he provides a historical overview of community pediatrics in Rochester, a definition of this field, and a compelling argument as to its importance. Dr Charney's article is titled "Medical Education in the Community: The Primary Care Setting as Laboratory and Training Site" and is of great topical importance as innovative community-based pediatrie education will be a key ingrethent in the health professional training reform that is likely to accompany health-care reform. Barry Pless, one of the major forces in community pediatrics1 research, has written an article on "The Future of Community Pediatric Research."

James Perrin, who was a resident and fellow with Drs Hoekelman, Haggerty, Charney, and Pless, writes about regional variations in children's hospitalization rates, a vitally important topic in times of cost containment and increasing emphasis on the outcomes of medical efforts. Vince Hutchins, who was at the head of federal efforts to implement a community pediatrics service, education, and research agenda for much of the last 20 years writes on "Community Pediatrics from the Federal Government's Perspective." Joel J. Alpert, who has spent his career championing community pediatrics and the care of America's children living in urban poverty, writes on "The Future and Primary Care."

Each of these anieles deals with a subject that is germane to contemporary community pediatrics and touches on some aspect of Dr Hoekelman's work. I would like to chronicle just some of these aspects and some of the landmarks in his career to date because of the influence he has had not just on the readership of Pediatric Annals, but on all of pediatric education.

Dr Hoekelman received his BA degree from Dartmouth College and his MD degree from Columbia University College of Physicians and Surgeons. He then did a rotating internship and 1 year of pediatric residency training at Mary Hitchcock Memorial Hospital, completing his pediatric training at Babies Hospital, Columbia-Presbyterian Medical Center. After serving in the US Navy for 2 years, Dr Hoekelman was in private pediatric practice in Canandaigua, New York from 1955 to 1967. His effectiveness in this endeavor is attested to by his being named "Mr Canandaigua" (Canandaigua's Citizen of the Year Award) by the Canandaigua Chamber of Commerce in 1968. In 1967, he was recruited out of practice by Robert J. Haggerty, MD, to join the full-time faculty of the pediatrics department at the University of Rochester where he has served ever since.

In the more than 25 years that Dr Hoekelman has been a faculty member at the University of Rochester, he has made countless pediatrie educational contributions. From 1967 to 1976, he was the director of Ambulatory Pediatrie Services at Strong Memorial Hospital, and from 1968 to 1976, he was the codirector of the University of Rochester Pediatrie Nurse Practitioner Training Program. From 1976 to 1984, he was chief of the General Pediatrics Division, and from 1976 to 1990, he was director of the University of Rochester General Pediatrics Academic Fellowship Training Program. Dr Hoekelman was acting cochairman of the pediatrics department from 1974 to 1976, and he was the chairman from 1983 to 1993. In these many roles, he has contributed directly to the training of hundreds of pediatrie house officers and more than 75 general academic pediatrie fellows, as well as shaping the pediatrics department in ways that will influence its educational programs for years to come. In July of last year, he stepped down from his position as chairman and assumed responsibility as the associate dean for planning for the University of Rochester School of Medicine. In this capacity, he is helping this medical center prepare the medical education and pediatrie training reform that will be such a crucial aspect of health-care reform.

Dr Hoekelman's educational contributions at the University of Rochester have been more than matched by his contributions at the state and national levels, among which are the following: chairperson, National Joint Practice Commission; member of the National Advisory Council on Nurse Training, US Department of Health, Education, and Welfare; alternate chairman, NY State District, American Academy of Pediatrics; president, Ambulatory Pediatrie Association; advisor, Primary Care Training Programs, US Department of Health, Education, and Welfare; member National Study Group on Pediatric Education; and member of the executive councils of the Association of medical School Pediatric Department Chairmen, the American Pediatric Society, and the Association of Pediatric Residency Program Directors.

Dr Hoekelman also has been a prolific contributor to the pediatric and general medical literature. He has been the editor of 9 books, and he has authored 38 textbook chapters, 5 monographs, 56 articles in scientific journals, and 59 Pediatric Annals editorials. He has served as editor-in-chief of Primary Pediatric Care, a major general pediatrics textbook (three editions), and of Pediatric Annals (since 1990), as editor of the pediatrics and genetics section of the Merde Manual (13th through 16th editions), and as coauthor; with Barbara Bates, of A Guide to Physical Examination and History Taking (five editions), the bestseller among all medical textbooks.

This remarkable record of sustained contributions and accomplishments obviously has not gone unnoticed. In his presentation at the symposium last year, Dr Haggerty, who has served as mentor and inspiration to Dr Hoekelman and legions of those devoted to community pediatrics, attributed to Abraham Bergman, that dedicated child advocate and long-time leader of the Ambulatory Pediatrie Association, the statement that "the best thing you ever did was to recruit Bob Hoekelman from practice into full-time academic pediatrics." Dr Haggerty concurred that he thought this statement true.

This is no small honor. As noted above, the community in which he practiced chose to honor Bob Hoekelman with its Citizen of the Year Award the year after he joined academia. In 1981, he was the recipient of the American Academy of Pediatrics1 Job Lewis Smith Award, and in 1987, he received the Ambulatory Pediatrie Association's George Armstrong Award. What these awards can only hint at to those who have not had the good fortune to work closely with Dr Hoekelman is his boundless energy and good will, his encyclopedic knowledge of and readily apparent love of pediatrics, his steadfast commitment to the training of pediatricians and the continuing education of those in practice, his compassion and humanity (for those in training and in practice as well as for children and families), and the wisdom that has enabled him to engender loyalty and admiration from a truly huge number of physicians over the course of his more than 40 years in pediatrics.

What a remarkable odyssey and legacy of accomplishments. A community practitioner, with no formal academic training, successfully rose through the academic ranks, assumed leadership of a renowned pediatrie department, and nurtured and guided it through a period of profound growth, while at the same time making all of those other contributions over an unflagging period of 25 years. As Dr Hoekelman steps down from his leadership of Pediatrie Annals, it seems only fitting to honor his countless contributions with an issue devoted to community pediatrics with contributions by six eminent scholars and contributors to this field, all of whom also are long-term colleagues, collaborators, and admirers of Dr Hoekelman.

10.3928/0090-4481-19941201-04

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