Paediatric care in the rural area: problems and alternatives

We have made an attempt to approach the underlying problems that paediatricians working in a rural zone face on a daily basis. For this purpose we developed and mailed two separate questionnaires; one aimed directly at paediatricians that are currently working in rural zones of the differing Spanish Autonomic Provinces, and the other one addressed to any federated regional associations to the Spanish Paediatric Primary Care Association (AEPap). The main problems found were: professional and personal isolation, lack of paediatric nursing, increased risks and difficulties created by trips, precarious working conditions, difficulty for paediatric updating and an alarming and unjustified increase of area paediatricians (pediatras de area). We have chosen the best proposals and alternatives given by the people contacted in our surveys and we consider that the following ideas will better guarantee paediatric care for rural area: to centralize primary paediatric care in the referential primary care centre of each medical care area, a specific and exclusive paediatric nursing personnel, an adjustment of patient-doctor quotas and a retribution system for these special working conditions, guarantee the continuous paediatric training and education, and disappearance of the area paediatrician where feasible.