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The gospel that I am trying to preach is to my colleagues in medicine, understand what's happening, learn the facts, lift up your heads enough to see what's going on around you. Understand the problem and then begin to ask yourselves "What can I do to help?"

When I started out in medicine in 1946 there was no such thing as a health care industry. The term health care industry had never been used. Nobody referred to it as an industry and nobody thought that being a physician was a business. Now we are dealing with the inevitable consequences of a health care system, which changed from a social service to a business. Just as you would predict it ignores more or less those who can't afford to pay. It exploits the opportunities to make money at the expense of the obligation to use resources conservatively in the most effective, medically appropriate way.

It invites all sorts of abuses including fraud and it's clear that it's not working and it can't work because there's a fundamental disconnect between medical care and almost all other economic activities in our society. A patient consulting a physician because they're sick, got injured, worried, or frightened that they may die or become seriously ill is not like an ordinary consumer in an ordinary market and physicians should not be like vendors in an ordinary market. Their objective should not be simply to sell whatever the consumer will buy.

Physicians are in the best position to decide how best to use the resources that we expend on health care. I've outlined what doctors might do if they wanted to. They could form multi-specialty group practices not-for-profit group practices that would be prepared to accept payment on a per capita rather than on a piece work basis, on a per capita basis for comprehensive care. There's no question that that system would work.

The only question is, how do we get it to occur politically in the current political climate? That's a big problem, we're going to have to change the attitude of the public and we're going to have to change the attitude of the legislators. It's issue of survival. We are simply not going to survive with the health care system we have now. It's going to implode. We must do something and doctors could help get it started. At least that's my hope and I think it's not unreasonable.

One of the hopeful aspects of all of this is that pretty soon half of all practicing physicians are going to be women. More and more multi-specialty groups are being formed and women are becoming a very significant part of that movement. I'm expecting that women may save the day.

Pediatrics is generally a very happy specialty. When it's sad it's a very sad specialty. I think pediatricians bond together for that reason. You know, I've heard people say they can't even walk into the children's hospital. It's too hard, it's too depressing. To me it's a wonderful place filled with hope.

Working with children is difficult because devices, medications, vaccines are all tested on adults. You're always going to be relying on adult studies and children are not just small adults.

About 10% of all infants in the first 90 days will have a fever. It's a really vexing problem especially for young infants. Because any fever could represent a very serious infection you have one chance in the emergency room to get it right. Do you admit them or do you send them home? And you want to make the right choice.

The current recommendation is all of those infants have medical care and that the majority of them would be hospitalized. But that's hundreds of thousands of admissions each year. It's incredibly costly, in the billions of dollars.

For the last 15 years or so, all of my time here at the University of Utah, I have focused on the development and implementation of something we call the Evidence Based Care Process Model. Using input from laboratory staff, nursing staff, administrators and parents we built a care process model that we could all say, "This represents the best possible care that we could give in our system".

We started small with one virus and now we have technology where we can diagnose 15 viruses, we can diagnose bacteria in under an hour. It's now routine in hundreds of hospitals around the country including many children's hospitals. And so being able to go to a parent and say, "I know why your baby has a fever," that is such a relief. And that's where the joy of it is and that's where the benefit of it is. You know that kids are better off not just here but in other places because you did the research.

Some of the most innovative things that we're thinking about right now are something referred to as milestones. So in the residency world, we're being able to now identify exactly where people are along a spectrum of skills in six different areas and with the idea and vision that as people meet those skills we can move them along the pathway and again get rid of the rigid timelines that we're currently married to.

For those of us who have been doing medical education for a long time, we know some people learn faster than others, and other people learn slower. The fact that we're facing a deficit of 90,000 physicians coming up here very soon in the next decade, we really need to be thinking about: How can we turn people out more quickly? How can we ensure that we get people in the pipeline, keep them in the pipeline, and then turn them out at the end?