"Operation mountain doctor": pediatric primary care outside of conurbations Plan of action for training specialist physicians in pediatric and adolescent medicine for the future care of rural regions

In many countries pediatric primary care is provided by pediatricians and general practitioners/family doctors; however, both professional groups are currently lacking successors, particularly in rural regions. As a consequence, many public positions remain vacant and many parents especially in rural areas are unable to find a pediatrician for their children. At present 14% of public pediatric primary care positions are vacant in Austria. Various measures to increase the attractiveness were so far unable to change this trend. The shortage of primary care pediatricians has also been observed in the region of Upper Styria (Austria). Without intervention, in the near future a high percentage of the population would have ended up without provision of public pediatric care. The "operation mountain doctor" (OperationBergdoktor) was initiated to counteract this trend. Within the framework of this initiative additional fellowship positions were established at the regional departments of pediatrics and adolescent medicine to guarantee the long-term provision of primary pediatric care. Additionally, satellite outpatient departments were/will be set up, which are in close cooperation with the regional hospital. The pediatricians working in these affiliated institutions are employees of the corresponding hospital. The next generation's conceptions, the high percentage of women in pediatrics and other circumstances enforce the development of new models of primary pediatric care and thus enable further provision of comprehensive primary care. A sufficient number of specialist physicians for pediatric and adolescent medicine in an intramural setting is then directly related to the care function in the extramural area and therefore has an influence on effectively integrated care models in a region.