As health care systems change, public agencies and professional organizations are increasingly saying that physicians need not be the sole purveyors of primary care – and indeed, that supply shortages dictate they can not be. A wider use of physician assistants and advanced practice nurses, innovations in care delivery, and new uses for telehealth and electronic communication are all touted as alternatives. But are these adequate substitutes for long-term relationships between pediatricians and the children and families they treat? One thing is certain: the importance of having a medical advocate who puts the needs of children first has not diminished.