PEDIATRICIANS? ATTITUDES TOWARD AND EXPERIENCES WITH PEDIATRIC HOSPITALISTS: A NATIONAL SURVEY Jack M. Percelay, Karen G. O?Connor, John M. Neff. Pediatrics, Children?s Hospital of New York, New York City, NY; Health Policy Research, American Academy of Pediatrics, Elk Grove Village, IL; Department of Pediatrics, Children?s Hospital and Regional Medical Center of Seattle, Seattle, WA.

BACKGROUND: Pediatric hospitalist programs consisting of dedicated inpatient (private, academic, specialty) attendings on the general pediatric ward have become increasingly common, but national data on pediatricians? use of pediatric hospitalists (PHs) are lacking.

OBJECTIVE: To assess the extent of and reasons for pediatricians? use of PHs, the impact of hospitalist programs on practice, and satisfaction with care provided by PHs.

DESIGN/METHODS: American Academy of Pediatrics (AAP) Periodic Survey mailed in 2002 to 1626 randomly selected U.S. members. RR =59%; n =654 pediatricians practicing in office or clinic based settings.

RESULTS: 40% of pediatricians are affiliated with hospitals with full-time PHs (n=252). Among these pediatricians, PHs care for ~45 % of general pediatric ward inpatients. Thus, nationally pediatricians refer ~18% of general ward inpatients to PHs. Utilization of PHs by pediatricians varies significantly: 40% report no referrals while 38% report all patients are referred. Of those who use PHs (n=158), the most common reasons for referral are better care because of PHs? full-time hospital presence (61%) and specialization in inpatient care (53%). 53% indicate attending on inpatients takes too much time away from office practice. 78% agree that using PHs makes office practice more manageable and predictable. 59% say using PHs limits their ability to maintain inpatient skills and 44% say it limits participation in major inpatient management decisions. 43% say use of PHs improves career satisfaction by allowing specialization in ambulatory pediatrics, but 20% say limited direct inpatient involvement diminishes career satisfaction. Most pediatricians say use of PHs increases overall quality of patient care (68%) and office productivity (57%), although 45% say continuity of care is decreased. Overall, 87% are satisfied with the care provided by PHs to their patients and 83% believe their patients are satisfied with this care.

CONCLUSIONS: Among AAP members practicing in an office or clinic based setting, an estimated 18% of general pediatric inpatient care is provided by PHs. Quality of care and practice style drive pediatricians? decisions to refer to PHs. Pediatrician and perceived patient satisfaction with the level of care provided are high. Continuity of care and involvement of the primary care pediatrician in inpatient management are areas for improvement.