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Hospitalists

 
​​​​Pediatric hospital medicine is a relatively new, but growing, specialty. In 2004, the AAP Section on Hospital Medicine had 225 members. In 2016, it had grown to 1,700. Self-reported data indicate that pediatric hospitalists now practice in at least 43 states and the District of Columbia. Exponential growth brings exciting changes but often leads to growing pains. Successful hospitalists must meet the evolving clinical needs of their institutions while facing limited resources. They need to balance their often non-traditional work hours with educational and administrative responsibilities. Pediatric hospitalists report substantial overall career satisfaction, but some have indicated that lack of mentorship is a challenging problem. 

Hospitalist programs may develop as an initiative of local physicians, or hospitals may choose to contract with them. They offer around-the-clock care to hospitalized patients that primary physicians often find difficult to provide. Utilizing hospitalists has been shown to improve quality measures—including length of stay, mortality, and 30-day readmission rate—in several common inpatient diagnoses. Evidence also shows that hospitalists reduce costs while achieving the same or better patient outcomes achieved by non-hospitalists. 

Hospitalists often practice in group-type structures. They may be simple informal arrangements among a group of physicians within a community who share hospital calls with or without teaching responsibilities, or they may be more elaborate corporate organizations that employ individual physicians. Some may even be organized on a national scale, with local “franchises” that operate within a community but are answerable to corporate headquarters. They may cover one or multiple hospitals depending on the demand and the particular relationships that exist between the group and hospital administration. In much the same way corporations offer benefits of scale in terms of sharing expenses, employee benefits, and tax advantage; groups that are more organized offer the advantage of monitoring the quality of care provided by their physicians. These groups may have methods in place to assess outcomes, lengths of stay, patient satisfaction, and reimbursement values. 

Physicians who practice within such a setting report the following advantages:

  • Satisfaction of working within a team 
  • Satisfaction of contributing to the improvement of inpatient care or hospital processes 
  • Flexibility of work hours (i.e., not necessarily 9:00 am–5:00 pm) 
  • ​Opportunities for various educational interactions (eg, with other specialists, residents, medical students) 
  • Opportunity to have nonmedical responsibilities (eg, administration, quality assurance) as much or as little as one wants
  • Large variety of clinical cases, which are often acute and whose successful outcomes provide enormous satisfaction
  • Being kept on one’s toes

Some hospitalists reported difficulty and even boredom when they previously worked in office practice, which often seems to involve the same medical problems over and over. These physicians also perceived the business side of keeping a practice afloat not to their liking. They express a high comfort level with a hospital setting and the pace that such work involves. 

Those contemplating a hospitalist position should ask themselves a number of questions.

  • What is the nature of the organization? Is it a corporation, a partnership among physicians, or a hospital-based group? Will a physician be an employee of the corporation or of the hospital? What is the basis of the corporation’s relationship to the hospital? What is the organizational structure? Who will serve as my direct supervisor(s) and what are his or her responsibilities?

  • What is the group’s composition? Are they all general pediatricians? Are there family or nurse practitioners? Who are the actual physicians participating in the call rotation? What are the responsibilities of each physician who takes calls? What is the call rotation schedule? 

  • Are there outpatient responsibilities or emergency department coverage apart from inpatient calls? Where will these be conducted?

  • Which hospitals does the group cover? If more than one, are there different responsibilities or expectations with each hospital setting? Are the patient load and population different with each hospital? What is the approximate distance between each hospital and one’s residence? Is there a central office location for the group?

  • What are other physician responsibilities apart from direct patient care? Are there administrative duties or teaching responsibilities? Are these expected, required, or optional? If one were to supervise or teach, does this involve nurse practitioners, physician assistants, other nursing personnel, residents, or medical students?

  • Does the group have subspecialty or surgical support? If so, who and where? ​Does it require transferring patients to a tertiary hospital? 

  • What is the rate of physician compensation? What is the basis of this scale (e.g., seniority, productivity, patient load, call load)? How is one’s productivity calculated and what factors go into this calculation? How does one’s productivity affect compensation and future raises?

  • What benefits are offered to physicians? Do these include health insurance coverage, malpractice liability, other insurance coverage, and retirement funds? If transferring from another practice, will the group offer tail coverage?

  • What constitutes terms of separation, termination, and contractual breach? Are there any restrictive covenants (eg, geographic practice restrictions)?

  • What are the laws of the state governing all of this and what are the responsibilities and liabilities if one assumes this position? You may need to consult your state medical board or a local lawyer.​​
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