Adaptability is a core attribute for the successful Pediatric Hospitalist (PH). Perhaps it is because our specialty is so young that accepting and leading change seems to be woven into the PH’s DNA. Adaptability has served us well as our specialty has and continues to evolve to meet the changes in healthcare delivery models while striving to improve the care delivered to hospitalized children.
In 1996 Dr. Robert Wachter defined a hospitalist as a physician dedicated to the delivery of comprehensive medical care to hospitalized patients, while engaging in clinical care, teaching, research, or leadership in the field of General Hospital Medicine. In addition, hospitalists work to enhance the performance of hospitals and healthcare systems.1 This definition for the hospitalist caring for adult patients also fits the pediatric hospitalist (PH), but in addition to providing expert care for infants and children, the PH must be proficient in providing family-centered patient care.2
Clinical expertise therefore, is another core attribute for PH. Pediatric Hospitalist Medicine (PHM) initially evolved to address the patient care needs of the hospitalized child. The PHM model of care diverged from the traditional model where pediatricians rounded on the ward and in the nursery at the beginning and end of the day, while spending the bulk of time caring for patients in the office setting. The traditional model worked because individual pediatricians generally had few inpatients with low acuity and relied on pediatric residents and subspecialists for hands-on management during office hours.3 Since the mid-1990’s care of the hospitalized child has become increasingly complex, both in terms of the nature of the underlying disease process, the complexity of the patient with respect to multisystem chronic illness and survival based on medical technology.4 Increasingly, only the sickest of patients are hospitalized.5 The increased acuity and complexity of inpatient pediatrics coupled with external pressures focusing on patient safety and hospital utilization made the traditional model untenable for the majority of primary care pediatricians.
What sets the PH apart from the primary care pediatrician however, is her/his focus on systems-based practice within the hospital setting. Essentially, everything that a PH does must be in the context of the impact on the healthcare system as well as that of the patient.6 Dr. Wachter stated during a recent American Public Media interview “…the doctor of the future has two sick patients. One is the patient they are taking care of. One is the system they are working in,”.7 This is especially true for PHs who are frequently the linchpin in effective patient management within the complex and expensive inpatient setting. In essence Wachter is saying that one of the keys to curing our healthcare system is preparing Hospitalists for effective careers.
In this chapter we describe current career opportunities for pediatric hospitalists in a variety of settings. These include the tertiary care academic university/children’s hospital, the ...