The primary challenge stems from the relatively small neonatal and pediatric services. Combining the neonatal and pediatric programs to provide 24/7 coverage required the difficult task of recruiting of neonatologists willing to provide pediatric care and pediatric hospitalists willing to provide care in the NICU. Additionally, because of the small services, there is limited pediatric subspecialty support available at the Medical Center. The hospitalist occasionally serves as consultant to community PCPs on issues related to pediatric cardiology, neurology, endocrinology, and other disciplines for which there are no other consulting specialists available.
Although the team has grown to include 5 full-time healthcare providers, the small size of the team still provides challenges. There is little flexibility in scheduling, making it difficult for 2 providers to take an extended vacation at the same time. Finally, the small size of the group prevents the ability to provide back-up coverage to the in-house hospitalist. Community pediatricians fulfill this function.
Every year the team is producing improved financial results but still does not generate revenues to support the team’s salaries; a hospital subsidy provides the difference.
The neonatal-hospital team continues to explore opportunities for growth. Opportunities under consideration include provision of pediatric conscious sedation, developing Level II pediatric intensive care unit services, performance of circumcisions on normal newborns, marketing the NICU to nearby primary care community hospitals to obtain more neonatal, pediatric, and obstetric referrals and provision of expanded services in the emergency department.