The young specialty of hospital medicine has an even younger sibling—pediatric hospital medicine. “Just seven years ago, when I put on my pediatric hospitalist badge, people would ask me, ‘What is that?’” Douglas Carlson, MD, an associate professor at the Washington University School of Medicine in St. Louis, says. “They don’t do that anymore.”
Times certainly are a changing.
With an estimated 1,500 practitioners, pediatric hospitalists make up about 9% of the total hospitalist workforce in the United States. Growth in the pediatric field has been fueled by the need for expertise in treating hospitalized pediatric patients, the increasing complexity of hospitalized cases, mandates to reduce hospital costs and readmission rates, and the curtailment of resident hours.
“The biggest thing is the whole field is blossoming,” says SHM treasurer Jack Percelay, MD.
What Lies Ahead?
Pediatric hospital medicine may be young in years, but the primary focus is on the future. Such was the theme of the Pediatric Hospital Medicine Conference held by SHM, the American Academy of Pediatrics and the Academic Pediatrics Association in July in Denver.
“We are responsible for the future of hospital medicine,” keynote speaker Sanford Melzer, MD, of the University of Washington and Children’s Memorial Hospital and Regional Medical Center of Seattle says in an interview with The Hospitalist. “So what should that future look like?”
Pediatric hospitalists are in an ideal position to improve care, Dr. Melzer said. He outlined six crucial areas for action:
- Set standards of evidence-based patient care in areas not historically addressed, such as feeding tubes and severe reflux;
- Implement safety standards for issues such as medical errors, blood infections and hand-offs to other providers;
- Develop leaders who will work to bring about these changes;
- Stabilize the workforce by better defining pediatric hospital medicine as a career path;
- Create value for hospitals;
- Promote a holistic view of hospital care as a small part of the continuum of care for chronically ill children.
As Dr. Melzer succinctly puts it, “I am here to improve the whole system, not just to give kids meds and get them out.”
“I think our evolution in hospital medicine will follow that of ER physicians very closely,” says Dr. Carlson, who started out as an ER doctor. “Within 30 years, with fellowships and training, their specialty evolved.”
A similar progression is occurring with pediatric hospitalists. Carlson said he remembers when hospitalists would complain that their colleagues in other subspecialties would “treat them like glorified residents.” Not anymore. “We are now seen as equals,” he said.
Pediatric hospitalists bring a lot to the table, Dr. Carlson said, such as broad experience in treating acutely or chronically ill hospitalized children; the ability to coordinate care; knowledge in negotiating hospital routines and protocols; and the capacity to manage family fears.
But to survive and prosper, pediatric hospitalists must create value for their institutions, Dr. Melzer said. And value is exactly what evidence-based medicine can generate, he added. Establishing evidence-based guidelines for the treatment of the 10 most common conditions affecting 80% of patients would be a huge step forward in improving patient care, Melzer explained. It would create value for patients and, ultimately, the hospital.
Lending an Ear
Communication is another key, and can be particularly important in caring for children with life-threatening or terminal illnesses, said another speaker, Margaret Hood, MD, of Orlando Healthcare and Palliative Healthcare. Listening to patients and their families is a critical part of end-of-life care.