In fact, it is not uncommon for med-ped hospitalists to work full time in one discipline—usually adult—and moonlight or work part time in pediatrics. Jeff Whittall, MD, a hospitalist for MultiCare Inpatient Services in Tacoma, Wash., works primarily as an adult hospitalist at Tacoma General Hospital but provides pediatric urgent care at Mary Bridge Children’s Hospital in Tacoma as well. “It is a fantastic mix,” Dr. Whittall says.
That said, other med-ped hospitalists consider such combinations to be a compromise. Many yearn for that perfect mix of adult and pediatric hospitalist work, and have even taken on additional training to do so.
Oliver Medzihradsy, MD, was a half-time adult hospitalist at Barton Memorial Hospital in South Lake Tahoe, Calif., with the other half spent in outpatient pediatrics for Tahoe Carson Valley Medical Group, until this year. In August, be became a first-year fellow at Rady Children’s Hospital in pediatric hospital medicine.
“Having been out [of] hospital-based peds for four years now, I decided that, if I wanted to get back into … [pediatrics] as a hospitalist, it would serve me well to go back for a peds hospital medicine fellowship,” said Dr. Medzihradsy. “Economically, it’s rather foolhardy to take such a salary cut, not to mention the philosophical change of becoming a trainee again, but from a clinical passion standpoint, it’s what I wish to do.”
In some cases, community hospitalist programs, many of which offer a less territorial work environment and organizational structure, have been more successful at establishing full-fledged combined med-ped hospitalist programs. Elliot Hospital in Manchester, N.H., has built from the ground up a hospitalist program utilizing both internal medicine and med-ped-trained hospitalists. Currently, Elliot Hospital employs four med-ped-trained hospitalists, who staff the pediatric inpatient unit but are available for adult inpatients when pediatric volume is low. Other community hospitalist programs utilize the pediatric skills of their med-ped hospitalists in urgent-care or ED coverage in times of low pediatric volume.
“From the perspective of our med-ped physicians, they feel that this is a unique employment opportunity that allows them to have a truly balanced 50-50 medicine/pediatrics inpatient experience,” said Anita Ritenour, MD, assistant vice president for medical affairs at Elliot Hospital. Although trained in internal medicine, her familiarity with community med-ped physicians made her an early advocate of med-ped hospitalists.
Amy Stone, MD, director of Elliot Hospital’s pediatric hospitalist program and a med-ped-trained physician, typically starts her day at 7 a.m. with sign-out from the overnight provider, then touches base with nurses about overnight events. Family-centered rounds follow, with the afternoons being occupied by ED or direct admissions and family meetings. Given their training, however, the med-ped-trained pediatric hospitalists can get called upon to help out on the internal-medicine side.
“As a med-ped hospitalist on the peds service, we get pulled occasionally to help with the internal-medicine service to admit, both during the day and at night,” adds Dr. Craig Widness, another med-peds-trained hospitalist at Elliot.
But the scope of practice and volume has ramped up for the pediatric hospitalist service at Elliot, as many community pediatric groups have opted to utilize their services. In addition, a new pediatric ICU has recently been established, managed by the pediatric hospitalist service.
As a result, the opportunities for the med-ped-trained pediatric hospitalists to help out on the adult hospitalist vortex have been increasingly rare, which seem to be a welcome development to the pediatric hospitalists.
When one finds administrators and leaders that understand and respect the concept [of med-peds], hold on to them.—Jacques-Bret Burgess, MD, MPH, FAAP, Hospitalists of Northern Michigan, Traverse City