Building the Perfect Beast
So how does a med-ped physician entering hospital medicine build a job that satisfies the need to care for both adults and children? In some cases, the perfect med-ped position is already available. More likely, however, hospitalist jobs in a specific location are limited to either one discipline or another.
In many, if not most, cases, practice in one discipline will have to be somewhat compromised to fulfill the staffing needs of the “primary” job, at least initially. In the interview and hiring process, however, hospitalists wishing to pursue med-peds must make known their desire to work in both medicine and pediatrics. The transparency will allow hospital and group administrators to build into your schedule time to work in both pursuits.
“Start trying to arrange for pediatrics early. I started before I finished residency and it took me over a year to set up,” Dr. Hunt says, noting her current position is in the academic arena. “Discuss your plans with any medicine group you intend to join. See if your FTE would be flexible or if they can help arrange things. Get in touch with local med-ped program directors, if possible, as they often know people on both sides and might be able to help get you in touch with the right people.”
When looking at community hospitalist jobs, it is critical to ensure your administrators are familiar with med-peds residency training. It helps them better understand your skills, your goals, and allows them to put you in position to care for patients in all age groups.
“When one finds administrators and leaders that understand and respect the concept [of med-peds], hold on to them,” Dr. Burgess advises. “Do not let anyone take your unique training for granted and try to categorize you as one or the other; rather, we are both. We have two sets of boards, with separate training and a unique overlap that provides synergy with our abilities. Find a group that understands the level of training you possess.”
As uncommon as it is to find med-ped hospitalist jobs that feature built-in coordination of work in both disciplines, one should pay attention to coordinating salary, call, vacation, and CME between the two disciplines.
“Talk with potential groups about how they cover you for call, how you will be reimbursed, and what data will they base your pay and incentives on,” Dr. Burgess says. “What will they base your CME on—two disciplines or one? What is your depth if you have a sick child and sick adult at the same time?”
Most important, med-peds must make sure administrators of both disciplines are aware of your activities on both sides. “We do not want double-call days,” Dr. Burgess adds. He also warns that overcoming the frustrations of med-pedwork “takes a great deal of patience and discussion.”
Salary might be an issue, especially as one tries to mold a position. SHM and the Medical Group Management Association (MGMA) State of Hospital Medicine: 2010 Report Based on 2009 Data lists the median national annual compensation for adult hospitalists as $215,000, and $160,038 for pediatric hospitalists. This also has implications when IM time is bought down by pediatrics in academic centers, as pediatrics might not pay as much for clinical time as medicine will.
Back Where You Belong
Either by necessity or choice, med-ped-trained hospitalists all across the country have taken jobs in one setting or another and now yearn to get back into the other discipline. It might not be as difficult as you think.