If hospitalist work in the other discipline is available in your institution, you could consider a reduction of FTE in your current job to expand into the other discipline. Keep in mind, however, the interdepartmental coordination difficulties (i.e. scheduling, benefits, maintaining privileges). Those can be even more pronounced if two or more employers are involved.
Additionally, a reduction of FTE in your current job could lead to increased clinical time on the part of your colleagues, or perhaps even hiring additional staff, so this change needs to be discussed thoroughly with administrators and colleagues well in advance of any changes.
Less dramatic changes can enable a med-ped hospitalist to get a taste of the other discipline without wholesale changes in salary and schedule. Moonlighting as an intermittent hospitalist or nocturnist, taking call in the other discipline’s call schedule, or filling in for urgent-care slots can keep skills and knowledge from getting rusty.
It also can prevent the loss of pediatric admitting and procedural privileges. A patchwork approach also could lead to a steady hospitalist job in the other discipline.
“I discussed my desire to do pediatrics with friends and acquaintances who worked as pediatricians in local community hospitals through Children’s Hospital Boston,” Dr. Hunt says. “Eventually, [it led] to the peds work.”
As is often the case in HM, med-ped programs tend to follow the tenet “if you build it, they will come.” Once a hospitalist director discovers the flexibility and skill set a med-ped hospitalist provides the group, they often look to expand—especially to staff smaller pediatric units.
Such was the case at Elliot Hospital; familiarity with med-ped moonlighters eventually led to a full-time med-ped hospitalist hire. Following the full-time hire, the HM group realized a dramatic increase in local pediatric groups referring patients to Elliot’s hospitalist group, including the largest pediatric group in Southern New Hampshire, Dartmouth-Hitchcock Clinic.
“Initial referral base from the community was sluggish as community [pediatricians] wanted to hold onto their patients,” Dr. Ritenour says. “As the acuity of what we could support as hospitalists grew, more referrals were made for kids that might have previously been transferred.”
The Future of Med-Ped Hospitalists
At the dawn of combined med-ped residencies in the early 1960s, the hospitalist movement was only a twinkle in the eye of house physicians of yore. Now that both movements have matured, will we see this hybrid of a hybrid flourish?
“I think med-peds is well suited for hospital medicine, based on solid training that includes numerous inpatient wards and critical care in both internal medicine and pediatrics,” says Dr. Toth, adding she hopes to bring additional med-ped hospitalists to her group in Milwaukee in the future.
It seems inevitable that the med-ped movement, which has grown into the largest combined residency specialty in the country, and the hospitalist movement, which has exploded as the fastest-growing medical specialty, will continue to intertwine, branch out, and evolve.
And every year, some of those med-ped residency program graduates will continue to climb those twisted trunks, as challenging as it might seem. TH
Dr. Chang is a med-peds hospitalist at the University of California at San Diego and Rady Children’s Hospital. He is a member of Team Hospitalist.