The SHM/MGMA 2011 State of Hospital Medicine report offers some intriguing glimpses into the world of pediatric hospital medicine. Last year, we received responses from 31 pediatric HM groups, more than half of which were academic (an additional 29 groups reported caring for both adults and children).
SHM Pediatrics Committee chair Doug Carlson, MD, SFHM, professor of pediatrics and director of the Division of Pediatric Hospital Medicine at Washington University in St. Louis, believes that the number of community hospitals with pediatric hospitalists is growing, based on his work with the workforce group of the Pediatric Hospital Medicine leadership group. Hopefully we will see more community pediatric HM groups in future surveys.
As is the case in adult HM, academic pediatric practices tend to be larger than their nonacademic counterparts, with a median size of 6.0 FTEs vs. 4.0 FTEs in nonacademic groups. In both cases, this is well below the median size of comparable adult HM groups.
“Community hospital programs are often started to improve the quality of care around the clock,” Dr. Carlson says. “But the minimum number of FTEs needed for a sustainable 24-hour program is about five—even in very small units. Group size can often be larger in academic settings because pediatric units are larger, and their tertiary nature creates more opportunities for involvement in surgical comanagement and other types of complex care.”
The report shows turnover was higher for both academic and nonacademic pediatric HM practices than for adult medicine practices. The median turnover for nonacademic pediatric groups was 15.5%, for example, compared with 8.2% for the nonacademic adult groups. The sample size for pediatric groups was much smaller, however.
Pediatric hospitalist Dan Rauch, MD, FAAP, FHM, associate professor of pediatrics at Mount Sinai School of Medicine in New York, N.Y., and a former SHM Practice Analysis Committee member, notes that because the typical pediatric group size is much smaller than an adult practice, the loss of only a single hospitalist will result in a much higher turnover rate.
“It’s also my sense that community-based pediatric hospitalist positions are more likely to be transient spots as opposed to academic positions, which are more likely to lead to sustained careers,” he says.
Table 1 (above) presents some key median indicators for nonacademic HM practices. As is true for pediatricians in traditional practice, the typical pediatric hospitalist earned quite a bit less than her colleagues in adult medicine.
Even so, the finances of a pediatric HM program are more challenging than for adult hospitalists. Although professional fee collections per work relative value unit (wRVU) were slightly higher for pediatric groups than for adult groups (a surprising finding as the primary payor for many pediatric hospitalist groups is Medicaid), pediatric hospitalists’ typical annual wRVU production was about 53% lower than that of adult hospitalists, according to the 2011 report. As a result, the compensation-to-collections ratio for pediatric hospitalists was 1.75, which means that pediatric hospitalists collected only about 57 cents in professional fee revenues for every dollar of compensation paid. Adult hospitalists, by comparison, collected about 80 cents for each dollar of compensation.
Dr. Rauch isn’t particularly surprised by those figures. “The goals of nonacademic pediatric hospital medicine programs are more about providing service and expertise than about volume,” he says. “Most community hospital-based pediatric programs simply don’t have the consistent volume to support hospitalists on a billing basis, especially since they typically experience seasonal census variations that academic children’s hospitals don’t have.”
Leslie Flores, SHM senior advisor, practice management
Last chance for both pediatric and adult HM practices to participate in the 2012 State of Hospital Medicine survey: The survey closes March 9. Visit www.hospitalmedicine.org/survey.