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Role of the Hospitalist
In recent years, the model of how pediatricians care for hospitalized children has undergone significant changes with the advent of the pediatric hospitalist, and the field of pediatric hospital medicine. In many ways, this is the continuation of a trend toward location-based specialties seen with the emergence of adult hospital medicine, pediatric critical care, and pediatric emergency medicine.
General Pediatricians
The “traditional” model of pediatric inpatient care often involves a general pediatrician who rounds on an inpatient service anywhere from two to eight weeks out of the year. However, the vast majority of that pediatrician’s clinical time is spent seeing patients in his or her office or clinic. General pediatricians are found in a variety of settings. Their offices may be based at an academic center like our hospital, a community hospital, or more commonly, as a private practice in the community.
Pediatric Hospitalists
The pediatric hospitalist model distinguishes itself by the amount of time devoted to inpatient care. While different hospitals have defined the specific duties of hospital medicine physicians (i.e. hospitalists) differently, most hospitalists share some universal features. Pediatric hospitalists tend to have very limited or no oupatient clinical responsibilities. The majority of a hospitalist’s time is devoted to delivering and coordinating the care for a wide range of conditions affecting hospitalized children, while also dealing with administrative issues unique to the hospital setting. This includes, but is not limited to:
- Discharge planning
- Utilization review
- Quality improvement
- Medical education
Data suggests patients under the care of hospitalists tend to have decreased length of stay and decreased associated costs when compared to physicians with principally outpatient responsibilities[1].
Will Hospitalists Replace General Pediatricians in Inpatient Care?
The recent popularity of hospitalist programs has drawn the concern of some private practice physicians who fear a day when they are completely excluded from inpatient care. In fact, both the American Academy of Pediatrics (AAP) and the American Medical Association (AMA) have recently addressed this issue.
- A 2005 AAP policy statement stressed the importance of communication between hospitalists and primary care physicians while stating that pediatricians should “…always retain the option to admit and manage their own patients. They should also retain the privilege to accept and participate in unassigned patient admissions at their desire or discretion.[2]”
For those community pediatricians who maintain admitting privileges at our hospital, this continues to be an option. Both hospitalists and general pediatricians care for hospitalized patients at our hospital, and our division recognizes and respects the importance of the continued involvement of general pediatricians in the care of hospitalized patients. This is particularly important when helping children make the transition from the hospital setting back to the outpatient world.
Given the increasing complexity of our hospitalized children and their unique care needs, our hospitalists strive to provide the best care for every patient under our care. In short, we are specialists in the care of hospitalized children.
[1] “Pediatric Hospitalists: A Systematic Review of the Literature.” Pediatrics. 2006; 117 (5): 1736-1744.
[2] “Policy Statement: Guiding Principles for Pediatric Hospitalist Programs.” Pediatrics. 2005; 115 (4): 1101-1102.