Community Pediatric Hospitalist Workload: Results from a National Survey

Abstract

As a newly recognized subspecialty, understanding programmatic models for pediatric hospital medicine (PHM) programs is vital to lay the groundwork for a sustainable field. Although variability has been described within university-based PHM programs, there remains no national benchmark for community-based PHM programs. In this report, we describe the workload, clinical services, employment, and perception of sustainability of 70 community-based PHM programs in 29 states through a survey of community site leaders. The median hours for a full-time hospitalist was 1,882 hours/year with those employed by community hospitals working 8% more hours/year and viewing appropriate morning pediatric census as 20% higher than those employed by university institutions. Forty-three out of 70 (63%) site leaders perceived their programs as sustainable, with no significant difference by employer structure. Future studies should further explore root causes for workload discrepancies between community and academic employed programs along with establishing potential standards for PHM program development.

The Future of Pediatric Hospital Medicine: Challenges and Opportunities

“…Both university and community-based hospitalist programs report high weekend, overnight, and in-house clinical effort. 7,15 Recent studies reported that a signifi cant proportion of PHM program leaders (50% of division directors at university-affi liated programs and 37% of community program leaders) perceive their program to be unsustainable. 7,15 Among university-affi liated programs, a higher burden of weekend work as well as university employment were associated with perceived unsustainability, while no specifi c program or employer characteristic was associated with this perception in community programs.…”

“…Wide variability exists in the ways that programs address overall clinical burden, with strategies including census caps, seasonal expansion of coverage, and formal back-up systems. 7,15 Additional potential solutions may include differential weighting or fi nancial incentives for nights and weekends, support for nonclinical work, loan repayment programs, and competitive salaries. 11 In addition, structuring clinical and nonclinical roles to facilitate career development and advancement may enhance career longevity.…”

“…Many of the needs of hospitalized children differ across these settings, and the roles and challenges faced by hospitalists in these settings correspondingly differ. Community hospitalists frequently take active roles in newborn care and emergency department consultation, often without the support of other pediatric subspecialties 7 . In contrast, hospitalists working at children's hospitals more frequently care for highly complex patients, often collaborate across multiple specialties and assume nonclinical roles in quality improvement (QI), research, and medical education.…”

“…Despite this finding, there are a number of threats to the sustainability of current work models, some of which are unique to pediatrics given the overall lower patient volumes and greater seasonal variation compared with adult hospital medicine. Both university and community‐based hospitalist programs report high weekend, overnight, and in‐house clinical effort 7,15 . Recent studies reported that a significant proportion of PHM program leaders (50% of division directors at university‐affiliated programs and 37% of community program leaders) perceive their program to be unsustainable 7,15 .…”

Nurturing Sustainability in a Growing Community Pediatric Hospital Medicine Workforce

“…In this issue of the Journal of Hospital Medicine, Alvarez et al present the findings of structured interviews with 70 community PHM group leaders. 6 Each participant answered 12 questions about their group, addressing the definition of a full-time workload and hours, the design of backup systems, and the respondent's perception of the program's sustainability. The sample is robust, with the caveats that it disproportionately represents the Midwest and West (34.3% each) and more than half of the groups were employed by an academic institution.…”