“The palliative care offered by pediatric hospitalists becomes a lifeline to patients and their families,” she explained. “Sensitive communications can foster hope, even when the news is bad.”
Dr. Hood told the poignant story of a baby born with a lethal heart problem. “I asked her parents, “What do you want?” she said. “They told me, ‘We want her heart to get better.’”
The doctor—and the family—knew that the baby would never get better. “What else would you like?” she asked. “To hold my little girl,” the mother answered. “I have only held her twice in two months.”
“We can do that.” Dr. Hood quickly replied.
Hope comes in many forms—this time in a mother’s arms, as she finally held her daughter before she died.
Frank Talk on Stress and Career Satisfaction
The 24/7 connection hospitalists have with their institutions is the basis for much of their expertise. Then again, that same 24/7 connection can be a source of extraordinary stress.
“It is variable work, with highs and lows in volume and in unscheduled care,” Dr. Carlson explained. “For hospitalized patients, we always need call coverage. That means odd hours—or being on-call in odd hours. It means night work or evening work. Stress carries risks of unplanned turnover, absenteeism, judgment and action errors, conflicts with colleagues, physical illness and mental fatigue.
“Hospitalists may be burning out even quicker than those in other specialties,” Dr. Carlson added. “Hospitalists love clinical care, they love what they do, but they are working in an environment where they must do more and more. We have to learn how to balance enthusiasm for taking care of patients with the demands of the job.”
One area of concern among hospitals and their pediatric hospitalists is workforce stability. Young women make up the majority of the workforce, and hospitals are “dealing continuously with women who are having families,” Dr. Melzer said.
“I have some people using it as a stepping stone to other specialties,” Dr. Carlson said. “They work as pediatric hospitalists while children are young, for flexibility.”
Both Carlson and Melzer believe a sharper definition of the pediatric hospital medicine career track would make a difference. “How do we get others in the hospital to make this job satisfactory?” Dr. Carlson asked. “Hospitalists enjoy the work, but want to balance it … and make a career out of this.”
Recognition from other medical colleagues is critical to job satisfaction. More and more, pediatric hospitalists are playing key leadership roles. “We are increasingly seen as the experts for hospitalized patients,” Dr. Carlson said. “I believe we can do things better than many specialists and many generalists, because we know how hospitals work—and we are there all the time.”
What’s Next?
Implementing plans for the future of pediatric hospital medicine will require collaboration among the many specialists and groups involved in the care of children. Dr. Melzer suggests convening a “leadership summit” for representatives from all of these associations.
Dr. Percelay agreed.
“It’s exciting,” he says. “The fact that the president of the American Board of Pediatrics came and spoke to our community, along with the presidents of SHM, the American Academy of Pediatrics, and the Academic Pediatric Association, is testimony to the role we are playing in the care of hospitalized children in the United States. We need to take a lot of care to make sure we maintain links between pediatric hospitalists and primary care pediatricians.”
That would be in the best interests of all children. TH