By the fourth year of residency, most in combined internal medicine/pediatrics (commonly known as “med-ped”) residencies come to realize that their training is heavily weighted toward inpatient and ICU settings. After all, med-ped residency programs require that all the inpatient and ICU requirements of both the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP) be met. This allows med-ped graduates, numbering just over 300 each year, to sit for both boards, and potentially to be able to obtain admitting privileges for both adults and children. This seems to be the perfect training for a hospitalist-to-be, if one so desires.
But for hospitalists, there comes the dilemma: Should you concentrate on the adult or the pediatric population, or is it possible to be a med-ped hospitalist? By far, most HM job opportunities are for either purely adult hospitalists or purely pediatric hospitalists, although there are an increasing number of “off the shelf” med-ped hospitalist positions. Building a med-ped career as a hospitalist from shifts in adult and pediatric programs is a possibility but requires extra attention to scheduling, salary, and benefits.
Med-ped physicians are used to being creative about their work, but some might begin to ask themselves whether the additional effort is worth it. Seeking out knowledgeable administrators and department/division chiefs, following other med-ped hospitalists who have already blazed a trail, and being realistic about your “mix” of work are some solutions for the hybrid hospitalist.
Academia Fosters Cooperation—and Lack Thereof
An ever-increasing number of med-ped physicians seem to think being a med-peds hospitalist is possible, even desirable. Heather Toth, MD, program director for the med-ped residency program at Medical College of Wisconsin and a hospitalist at Children’s Hospital of Wisconsin, both in Milwaukee, doesn’t regret her decision to put in the extra work required to be a hospitalist for all age groups.
“[It is] absolutely a wonderful career and worth the effort to establish a combined position. There is much to be learned from each world [medicine and pediatrics] to enrich our patients’ care,” says Dr. Toth, who was a former chief resident for the med-ped program at the college. In her case, being close to the administrators of both departments played to her advantage and allowed her to craft her job “from the inside,” she says.
It is the hospital that derives the most benefit from a [combined] hospitalist program. And as such, they were easy to convince of the benefits of a med-peds model and expansion into pediatrics.—Allen Liles, MD, director, hospital medicine program, UNC Hospitals, Chapel Hill, N.C.
“The process was much smoother than anticipated,” Dr. Toth explains. “One concern was which department would own my time. This was overcome by splitting my time by months. For example, January is medicine wards, February is pediatric wards, etc., with corresponding overnight shifts/call.”
Others have experienced obstacles in carving out an academic med-peds hospitalist position. Susan Hunt, MD, a hospitalist at Brigham and Women’s Hospital in Boston, finished her med-ped residency at Duke University in 2008 and began her career as an adults-only hospitalist. However, the desire to work in pediatrics still burned, leading Dr. Hunt to seek pediatric hospitalist work within the Partners HealthCare system. Initially, her efforts were to no avail. More recently, she has been able to break into hospitalist work through the Children’s Hospital Boston’s outreach program at local community hospitals.
“Pediatric programs tend to be small and, in Boston, had very little turnover,” Dr. Hunt says. She also has a warning for pediatric hospitalist hopefuls. “Increasing pediatric time invariably results in decreased pay.”