For the most part, med-ped hospitalist positions in academic hospitals tend to be crafted from a combination of time from two distinct departments. But an academic setting does offer potential med-ped hospitalists a few advantages, such as:
- Typically more hospitalists in each department, leading to greater scheduling flexibility;
- Larger pediatric hospitalist programs that often encompass not only the “main” hospital, but also community hospitals; this leads to increased availability of hospitalist work; and
- The possibility of a med-ped residency program at the same site, which allows for the possibility of being a role model to med-ped residents.
Although the trends might be changing, there are multiple barriers to an academic med-ped hospitalist job. Often, the IM and pediatric departments are not used to working together. Determining who will pay the hospitalist’s salary and benefits, how the schedule will be coordinated, and to whom the hospitalist is responsible can be tricky. Moreover, it’s not always clear which department will take the lead in the promotion process. Departments expect hospitalists to act as good citizens by serving on committees, and it can be difficult to serve two masters.
As a result, many academic med-peds hospitalists have a primary appointment in one department and have their clinical salaries “bought down” by the other. A handful of hospital committees, including quality-improvement (QI) and information technology, allow med-ped hospitalists to serve on one committee and receive citizenship “credit” from both departments. Leonard Feldman, MD, FAAP, FACP, and Carrie Herzke, MD, have walked this tightrope at Johns Hopkins Hospital in Baltimore. Their successes in this arena have created more clinical and research opportunities for med-ped hospitalists, as the administrators and physicians have learned how to negotiate their relationship. One example of this success has been the Johns Hopkins Hospitalist Scholars Program, which provides up to $12,000 of annual funding to hospitalist faculty.
Although rare, the academic med-ped hospitalist program under a single administrative structure does exist. Allen Liles, MD, program director for the hospital medicine program at the University of North Carolina (UNC) Hospitals in Chapel Hill, has brought together a group of 17 hospitalists, six of whom are med-ped-trained.
“Both the pediatric portion and the medicine portion are administered within this one program,” states Dr. Liles. “I think this is a huge advantage to actually making it work. If I was not the director being med-peds-trained, I am not sure this would have happened.” According to Dr. Liles, it took six months of working closely with the CFO of UNC Hospitals to establish a program that he felt “managed to change the paradigm.”
“It is the hospital that derives the most benefit from a [combined] hospitalist program,” adds Dr. Liles. “And as such, they were easy to convince of the benefits of a med-ped model and expansion into pediatrics.”
The Community Setting: Challenges and Successes
Academic settings aren’t alone in their battles putting together med-ped hospitalist positions. Jacques-Bret Burgess, MD, MPH, FAAP, a hospitalist with Traverse City, Mich.-based Hospitalists of Northwest Michigan (HNM), began in April 2009 to establish a pediatric hospitalist program within his group of adult hospitalists. Since that time, med-ped-trained hospitalists have increased to five from just one out of the 30 hospitalists employed by HNM. But there have been growing pains.
“The majority of administrators and physicians just do not understand the potential, nor the efficiency, of a [med-ped] physician,” Dr. Burgess says. “Most frustrations come from trying to explain what an IM-ped physician is, what we are capable of, and then obtaining adequate support to practice both disciplines while at the same time maintaining some sense of self and family.”