Survey of Academic Pediatric Hospitalist Programs in the US

Organizational, Administrative, and Financial Factors

Craig Gosdin, MD, MSHA; Jeffrey Simmons, MD, MSc; Connie Yau, BS; Heidi Sucharew, PhD; Douglas Carlson, MD; Natalia Paciorkowski, MD, PhD

Disclosures

Journal of Hospital Medicine. 2013;8(6):285-291. 

In This Article

Abstract and Introduction

Abstract

Background Many pediatric academic centers have hospital medicine programs. Anecdotal data suggest that variability exists in program structure.

Objective To provide a description of the organizational, administrative, and financial structures of academic pediatric hospital medicine (PHM).

Methods This online survey focused on the organizational, administrative, and financial aspects of academic PHM programs, which were defined as hospitalist programs at US institutions associated with accredited pediatric residency program (n = 246) and identified using the Accreditation Council for Graduate Medical Education (ACGME) Fellowship and Residency Electronic Interactive Database. PHM directors and/or residency directors were targeted by both mail and the American Academy of Pediatrics Section on Hospital Medicine LISTSERV.

Results The overall response rate was 48.8% (120/246). 81.7% (98/120) of hospitals reported having an academic PHM program, and 9.1% (2/22) of hospitals without a program reported plans to start a program in the next 3 years. Over a quarter of programs provide coverage at multiple sites. Variability was identified in many program factors, including hospitalist workload and in-house coverage provided. Respondents reported planning increased in-house hospitalist coverage coinciding with the 2011 ACGME work-hour restrictions. Few programs reported having revenues greater than expenses (26% single site, 4% multiple site).

Conclusions PHM programs exist in the majority of academic centers, and there appears to be variability in many program factors. This study provides the most comprehensive data on academic PHM programs and can be used for benchmarking as well as program development.

Introduction

Pediatric hospital medicine (PHM) is a relatively new field that has been growing rapidly over the past 20 years.[1] The field has been increasingly recognized for its contributions to high-quality patient care, patient safety, systems improvement, medical education, and research.[2–9] However, there appears to be significant variation among programs, even in basic factors such as how clinical effort is defined, the extent of in-house coverage provided, and the scope of clinical services provided, and there exists a paucity of data describing these variations.[8]

Most previously published work did not specifically focus on academic programs,[2,3,8,9] and specifically targeted hospital leadership,[2] practicing hospitalists,[3] residents,[7] and pediatric residency or clerkship directors,[4,7] rather than hospitalist directors.[9] Furthermore, previous work focused on specific aspects of PHM programs such as education,[4,7] value,[2] work environment,[9] and clinical practice,[3] rather than a more comprehensive approach.

We conducted a survey of academic PHM programs to learn about the current state and variation among programs across multiple domains (organizational, administrative, and financial). We speculated that:

  • Many institutions currently lacking an academic PHM program were planning on starting a program in the next 3 years.

  • Variability exists in hospitalist workload among programs.

  • In programs providing clinical coverage at more than 1 site, variability exists in the relationship between the main site and satellite site(s) in terms of decision making, scheduling, and reporting of performance.

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