Advice?

[jlm013085]

1st year resident here; interested in primary care because of continuity but also enjoy acute care. Are there any ways that I could incorporate the two if I chose primary care for a career? Thanks

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[deleted564496]

Only a third year so obviously my experience is limited, but I'm also from a more rural part of my state and the pediatricians (2) there did it all. Clinic, NICU, hospitalist, did circumcisions/LPs/etc. I would guess that you could do this throughout the country in more rural areas. Obviously the NICU isn't extremely high acuity, but they also made the decisions on whether or not to send those babies to other hospitals.

 

[RuralMedicine]

There is much less hospitalist penetration on the pediatrics side than the adult side. I also think that although urgent cares abound urgent cares that aren't specifically geared to really seeing kids (and may use providers who have very little experience identifying and taking care of sick children) have the potential to miss significant things. Many pediatricians still have a mixed inpatient/outpatient practice along with a mix of preventive care/chronic health management/ acute illness management. My husband currently works in a practice where he admits all of his own patients to his service (many of whom present for admission through his office) pretty much year round (unless we are out of town). He and two other pediatricians share hospital call (where they cover ED consults/pediatric stabilization prior to admission, unassigned admissions, and delivery attendance/nursery coverage). He is admitting at a hospital without subspecialty coverage so intubations, CVLs, and other procedures are done by him or not done. He does any necessary delivery room stabilization/resuscitation. Babies who need a true NICU level of care are transferred to either the level 2 NICU about 2 hours away or the level 3 NICU about 3 hours away depending on their higher care needs.

 

[jlm013085]

There is much less hospitalist penetration on the pediatrics side than the adult side. I also think that although urgent cares abound urgent cares that aren't specifically geared to really seeing kids (and may use providers who have very little experience identifying and taking care of sick children) have the potential to miss significant things. Many pediatricians still have a mixed inpatient/outpatient practice along with a mix of preventive care/chronic health management/ acute illness management. My husband currently works in a practice where he admits all of his own patients to his service (many of whom present for admission through his office) pretty much year round (unless we are out of town). He and two other pediatricians share hospital call (where they cover ED consults/pediatric stabilization prior to admission, unassigned admissions, and delivery attendance/nursery coverage). He is admitting at a hospital without subspecialty coverage so intubations, CVLs, and other procedures are done by him or not done. He does any necessary delivery room stabilization/resuscitation. Babies who need a true NICU level of care are transferred to either the level 2 NICU about 2 hours away or the level 3 NICU about 3 hours away depending on their higher care needs.

That seems exactly what I would be interested in but it seems like his current setup might spread him a little thin. My two questions would be:

1. Are there still job opportunities that would allow for that type of inpatient/outpatient split?

2. Does he still have a good work/life balance?

Thank you for your responses!

 

[RuralMedicine]

That seems exactly what I would be interested in but it seems like his current setup might spread him a little thin. My two questions would be:

1. Are there still job opportunities that would allow for that type of inpatient/outpatient split?

Going by the job opportunities that show up in my inbox (I'm IM/Peds trained and dually boarded), I would say, yes. I will acknowledge that my husband practices in a rural community and the positions that I am seeing are also more likely to be rural or in smaller communities so practicing in a major metropolis and doing all of this at a stand alone children's hospital may not be realistic (although I can think of a few docs from my residency program who still do a lot of this at our county hospital and have admitting privileges (which they actually use) at our children's hospital across the street). I also do think that pediatric hospitalist program penetration will likely increase over time, but I'm not if we will ever see the kind of penetration that we have seen already on the adult side.

2. Does he still have a good work/life balance?

He would say he has a great life but I think out of context it may appear that the work/life balance is a little skewed. There is a lot of ebb and flow to his practice and there are the busy times and the less busy times and he is usually able to take advantage of the lighter times to regroup and take some time for himself and our family. He did have a bit of a rough six months because just when he got through the Enterovirus D68 epidemic it was early RSV time and that led right into the worst of a particularly bad influenza season but he made it through that and has recharged fully. It helps that we live within walking distance of his hospital. It helps that we live in an great neighborhood with great neighbors so we have a grounding sense of community. I like to think it helps that he is married to a physician who gets where he is coming from, who is willing to maintain privileges at his hospital so she can pick up a call or two when he's had a really busy week and needs the weekend to regroup and be the involved dad he wants to be (and really is). It probably also helps that I work only part-time as a hospitalist so we're able to work our schedules in a way that we avoid outside childcare so we have good peace of mind that our kids are in great hands while we're working. I know that makes it easier for me to not stress about that aspect when I'm working.