free-standing vs integrated hospitals for peds

[snow88]

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What are peoples' thoughts on free-standing versus "hospital within a hospital" for pediatrics? I've interviewed at both types of programs and I find that on interview day, the residents/PD are always able to convince me that their particular approach (be it free-standing or within a hospital) is ideal compared to the other approach - so I'm left feeling pretty confused as to how these different arrangements really play out on the day-to-day life in residency and what, if any, difference it makes in training/opportunities for fellowships down the road?

 

[mvenus929]

I went to med school at a hospital within a hospital, but am in residency in a freestanding hospital.

Day to day life.... I see fewer residents from other programs in the freestanding hospital, because I don't bump into them in the cafeteria, etc. Our program certainly does more for us than my med school's program did, and part of it may be the fundraising structure of the hospital. And, of course, the volume is different. You'll see more at a freestanding hospital just because there is more room to see them.

The philosophy is also a bit different. At the hospital within a hospital, Peds is a very small part of the overall picture. In freestanding hospitals, the whole structure is based on taking car of children, so everyone has a focus in Peds, whereas you may get a good deal of cross coverage in an adult hospital (phelbs, RTs, pharmacists, etc). Which may not be such a big deal, but leaves more room for bad patient care.

Most freestanding hospitals are strong academic centers, which means you stand a good shot to place into fellowship, but I don't think you need a freestanding hospital to get a good fellowship.

 

[Stitch]

Agree with Mvenus. There's nothing wrong with a hospital within a hospital. You'll get great training there, but it is a different way of doing things. There are other logistics present at the administrative level (peds makes money differently than adults so the cash flow is different), but most of these things make little difference at the resident or fellow level. One thing you could ask about is traumaa and where peds trauma goes. Who takes care of it, etc. Sometimes the integrated hospitals will take traumas that free standing facilities don't because the ED and the trauma surgeons are there. But there are also plenty of freestanding hospitals that do peds trauma.

 

[michigangirl]

What Stitch said. For example our Children's Hospital at Hopkins is still connected to the adult side, which makes for great integration/collaboration opportunities and also all of the benefits of the entire enterprise (food, services, etc.). It could be free standing for all intents and purposes, but I wouldn't have it any other way. I know there are advantages to both scenarios-- I don't think anyone can say one is clearly better than the other.

 

[BigRedBeta]

I would look past physical plant. If things like subspecialty representation is equal, then it's just a matter of where you go to work every day.

In general, I think the reason people harp on preferring free standing children's hospitals is because there's a sense that they are more "complete", that they're more likely to have all the bells and whistles for taking care of kids - from kid centered ancillary staff and equipment to the litany of pediatric subspecialty care - whereas that is less often the case in hospital within a hospital. Again, that's a general rule and you'll certainly find exceptions to this perception all over the country. What that means for a peds resident though is really uncertain and contingent on your interests and career plans. If you're interested in community pediatrics and public health is missing a pediatric ENT surgeon for complex airway reconstructions that important? Is being at an ECMO center important for you to pass the Peds boards? Is a specialized neurooncology team vital for your learning? Respectively: Probably not, no way, and unlikely. But if you're going into critical care or Heme/Onc, those things may be super intriguing for you, even if they won't help in passing boards. Now the lack of pediatric surgical subspecialties is easier to overlook, the more difficult question to answer is if a location is missing pediatric medical subspecialties. What is the priority ranking of those? Can you get a good peds education relying on adult rheumatologists or radiologists? What about Emergency Med or ID or GI? Which is more vital, Peds neuro or Peds Cardiology? Again, residents are going to see those value judgements differently.

So again, I would look at the people who work at a location rather than the buildings there.

 

[settingqt31]

My residency has both a huge free standing pediatric hospital and a county hospital with pediatrics floors. I think with free standing everything is more geared for children (like all the radiologist are peds, IR, etc.) but I'm thankful for the county setting as for us we have a lot more autonomy in that setting. While there are other specialties at county I usually only interact with the ED people who are in the peds ED (they are seperate which is nice) or the OB during deliveries.