Opportunities for procedures as a peds hospitalist?

[lemonsrule8]

Are there any opportunities for a peds hospitalist to do procedures? I'm aware that hospitalists sometimes cover PICU and NICU but is it high enough acuity to do procedures? And can any procedures be done on the wards? I'm sure this is pretty location dependent, but I'd like to hear what you guys say. Thanks!

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[NurWollen]

It's going to be location dependent, for sure. For pediatric hospitalists in a general peds floor setting, your most common procedure is probably going to be an lumbar punctures, at least where I'm training. At some hospitals, the peds hospitalists run the sedation service; at others, it's the PICU docs or anesthesia. If you do newborn hospitalist, you might be the one doing circs, but again, this is very location dependent. I've never been at a place that has NICU hospitalists, but if their responsibilities are similar to that of NNPs, then you might be doing intubations, PICC lines, UACs, UVCs, chest tubes, you name it. I suspect those jobs are probably pretty rare, though. Overall, I wouldn't say peds hospital medicine is a heavily procedural field, and even less so at bigger academic centers. I've only been a resident at one place though, my experience is limited, so YMMV.

Are there any opportunities for a peds hospitalist to do procedures? I'm aware that hospitalists sometimes cover PICU and NICU but is it high enough acuity to do procedures? And can any procedures be done on the wards? I'm sure this is pretty location dependent, but I'd like to hear what you guys say. Thanks!

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[FrkyBgStok]

I would say that if you are a standard hospitalist, LP is going to basically be your only procedure. Circs and sedation if you add those on and are able. Everything else is going to be so rare that your skills will atrophy. I’ve only seen one child need intubated so badly on the floor that it can’t wait for getting to the picu. Your colleagues (other hospitalists, nursing staff, etc) are likely not going to feel comfortable for other procedures on the floor limiting your ability no matter how comfortable you are.

there are also EM position that can be done with just residency. And if you are in a more rural setting (like a larger town) you may be able to practice peds in almost every setting which would definitely increase your procedures. And the above stuff mentioned.

 

[Perrotfish]

I've never been at a place that has NICU hospitalists, but if their responsibilities are similar to that of NNPs, then you might be doing intubations, PICC lines, UACs, UVCs, chest tubes, you name it. I suspect those jobs are probably pretty rare, though.

A few of the places that I interviewed the hospitalist service was in house for either NICU or PICU at night, with the intensivist on home call and night. I didn't find any jobs for daytime NICU or PICU hospitalists.

 

[BigRedBeta]

Where I did PICU fellowship, the hospitalist service actually had a fairly unique set up in that they provided staff to a number of different units - newborn nursery, part of the NICU at both the women's hospital and children's hospital, to the PICU, the 23 hour obs unit, the general medicine resident teams, and then an overflow service during times of high census. Those with the most seniority got to pick their main service (most either in the Newborn Nursery or managing the resident teams) and the younger attendings had to rotate through the various spots. In the PICU at least, they were treated at the same level as our nurse practitioners, same hours, same overnight call burden.

 

[shepardsun]

IMO sedation should only be within one's purview if they are able to handle the attendant issues that arise when mild/moderate sedation very quickly becomes deep sedation and airway/hemodynamic support is needed.

 

[NurWollen]

IMO sedation should only be within one's purview if they are able to handle the attendant issues that arise when mild/moderate sedation very quickly becomes deep sedation and airway/hemodynamic support is needed.

Well, better a well-trained pediatrician than a dentist.

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[BigRedBeta]

Well, better a well-trained pediatrician than a dentist.

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It'd be funny if it wasn't so true