Questions about pediatric hospital medicine

[Funke]

I'm an M3 narrowing down what I want to apply to, and my favorite rotation so far has been pediatric wards. I've read a lot about peds hospital medicine but there's not as much info on the schedules and job market as some other fields.

I was hoping any hospitalists, fellows, or even residents that have gotten job advertisements could share their experiences on what the common schedules are like, such as M-F, 7/7, 14/14, and how those duties are split up, like if you just do general wards, or if you also do weeks in newborn, NICU, etc.

I know nobody can predict the future job market, and the move to fellowship might complicate that as well, but is pediatric hospital medicine something you can generally find a job in wherever you want to go? I'm not trying to settle in California or New York, more like SLC, Phoenix, or Atlanta.

Thanks for your input!

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[Stitch]

As you allude to, all these questions are pretty difficult to answer. There is a wide variety of jobs and responsibilities out there and it depends on what sort of place you end up practicing. Hours are going to depend on how busy the hospital is and how many people in the group. Some smaller rural places might have you on for several days at at time because there's less volume and that's doable. Larger centers would make that impossible.

Right now a lot of places are hiring hospitalists, but many may soon require or expect you to be fellowship trained. That's an extra few years of your life. Again, smaller places are less likely to see that as a requirement, but who knows where that's going in the 4-6 years it's going to take you to get there. Yes you can probably find a job most places with the hospitalist skill set. Whether those places will be able to keep you interested and be the kind of work you find fulfilling is largely up to you.

 

[BigRedBeta]

I have friends that are hospitalists in a variety of situations - large academic, small academic, large private practice, and small/rural private practice

Bottom line, every place is different and has different variations of normal. Some people do nothing but newborn nursery but their acuity there is widely variable with some taking nothing but healthy term infants, and others taking essentially pretty sick level 2 NICU stuff that simply was born at 35 weeks instead of 34 and change, meaning they weren't NICU material at that particular institution. Some people are rotating through a system where they do some weeks newborn nursery, some NICU stuff (essentially scut for the neonatologists), some 24 hour obs unit, and some true inpatient medicine weeks covering a wide variety of conditions that at other centers would have made been on an inpatient primary subspecialty service. The rural private practice people are doing ALL of those things at the same time when they are on service.

Bigger centers are more likely to be more shift work, and you'll rotate night coverage or potentially have nocturnists. The academic people are taking call from home with residents in house, the rural PP group does 7 on/7 off with call from home and so they may be coming in at 230a to do an admit.

I think if you're interested being a hospitalist, you'll have to make a decision on priorities - either pick your location and accept a job that maybe isn't your ideal scenario, or choose a job that is closer to what you consider ideal and be willing to move for it. As someone who went through a similar decision making process for my PICU job out of fellowship, I can tell you, sometimes it's a compromise on both job and location.

 

[settingqt31]

It's very highly variable- my group is at a non-academic large hospital and we have a day call and night call person for each day (add a couple helpers at night in winter) who do all admits when they are on (with an NP). We divide those shifts between us so usually 1-2 day and 1-2 night calls a month. Then we have a flexible daily weekday rounder schedule and just have a maximum number of people off per day depending on time of year. We have a way to request days off in advance for specific events/vacation and then you can pick random days if open on our group calendar. Each person gets a certain number of weekdays off per year. It sounds confusing but works well. We also assign weekend rounding shifts so we all work equal number (averages 1/3 of weekends)

I have friends who do 7on-7off, ones who do day rounding for well baby or hospitalized kids and only are on call from home at night, etc. I know a couple moms who do nocturnal positions. Literally each group is different

I briefly did well baby only coverage where I rounded in day and the nurses could call me at night if needed

 

[hmockingbird]

At my residency (academic hospital) we have separate hospitalists and newborn nursery docs, but the hospitalists can fill shifts for the nursery. Nursery attending coverage overnight is the NICU. The hospitalists have day and night shifts. The hospitalists don’t have any other coverage. We do have some part time hospitalists. I think it just comes down to how many weeks per year they cover. Day shifts are covering for a week, and then you have random separate night shifts (from what I understand). There are other hospitals with separate nocturnists.

I do know someone who’s doing a rural job which includes nursery, level 2 NICU, inpatient coverage and clinic. I’m not sure her hours, but I think the people in the clinic rotate who’s outpatient vs inpatient. So there’s a huge variation. I was kind of interested in a job like this but was intimidated doing it for a first job!