Turning Pediatric Hospital Medicine From a Pit Stop Into a Career

Dr. Douglas Carlson initially trained as a pediatric emergency physician and didn’t really start to think of himself as a pediatric hospitalist until a decade ago.

But today he heads up the division of pediatric hospital medicine at Washington University in St. Louis and devotes many of his off hours to ensuring that more pediatricians will choose hospital medicine as a life-long career.

“We’ve put a lot of thought into making sure these are true careers,” he said.

One of the biggest changes in the last few years has been a move away from physicians’ choosing to spend just a few years as pediatric hospitalists and moving on. Instead, those physicians who choose the specialty are staying in it longer, noted Dr. Carlson, who co-chairs a workforce committee for the Pediatric Hospital Medicine Strategic Planning Roundtable and served on the Society of Hospital Medicine’s Career Satisfaction Task Force.

Drawing physicians to pediatric hospital medicine, however, remains a challenge. Factors such as scheduling, workload, autonomy, and compensation are all important in attracting physicians to the speciality and preventing burnout. However, recognition tends to trump those issues in the eyes of most young pediatricians who are thinking about their career choices, he said.

Academic medical centers and community hospitals have been showing signs of a greater awareness of the skills that pediatric hospitalists possess that other specialists don’t bring to the table, he said. In increasing numbers, pediatric hospitalists are moving into leadership roles in their hospitals, becoming chief medical officers, for instance. And at Washington University, where Dr. Carlson works, hospital medicine became an official division within the pediatric department last September. That type of recognition is vital, he said, because many young hospitalists fear not being seen as equal to their peers in other specialties such as cardiology or gastroenterology. “But I think that’s changing rapidly,” he said.

The next step is for pediatric hospitalists to gain recognition from the American Board of Pediatrics (ABP). Dr. Carlson and others in the field are working to bring together a diverse group of pediatric hospitalists to help design the ideal pathway for certification in pediatric hospital medicine.

The American Board of Internal Medicine and the American Board of Family Medicine both recently established a “recognition of focused practice” pathway in hospital medicine for their currently certified diplomates. But so far, the ABP has been more reluctant to follow with a similar model for pediatrics, he said.

Along with persuading the leadership of the ABP to embrace the idea of certification, another major challenge is to design a pathway that continues to allow for growth in the field. Dr. Carlson said he sees value in offering 1- or 2-year fellowships in pediatric hospital medicine, which would help build the scholarly foundation of the specialty. However, he worries that it would be difficult to convince young physicians to spend those extra years in training. And it would be a challenge just to keep up with the demand. Dr. Carlson estimates that there would need to be 100-200 fellowship positions per year to keep up with the current growth in the field. “That’s a huge amount,” he said.

But he says that he is confident that these issues can be worked out in the next few years.

The double-digit growth in the field will likely slow slightly and jobs may not be quite as easy to find, he predicted. Talented physicians, however, shouldn’t worry. “There are still lots of opportunities to come in and make your mark locally, regionally, or nationally within pediatric hospital medicine,” he said.

Dr. Douglas Carlson initially trained as a pediatric emergency physician and didn’t really start to think of himself as a pediatric hospitalist until a decade ago.

But today he heads up the division of pediatric hospital medicine at Washington University in St. Louis and devotes many of his off hours to ensuring that more pediatricians will choose hospital medicine as a life-long career.

“We’ve put a lot of thought into making sure these are true careers,” he said.

One of the biggest changes in the last few years has been a move away from physicians’ choosing to spend just a few years as pediatric hospitalists and moving on. Instead, those physicians who choose the specialty are staying in it longer, noted Dr. Carlson, who co-chairs a workforce committee for the Pediatric Hospital Medicine Strategic Planning Roundtable and served on the Society of Hospital Medicine’s Career Satisfaction Task Force.

Drawing physicians to pediatric hospital medicine, however, remains a challenge. Factors such as scheduling, workload, autonomy, and compensation are all important in attracting physicians to the speciality and preventing burnout. However, recognition tends to trump those issues in the eyes of most young pediatricians who are thinking about their career choices, he said.

Academic medical centers and community hospitals have been showing signs of a greater awareness of the skills that pediatric hospitalists possess that other specialists don’t bring to the table, he said. In increasing numbers, pediatric hospitalists are moving into leadership roles in their hospitals, becoming chief medical officers, for instance. And at Washington University, where Dr. Carlson works, hospital medicine became an official division within the pediatric department last September. That type of recognition is vital, he said, because many young hospitalists fear not being seen as equal to their peers in other specialties such as cardiology or gastroenterology. “But I think that’s changing rapidly,” he said.

The next step is for pediatric hospitalists to gain recognition from the American Board of Pediatrics (ABP). Dr. Carlson and others in the field are working to bring together a diverse group of pediatric hospitalists to help design the ideal pathway for certification in pediatric hospital medicine.

The American Board of Internal Medicine and the American Board of Family Medicine both recently established a “recognition of focused practice” pathway in hospital medicine for their currently certified diplomates. But so far, the ABP has been more reluctant to follow with a similar model for pediatrics, he said.

Along with persuading the leadership of the ABP to embrace the idea of certification, another major challenge is to design a pathway that continues to allow for growth in the field. Dr. Carlson said he sees value in offering 1- or 2-year fellowships in pediatric hospital medicine, which would help build the scholarly foundation of the specialty. However, he worries that it would be difficult to convince young physicians to spend those extra years in training. And it would be a challenge just to keep up with the demand. Dr. Carlson estimates that there would need to be 100-200 fellowship positions per year to keep up with the current growth in the field. “That’s a huge amount,” he said.

But he says that he is confident that these issues can be worked out in the next few years.

The double-digit growth in the field will likely slow slightly and jobs may not be quite as easy to find, he predicted. Talented physicians, however, shouldn’t worry. “There are still lots of opportunities to come in and make your mark locally, regionally, or nationally within pediatric hospital medicine,” he said.

Dr. Douglas Carlson initially trained as a pediatric emergency physician and didn’t really start to think of himself as a pediatric hospitalist until a decade ago.

But today he heads up the division of pediatric hospital medicine at Washington University in St. Louis and devotes many of his off hours to ensuring that more pediatricians will choose hospital medicine as a life-long career.

“We’ve put a lot of thought into making sure these are true careers,” he said.

One of the biggest changes in the last few years has been a move away from physicians’ choosing to spend just a few years as pediatric hospitalists and moving on. Instead, those physicians who choose the specialty are staying in it longer, noted Dr. Carlson, who co-chairs a workforce committee for the Pediatric Hospital Medicine Strategic Planning Roundtable and served on the Society of Hospital Medicine’s Career Satisfaction Task Force.

Drawing physicians to pediatric hospital medicine, however, remains a challenge. Factors such as scheduling, workload, autonomy, and compensation are all important in attracting physicians to the speciality and preventing burnout. However, recognition tends to trump those issues in the eyes of most young pediatricians who are thinking about their career choices, he said.

Academic medical centers and community hospitals have been showing signs of a greater awareness of the skills that pediatric hospitalists possess that other specialists don’t bring to the table, he said. In increasing numbers, pediatric hospitalists are moving into leadership roles in their hospitals, becoming chief medical officers, for instance. And at Washington University, where Dr. Carlson works, hospital medicine became an official division within the pediatric department last September. That type of recognition is vital, he said, because many young hospitalists fear not being seen as equal to their peers in other specialties such as cardiology or gastroenterology. “But I think that’s changing rapidly,” he said.

The next step is for pediatric hospitalists to gain recognition from the American Board of Pediatrics (ABP). Dr. Carlson and others in the field are working to bring together a diverse group of pediatric hospitalists to help design the ideal pathway for certification in pediatric hospital medicine.

The American Board of Internal Medicine and the American Board of Family Medicine both recently established a “recognition of focused practice” pathway in hospital medicine for their currently certified diplomates. But so far, the ABP has been more reluctant to follow with a similar model for pediatrics, he said.

Along with persuading the leadership of the ABP to embrace the idea of certification, another major challenge is to design a pathway that continues to allow for growth in the field. Dr. Carlson said he sees value in offering 1- or 2-year fellowships in pediatric hospital medicine, which would help build the scholarly foundation of the specialty. However, he worries that it would be difficult to convince young physicians to spend those extra years in training. And it would be a challenge just to keep up with the demand. Dr. Carlson estimates that there would need to be 100-200 fellowship positions per year to keep up with the current growth in the field. “That’s a huge amount,” he said.

But he says that he is confident that these issues can be worked out in the next few years.

The double-digit growth in the field will likely slow slightly and jobs may not be quite as easy to find, he predicted. Talented physicians, however, shouldn’t worry. “There are still lots of opportunities to come in and make your mark locally, regionally, or nationally within pediatric hospital medicine,” he said.