The Practice Patterns of Recently Graduated Internal Medicine–Pediatric Hospitalists

Abstract

RESULTS:Forty-nine program directors (62%) completed the survey and provided data on 1042 graduates from 46 programs. Of those graduates, 26.4% (n = 275) practice as hospitalists, and none had completed an HM fellowship. Approximately two-thirds (65%) of med-peds hospitalists provide care to hospitalized children and adults, with one-third providing care solely to hospitalized adults. Approximately one-half (53.5%) have an appointment with a medical school and roughly one-quarter (28%) practice in a freestanding children's hospital. CONCLUSIONS:An increasing percentage of recent med-peds graduates are pursuing careers in HM, and two-thirds are providing care to hospitalized children. As consideration for an accredited pediatric HM fellowship continues, certifying and accrediting bodies should consider how this will impact the med-peds workforce and allow med-peds graduates fl exibility in their training requirements that will permit them to acquire the necessary skills to care for hospitalized children and adults.

Characteristics of the Combined Internal Medicine–Pediatrics Workforce

“…3 Our survey queried practicing physicians, thus capturing a more comprehensive evaluation of the current workforce. [5][6][7] In keeping with current medical workforce trends, our survey showed many differences among physicians in practice fewer than 10 years vs individuals practicing longer. Newer med-peds physicians are increasingly choosing nonprimary care careers and are less likely to consider themselves primary care providers compared with physicians who trained previously, mirroring trends in medical students, 10,11 categorical pediatric, 12 and internal medicine residency graduates.…”

“…Of residency graduates in the last 5 years who practice primarily in the outpatient setting, 19% provide some type of inpatient care. 7 Our study contained several limitations. First, we sampled only about 75% of the estimated med-peds workforce and had a modest response rate.…”

“…3 Other surveys looked only at career plans during residency or for very recent graduates. [4][5][6][7] One study compared graduating med-peds residents with pediatric residents in [2003][2004], finding that med-peds residents were more likely to start residency with a primary care plan but then pursue postresidency subspecialty training. 4 Others focused on postresidency career plans or surveyed physicians up to 4 years out of training, finding that many planned to care for or continued to see both adults and children in primary care.…”

“…5,6 A survey of med-peds residency directors found that 26.4% of residency graduates from 2009-2013 are practicing as hospitalists. 7 Concerns have been voiced about a projected shortage of primary care providers due to an aging population and simultaneous increases in the number of children with special health care needs who need to transition into adult provider practices. Additionally, many practice changes over the last decade, including the rise of the hospitalist movement, may affect career paths chosen by newer graduates.…”

Hospitalist Medicine—Chairs' Perspective of Specialty Status and Training Requirements

“…More than one-quarter of recent combined medicine-pediatrics graduates pursued hospital medicine positions, with more than two-thirds of those caring for both adult and pediatric inpatients. 7 In a survey of 112 pediatric hospitalist programs in 2006 and 2007, hospitalist directors reported that 46% of their physicians were relatively newly employed (ie, for <3 years) with an average duration of employment of 63 months. 8 Hospitalists serve as role models for medical learners on inpatient rotations, and provide hospital administrative leadership in programs such as quality, safety, and electronic health systems.…”