A Whole New World With an Academic Pediatric Hospitalist

Session 154

The pediatric hospitalist position is a relatively new one. Today, she’s joined by Dr. Jamee Walters, an academic pediatric hospitalist who has been out of training now for almost seven years. She talks about myths, lifestyle, training pathways, and more!

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:45] Interest in Pediatric Hospitalist Medicine

Jamee didn’t want to do pediatrics until about the end of the third year. She was very motivated to do OB/Gyn. In fact, her activities in medical school were all centered around OB/Gyn. However, going into it, she realized she wouldn’t be good at it.

When she did her pediatric rotation, the pathophysiology and the disease processes interested her much more than anything else had. So she started really thinking about pediatrics and all. Jamee also enjoyed the newborn side of it.

What pulled her to OB/GYN is the same thing that pulled her to Pediatrics, which is the primary care aspect. She liked the advocacy aspect of taking care of the underserved.

She went to the University of Miami for medical school and they did a lot of free clinics. She was running the OB/Gyn station and just really enjoyed that piece of it. She thought that’s why she wanted to do OB/Gyn. But what she really liked was seeing patients and being in the hospital.

[03:53] Traits That Lead to Being a Good Pediatric Hospitalist

Jamee says that you have to establish a relationship quickly. These people don’t know you. They’re scared. You’re usually being introduced to them during one of their worst times because they were not planning on being admitted. And they come into the ER and find out that they’re going to be in the hospital.

“Knowing how to establish that relationship, establish trust with that family quickly, is a big trait that you need to have.”Click To Tweet

It’s also important to have great communication skills as well as the diagnostic. What Jamee likes about internal medicine and pediatrics is the diagnostic part. A big part of her job figuring out what’s going on and why. So sitting with all the facts and looking at everything and trying to figure that out is essential.

[05:08] What is pediatric hospitalist medicine?

Pediatric hospitals work in a variety of settings. They can work in academic medicine. They can work in community hospitals. Their primary site is the hospital but they often work in the newborn side where they see brand new babies or they may be managing a lower level NICU.

They also will work on the inpatient side and see all the patients who are admitted. And then if you work in a community hospital, you would see patients in the ER and sometimes even the higher level inpatient.

Jamee sees all inpatient pediatrics and newborns. So it’s only in the hospital they don’t do any outpatient medicine at all. And right now since they are now boarded, there is a fellowship for two years that you do after pediatrics.

Before this pediatric hospitalist was a thing, the outpatient pediatricians would be managing the inpatients. They would come around in the morning and go back to their offices. And then hospitals just started taking over that space and it’s much easier for them. In fact, a lot of the outpatient doctors are happy to pass off that piece.

[07:05] The Biggest Myths or Misconceptions About Pediatric Hospitalist Medicine

The biggest misconception around them is that they might not be able to take care of the patients well because they don’t know them. They don’t have those relationships with the patients. But they’re actually specialized in seeing patients in the hospital, knowing the disease processes, and knowing how to take care of acute emergencies.

That’s why when medical students shadow them, students realize that there is just a whole nother thought process that goes through in terms of seeing a healthy kid in the clinic versus seeing a sick kid in hospital.

[07:54] Types of Patients

Kids get really sick with a couple of main diseases. Respiratory disease is huge for them (asthma, exacerbations, pneumonia, bronchitis). A number of patients also come in for gastroenteritis and dehydration. Those are the two big ones for healthy kids.

“Now, with all of the big advancement in acute medicine, a lot of kids are living longer.”Click To Tweet

Before, kids would die younger and now they’re living longer with the advancement in acute medicine.

Moreover, they are complex care physicians as well. They get to know these kids intimately who come in and out of the hospital with diseases like pneumonia, bronchiolitis and gastroenteritis. Constipation is a big one as well. But because they’re so complex, they require a lot more care and have a lot more medications, etc. They’re also very ID-heavy so they see a lot of septic arthritis and osteomyelitis.

[09:27] Typical Day

Jamee does shift work so her day is very dependent on which service she’s on. If she’s on the floors, she has a very traditional academic practice. They round with the residents in the morning from 9 am to 12 pm, going over the new patients and those who are going to go home etc.

Her day is usually filled with meetings in the afternoon. She’s also the Associate Program Director for their pediatric residency program. So she goes back to see the team and run the list with them. They go over any new admissions that she needs to see or patients who were there and just needed her to go back into them again. Then they come up with contingency plans for the nighttime team. Jamee is usually done around 4-5 pm.

If she’s in a newborn nursery, it’s all new babies in the mornings and then procedures in the afternoon like circumcisions or frenulotomy, which is a cutting procedure for tongue ties.

For academic hospitals, they often do seven days on for their inpatient week. But they won’t just have done seven off and do another seven. They usually have scattered shifts of either newborn nursery. A lot of pediatric hospitals programs have a float or an extra person. It’s the person that basically holds the pager or the cell phone. They field all new questions or triage and all new admissions. So the shift is scattered throughout. She might do two or three of those in a row, but not seven.

[11:37] Taking Calls and Life Outside of the Hospital

Jamee takes calls. Although she said she does shift work, it’s a little bit like a mix and it’s really confusing unless you’re in it. But when she’s on, they do a lot of weekend calls, specifically Friday night calls. They are on during the week if they don’t have a night doc. Just depending on staffing, they will be on call for that night. Although they just recently added a nighttime person Monday through Thursday. The downside is they work on weekends and holidays.

At first glance, it might look like there isn’t that much time. But the thing that she loves the most about her job is that she’s home practically every single night for dinner, which is quite unheard of. She has a six-year-old so she gets to be home for bedtime and all that special time.

Jamee adds that she gets random weekdays off which is nice. So she can go on a field trip or a school party if she needs to. This is despite working on weekends and holidays, which at first glance, looks terrible. It’s awesome that she can also be super involved with her kid’s activities despite having a full-time job.

[13:59] The Training Path

So you have three years of pediatric residency, and then you do a two-year Fellowship Program. There are currently about 40 programs. And they just became official American board-specialized. They have the official boards now that’s drastically increasing.

With 40 programs now, one of their biggest concerns is that the job pipeline is going to get smaller.

It’s pretty competitive. There’s always people who don’t match right now, just because of the number of spots that are in pediatric hospitalist medicine.

“The one good thing right now is that much like when ER became a specialty many years ago, people are still hiring general pediatricians as peds hospitalists right out of residency.”Click To Tweet

The one good thing right now is that much like when ER became a specialty many years ago, people are still hiring general pediatricians as peds hospitalists right out of residency. It might not be that way in 10-15 years. But then she would also hope that by then, there’ll be enough fellowships and enough spots for everyone to match.

Big academic centers are the first ones to have fellowships. And some of the smaller residency programs are developing fellowships as well. But usually it’s the big academic medical centers with the medical school attached to it for the fellowships.

For pediatrics, it’s a lot more spread out. There are big programs where you have a ton of residents. There are also medium-sized programs with around 40 residents. And there are the smaller hospitals. There’s a lot of pediatric residency throughout the country so that’s completely different.

[16:55] Opportunities to Further Sub-Specialize

Jamee explains that pediatric hospital medicine is a lot broader than people realize. Depending on your interest, people might go into more hospital administration. That’s a big one because they have to work so closely with the hospital administrators.

“You really can't be a hospitalist without doing some type of administrative role.”Click To Tweet

As pediatric hospitalists, they do a lot of administrative stuff. They go to a bunch of meetings. There are also people who might just do newborn hospitalists or peds onc. So they’re not necessarily attracted to specialize in those things, but they tend to become subspecialized because they’re just working in that setting.

[17:50] Message to Osteopathic Students

Jamee is in pediatrics and they really don’t care whether you’re MD vs. DO. The steps don’t matter whether or not they’re DO. Just really focus on making sure you have strong scores and you’re doing really well in your clinical years. In pediatrics, they really care about the clinical things. They care about how you perform clinically in your third-year rotations, and having good letters of recommendation. If you have those things, MD or DO, it really doesn’t matter nearly as much as it does in other specialties.

[18:57] How to Be a Good Candidate for Rotations

Doing a pediatric sub is a must. So if your school requires you to do a sub and pediatrics was not an option. Jamee encourages you to do a second sub she in pediatrics. In turn, you could do well in newborn medicine, GI, infectious disease – more of the general peds subspecialties. Do those to get yourself ready for intern year.

“There's nothing necessarily specific but newborn is a big one because most medical schools don't have a lot of newborn exposure.”Click To Tweet

Jamee advises doing newborn medicine rotations and then supplementing it with the pediatric subspecialties like infectious disease and GI.

[19:47] Other Specialties They Work the Closest With

Jamee says they work closely with Pulmonology, ER, and PICU. Those are the big ones as well as GI and Infectious Diseases. Others are Adolescent and Genetics. They also work a lot with pediatric surgery since they do a lot of post-op co-management with both pediatric surgeons, pediatric neurosurgeons, and pediatric orthopedic surgeons.

[20:18] What She Wished She Knew that She Knows Now

Jamee says that there’s this common misperception that you have to have grown up loving kids and babysitting and doing all those kid-friendly activities in order to be a pediatrician. But you don’t need this to be a really good physician. You need to be a good person and you need to communicate well. You don’t have to have a bubbly personality to be a pediatrician. You also don’t have to have a child to be a pediatrician.

“There's a common misperception that if you go into pediatrics, you have to have a kid in order to understand it.”Click To Tweet

Pediatric Hospital Medicine is different as well. So you just pick whatever you like. And you can then figure out once you get into peds as to which subspecialty you like to get into.

[21:51] The Least and Most Liked Things

What Jamee loves about her specialty is she gets to take care of everyone. She never wanted to be in a practice where she had to worry about insurance status.

Jamee likes taking care of complex care patients for which they’ve become subspecialists in that. Jamee finds it gratifying to take care of patients who are in and out of the hospital with so many issues.

On the flip side, what she likes the least is probably the thought that you don’t go into detox wellness thinking you’re going to be revered. Don’t expect to get letters from your patients. You’re not going to have a nurse or nursing administrative staff that thinks you’re the best thing ever. You really have to be okay with your own awesomeness.

“Be okay with the fact that you're not going to have these long-term relationships.”Click To Tweet

Don’t expect that you’re going to get a lot of positive feedback from anyone at the top. Not that you need your ego stroked, but sometimes it’s nice to be appreciated. It’s similar to ER where you come in, you do the work, and you do a really good job. And if you’re not recognized, that’s fine. It’s just the job. That being said, the kids appreciate you in so many ways so that makes it all worth it.

[24:13] Major Future Changes in the Field

Right now, the focus of many pediatric programs is to get a fellowship so that there can be enough spots. Especially in community hospitals, it’s hard enough for community hospitals to hire pediatric hospitalists. It’s no secret that pediatrics is not a big hospital moneymaker. And so it’s hard enough to get people out into the community hospital and into the rural areas.

So they’re hoping to have a big increase in fellowships. And that everyone’s going to be shifted into going into fellowships up until about this year. Unfortunately for our current residents and medical students coming up, that’s not going to be an option. They’re going to have to do fellowship, if they want to be boarded in it.

[25:27] Final Words of Wisdom

If she had to do it all over again, Jamee would still have chosen the same field because she loves it.

Finally, for students thinking about pediatrics or wanting to look into pediatric hospitalist medicine, her advice is that when picking your specialty don’t focus too much on schedule and lifestyle.

“You can make your job what you want it to be.”Click To Tweet

Pick what you really love. At the end of the day, if you come in during your 8- or 12-hour day and you don’t like the work, it really doesn’t matter if you have a great schedule. So pick a specialty that you enjoy. And then with this day and age, you can make your schedule however you need it, so don’t worry!