Med/Peds in a Changing Marketplace and the Rise of Hospitalist Programs
By Norman Toy

I began the process of looking for MP’s opportunities and marketing MP candidates to health systems long before MPs became “almost” mainstream, as they are today. Each year I notice an increase in demand for MPs in the marketplace. The increase is a result of an ever-expanding field of MPs and a growing understanding within health systems of their versatility.

The process of finding an MP opportunity has changed dramatically in the ten years since I placed my first MP. Most candidates still ask me if I have opportunities with MP groups. The next most common request is for mixed primary care groups that may include MPs, Internists or Pediatricians. Ten years ago I considered myself lucky to find a health system with even one MP in it, in the hope that this provider might be included in the primary care call group. While many of my candidates had no choice but to join family practice groups, they found it far more attractive when at least one other MP was in the system. Now, more and more health systems have gone through the process of hiring MPs, have MPs working in their system, and have learned what to do with them when they come across one.

Call has always been the biggest challenge, and it still is, especially regarding pediatric patients. The quality of care provided to pediatric hospital patients has consistently been a big concern for MPs when they evaluate possible practice opportunities. It often drives their desire to join other MPs or Pediatricians and explains their reluctance to work exclusively with family practitioners. This issue cuts both ways however. I regularly speak with administrators who gripe about the difficulty they have had arranging call for MPs, and they steer clear of them altogether. Overall, though, looking for an MP opportunity where pediatric patients are well covered is getting easier all the time.

With the exploding growth of Hospitalist programs, new challenges have developed which hinge on similar issues that have always plagued MPs. More and more MPs approach me every year seeking Hospitalist opportunities. Stepping from MP residency into a Hospitalist position is apparently a natural progression. Except for universities and fairly large metropolitan hospitals, the majority of Hospitalist programs treat adults exclusively, and those that treat children treat very few. After taking that extra year of training to obtain board eligibility in pediatrics, treating zero to very few pediatric patients is just not very satisfying. When faced with the dilemma of going into traditional primary care practice or dropping pediatric patients altogether, I have seen MPs who have developed a love for hospital work give up pediatrics despite the time and effort that went into becoming an MP. Many just accept that less than ten percent of their patients will be children and live with an extremely unbalanced ratio of adults to kids. I’ve seen a few MP Hospitalists treat adults in the hospital and manage to work a few shifts in a local pediatric practice, but it’s rare, and it always seems very difficult to manage.

Ironically, it just so happens that more and more hospitals are calling me and asking for MPs for their Hospitalist programs. For them it’s a dream to think that they could have a group cover all their patients, from newborns to geriatrics. (I have found it interesting that they won’t hire family practitioners for these positions, yet when it comes time to set compensation models for Med/Peds in traditional primary care settings, these same hospitals sometimes argue that a MP is equal to a family practitioner and should be compensated accordingly. That’s another issue altogether, however, and I will write about it elsewhere.) Primary care providers are enjoying the lifestyle advantages of outpatient-only practices, and the hospitals reinforce that business model at every opportunity. By recruiting MPs for their Hospitalist program, Internists, Pediatricians, Family Practitioners, and Med/Peds can turn all of their patients over to the Hospitalists. Even though pediatric admissions are light, if the Hospitalist group is trained to treat all comers, it is a win-win for the hospital. The MP Hospitalist suffers however. Pediatricians have been slower to embrace the Hospitalist concept, because in most cases, they haven’t been offered an alternative until recently. It becomes a matter of re-conditioning the way they think. They have been leery about turning patients over to Hospitalists. It is the job of hospital administration and the MP Hospitalist to reach out to and educate the outpatient network about the role of the MP in pediatric inpatient care so pediatricians can feel confident in the care their patients will receive from a Pediatric Hospitalist. Every Hospitalist program’s growth is dependent on the support of the primary care network. It takes time to build confidence.

On the other hand my newly trained MP candidates who opt for traditional primary care jobs retain their hospital privileges more often than my Internal Medicine or Family Practice candidates. In large part, they seem to love both inpatient and outpatient medicine, especially early in their careers, though the lifestyle advantages of an outpatient practice often become very attractive after awhile. Improving physicians’ lifestyles and efficiencies in practice management and billing fuels the phenomenal growth of Hospitalist programs.

I have seen some hospitals work very hard to accommodate MP Hospitalists, educating their outpatient pediatricians and promoting the excellent inpatient care MPs provide to their patients. These systems find that when the pediatric network feels secure with the inpatient care, they discover the advantages of turning their patients over to the MP Hospitalists. This increases the numbers of pediatric patients for the MP Hospitalists, and everybody benefits. It takes a savvy administrator to understand and implement an outreach effort like that, and, unfortunately, I don’t see it very often.

No matter what, MP’s are still unique, and bring an assortment of unique advantages and challenges to the table when they are searching for a rewarding professional job opportunity. They are being sought after more than ever before. Each new system needs to be tweaked and modified along the way to accommodate new ways of delivering healthcare. With the concerted effort of both the MP provider and the hospital or employer, the nuances around MPs are changing all the time, consistently for the better.