Pediatric hospitalists in community hospitals: hospital-based generalists with expanded roles.

A few years ago, I was interviewing candidates for a position in our community hospital group. I was telling a resident who was graduating from a highly specialized university program about our range of activities and proudly describing our relationships with community practitioners when she abruptly ended the interview, explaining that she did not want to be what we were; she wanted to be a hospitalist. I was confused. If we were not hospitalists, what were we? “Hospital-based generalists,” she said. Until that exchange, I had no appreciation for a difference between being a pediatric hospitalist and being a hospital-based pediatric generalist. But as I considered her frame of reference, I understood: she was seeking what she knew, a general inpatient niche position within a full department of pediatrics, whereas we aspired to address the care of children everywhere in the hospital as an integral part of a pediatric community providing care for children. The distinction might largely be between the role generally performed by pediatric hospitalists in university/children’s hospitals and what pediatric hospitalists do in community hospitals, activities that may include any or all of the following in addition to inpatient care: newborn nursery care, delivery room resuscitations/stabilization, emergency department consultations, outpatient consultations; procedural sedations, advocacy for the needs of children within an adult-oriented system, and transport medicine. Hospitalists in university/children’s hospitals may perform some of these activities as well, of course, but the expanded scope of activities may well defi ne the unique role of pediatric generalists in community hospitals. The role, or opportunity, as I see it, is generally out of sight of learners making career choices, and the literature about pediatrics in community hospitals is scant.1–5 So for those who aspire to be “hospital-based pediatric generalists” with an expanded role, this commentary seeks to make the case for being a pediatric hospitalist in a community hospital.