Freed Gary L, Brzoznowski Kathryn, Neighbors Kamilah, Lakhani Indu
Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI 48109-0456, USA.
Pediatrics. 2007 Jul;120(1):33-9. doi: 10.1542/peds.2007-0304.
Over the past 10 years, the use of hospitalists has grown in both the adult and pediatric setting as a response to pressure to deliver cost-effective, high-quality care. However, there is a paucity of information regarding the variation in the clinical roles, educational responsibilities, work patterns, and employment characteristics of pediatric hospitalists. This lack of information hampers efforts to define the nature of the field and determine whether any formalized, additional training or experience should be required for physicians in this clinical practice domain.
We conducted a telephone survey of a national sample of pediatric hospitalist program directors (n = 116). Questionnaire items focused on exploring the clinical roles, work patterns, employment characteristics, and training of pediatric hospitalists within each institution. Results were stratified by teaching hospitals, urban/rural location, hospital size, and membership in the National Association of Children's Hospitals and Related Institutions.
The response rate was 97%. The majority of hospitals surveyed (70%) reported that hospitalists do not generate enough income from professional billing to pay their salaries. Fewer than half (39%) of respondents reported that their hospital measures pediatric clinical outcomes associated with hospitalist care. A total of 42% of hospitalist program directors reported that most of their hospitalists had an average duration of employment of <3 years. In programs with residents, hospitalists serve as teaching attendings for pediatric patients in almost all cases (89%).
Hospital medicine is a rapidly growing enterprise. A better understanding of both its participants, as well as those affected by its practice, will enable planning for a future that meets as many needs as possible while ensuring the best possible care for children.
在过去10年中，为应对提供具有成本效益的高质量医疗服务的压力，成人和儿科环境中住院医师的使用都有所增加。然而，关于儿科住院医师的临床角色、教育职责、工作模式和就业特征的差异，信息却很匮乏。这种信息的缺乏阻碍了我们界定该领域的性质，并确定在这一临床实践领域的医生是否需要任何形式的额外培训或经验。
我们对全国儿科住院医师项目主任样本（n = 116）进行了电话调查。问卷项目重点探讨了各机构内儿科住院医师的临床角色、工作模式、就业特征和培训情况。结果按教学医院、城市/农村地点、医院规模以及是否为美国儿童医院及相关机构协会成员进行了分层。
回复率为97%。大多数接受调查的医院（70%）报告称，住院医师通过专业计费获得的收入不足以支付他们的工资。不到一半（39%）的受访者报告称，他们的医院会衡量与住院医师护理相关的儿科临床结果。共有42%的住院医师项目主任报告称，他们的大多数住院医师平均工作年限不到3年。在有住院医师的项目中，住院医师几乎在所有情况下（89%）都担任儿科患者的带教主治医师。
医院医学是一个快速发展的领域。更好地了解其参与者以及受其实践影响的人，将有助于规划未来，在确保为儿童提供尽可能最佳护理的同时，满足尽可能多的需求。
