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Traditionally, many pediatricians have managed their own patients on the pediatric ward. They enjoy the opportunity to practice in the inpatient setting and to support their patients through a difficult illness. Families appreciate a familiar face and the presence of someone they know to be trustworthy during this stressful time in a foreign environment. Caring for patients on the ward is an honored tradition in pediatric medicine and a rewarding part of practice.
Despite these benefits, however, demands on pediatricians have led to a shift of practice patterns away from this traditional model. The office schedule is tight and rarely lends itself to leisurely or frequent hospital rounds. Improvements in outpatient care have resulted in an increase in illness severity for inpatients, requiring increased physician time. Payers expect shorter lengths of stay, necessitating higher levels of efficiency in care. Division of labor has become an important part of managing this increasing workload, resulting in fewer opportunities for a single pediatrician to follow a patient through the full course of hospitalization. The traditional experience of a single physician making daily rounds until patient discharge seems to be a vanishing phenomenon.
Physicians and their counterparts within hospital administration have experimented with several options for addressing these and related problems. In some cases, the physician chooses to refer a portion of patients to a tertiary center, keeping instead only those who might be managed with one or two visits per day. In extreme cases, this practice has led some hospitals to close their pediatric ward services altogether as patient volumes dwindle below the level needed to justify staffing expenses.
Some groups may designate one of their physicians to care for ward patients. This allows for some continuity but takes the physician out of service from the office, sacrificing a morning's worth of outpatients to see four or five inpatients. In some communities, even the payers participate by contracting with one or more physicians to provide inpatient care to patients who are members of a given health plan.
THE HOSPITALIST ALTERNATIVE
The hospitalist movement has evolved from a novel approach to local problem-solving to the establishment of a new standard of care.1 These physicians add a unique and valuable dimension to the care of pediatric inpatients. Although there may...