Leaders: Monitoring Health Reform's Impact on Pediatrics

Dr. Daniel Rauch, the associate director of pediatrics at Elmhurst Hospital Center in Queens, N.Y., and an associate professor of pediatrics at Mount Sinai School of Medicine, is one of the founders of the pediatric hospital medicine movement. He is the current chair of the American Academy of Pediatrics’ Section of Hospital Medicine and served on the planning committees for the first five national Pediatric Hospital Medicine Conferences.

Hospitalist News spoke with Dr. Rauch about the importance of mentoring and the potential impact of the controversial health reform law.

Hospitalist News: What advice do you give to people who are thinking about becoming pediatric hospitalists or have chosen it and are looking for ways to excel?

Dr. Rauch: I think for residents, they should ask the people whom they are working with what their life is like. A lot of people see the clinical role, and they don’t see what else the hospitalists do when they disappear from the floor. So they don’t have a full appreciation of the committee work, and the quality improvement work, and the research work. If that still appeals to you, then I think when you’re looking for a job the most important thing you need is some type of mentorship. A lot of people think that’s only applicable to an academic career. I would say that’s incorrect.

I think you need a mentor to move forward in your professional career, whatever that is. At the very least, you need someone who is a hospitalist who is going to help you clinically. If you’re going to be alone for all of your shifts and there’s no one to call, what are you going to do when you see a rash that you’ve never seen before? Likewise, a lot of being a hospitalist is leadership: leading the team on the floor, leading the nurses to develop new protocols, leading a committee in the hospital on safety. Those aren’t intuitive skills.

HN: How do you see pediatric hospitalists being potentially affected by some of the changes made by the Affordable Care Act?

Dr. Rauch: I’m in favor of the Affordable Care Act as a whole. I think it’s done tremendous things, and if it stays intact it will do tremendous things for children’s health across the board. But I am concerned about unintended consequences specific to pediatric hospitalists. I think the problem is going to be the way the law is set up to finance hospitalization costs. It’s going to squeeze pediatric beds in non-children’s hospitals. Pediatric beds give you the least return to begin with, so for a community hospital that’s on a tight budget, are they going to continue their pediatric beds or are they going to convert those to adult beds? We know that the anticipated growth in adult hospitalizations far exceeds that in pediatric hospitalizations. So from a pure financial standpoint, I think there’s going to be an issue.

While I hope there will be better access to primary care, I’m not sure how that’s going to affect access to care for the hospitalized child. I think it’s something that we have to monitor very carefully, and I am worried about it.

HN: What research projects are you working on now?

Dr. Rauch: I’m trying to work with some people to get an idea of what the national pediatric bed census is today. I want to establish standards and see if there have been trends over time. There’s a lot of local data. For instance, California has lost 18% of its pediatric bed capacity over the last 10 years. In New York City, there’s been a huge decrement in the number of pediatric beds. But I don’t know how full those beds were beforehand. We may be closing beds that weren’t utilized. On the other hand, a previous study by the American Academy of Pediatrics documented that community providers were having a more difficult time hospitalizing their patients.

I get a sense that a squeeze is happening, but we need to document it and then we need to follow it forward. We’ll be enlisting the help of pediatric hospitalists nationally to tell us their experience. If we think it’s something that’s affecting the care of children, we’ll lobby appropriately.

This column, "Leaders," appears regularly in Hospitalist News, a publication of Elsevier.

Dr. Daniel Rauch, the associate director of pediatrics at Elmhurst Hospital Center in Queens, N.Y., and an associate professor of pediatrics at Mount Sinai School of Medicine, is one of the founders of the pediatric hospital medicine movement. He is the current chair of the American Academy of Pediatrics’ Section of Hospital Medicine and served on the planning committees for the first five national Pediatric Hospital Medicine Conferences.

Hospitalist News spoke with Dr. Rauch about the importance of mentoring and the potential impact of the controversial health reform law.

Hospitalist News: What advice do you give to people who are thinking about becoming pediatric hospitalists or have chosen it and are looking for ways to excel?

Dr. Rauch: I think for residents, they should ask the people whom they are working with what their life is like. A lot of people see the clinical role, and they don’t see what else the hospitalists do when they disappear from the floor. So they don’t have a full appreciation of the committee work, and the quality improvement work, and the research work. If that still appeals to you, then I think when you’re looking for a job the most important thing you need is some type of mentorship. A lot of people think that’s only applicable to an academic career. I would say that’s incorrect.

I think you need a mentor to move forward in your professional career, whatever that is. At the very least, you need someone who is a hospitalist who is going to help you clinically. If you’re going to be alone for all of your shifts and there’s no one to call, what are you going to do when you see a rash that you’ve never seen before? Likewise, a lot of being a hospitalist is leadership: leading the team on the floor, leading the nurses to develop new protocols, leading a committee in the hospital on safety. Those aren’t intuitive skills.

HN: How do you see pediatric hospitalists being potentially affected by some of the changes made by the Affordable Care Act?

Dr. Rauch: I’m in favor of the Affordable Care Act as a whole. I think it’s done tremendous things, and if it stays intact it will do tremendous things for children’s health across the board. But I am concerned about unintended consequences specific to pediatric hospitalists. I think the problem is going to be the way the law is set up to finance hospitalization costs. It’s going to squeeze pediatric beds in non-children’s hospitals. Pediatric beds give you the least return to begin with, so for a community hospital that’s on a tight budget, are they going to continue their pediatric beds or are they going to convert those to adult beds? We know that the anticipated growth in adult hospitalizations far exceeds that in pediatric hospitalizations. So from a pure financial standpoint, I think there’s going to be an issue.

While I hope there will be better access to primary care, I’m not sure how that’s going to affect access to care for the hospitalized child. I think it’s something that we have to monitor very carefully, and I am worried about it.

HN: What research projects are you working on now?

Dr. Rauch: I’m trying to work with some people to get an idea of what the national pediatric bed census is today. I want to establish standards and see if there have been trends over time. There’s a lot of local data. For instance, California has lost 18% of its pediatric bed capacity over the last 10 years. In New York City, there’s been a huge decrement in the number of pediatric beds. But I don’t know how full those beds were beforehand. We may be closing beds that weren’t utilized. On the other hand, a previous study by the American Academy of Pediatrics documented that community providers were having a more difficult time hospitalizing their patients.

I get a sense that a squeeze is happening, but we need to document it and then we need to follow it forward. We’ll be enlisting the help of pediatric hospitalists nationally to tell us their experience. If we think it’s something that’s affecting the care of children, we’ll lobby appropriately.

This column, "Leaders," appears regularly in Hospitalist News, a publication of Elsevier.

Dr. Daniel Rauch, the associate director of pediatrics at Elmhurst Hospital Center in Queens, N.Y., and an associate professor of pediatrics at Mount Sinai School of Medicine, is one of the founders of the pediatric hospital medicine movement. He is the current chair of the American Academy of Pediatrics’ Section of Hospital Medicine and served on the planning committees for the first five national Pediatric Hospital Medicine Conferences.

Hospitalist News spoke with Dr. Rauch about the importance of mentoring and the potential impact of the controversial health reform law.

Hospitalist News: What advice do you give to people who are thinking about becoming pediatric hospitalists or have chosen it and are looking for ways to excel?

Dr. Rauch: I think for residents, they should ask the people whom they are working with what their life is like. A lot of people see the clinical role, and they don’t see what else the hospitalists do when they disappear from the floor. So they don’t have a full appreciation of the committee work, and the quality improvement work, and the research work. If that still appeals to you, then I think when you’re looking for a job the most important thing you need is some type of mentorship. A lot of people think that’s only applicable to an academic career. I would say that’s incorrect.

I think you need a mentor to move forward in your professional career, whatever that is. At the very least, you need someone who is a hospitalist who is going to help you clinically. If you’re going to be alone for all of your shifts and there’s no one to call, what are you going to do when you see a rash that you’ve never seen before? Likewise, a lot of being a hospitalist is leadership: leading the team on the floor, leading the nurses to develop new protocols, leading a committee in the hospital on safety. Those aren’t intuitive skills.

HN: How do you see pediatric hospitalists being potentially affected by some of the changes made by the Affordable Care Act?

Dr. Rauch: I’m in favor of the Affordable Care Act as a whole. I think it’s done tremendous things, and if it stays intact it will do tremendous things for children’s health across the board. But I am concerned about unintended consequences specific to pediatric hospitalists. I think the problem is going to be the way the law is set up to finance hospitalization costs. It’s going to squeeze pediatric beds in non-children’s hospitals. Pediatric beds give you the least return to begin with, so for a community hospital that’s on a tight budget, are they going to continue their pediatric beds or are they going to convert those to adult beds? We know that the anticipated growth in adult hospitalizations far exceeds that in pediatric hospitalizations. So from a pure financial standpoint, I think there’s going to be an issue.

While I hope there will be better access to primary care, I’m not sure how that’s going to affect access to care for the hospitalized child. I think it’s something that we have to monitor very carefully, and I am worried about it.

HN: What research projects are you working on now?

Dr. Rauch: I’m trying to work with some people to get an idea of what the national pediatric bed census is today. I want to establish standards and see if there have been trends over time. There’s a lot of local data. For instance, California has lost 18% of its pediatric bed capacity over the last 10 years. In New York City, there’s been a huge decrement in the number of pediatric beds. But I don’t know how full those beds were beforehand. We may be closing beds that weren’t utilized. On the other hand, a previous study by the American Academy of Pediatrics documented that community providers were having a more difficult time hospitalizing their patients.

I get a sense that a squeeze is happening, but we need to document it and then we need to follow it forward. We’ll be enlisting the help of pediatric hospitalists nationally to tell us their experience. If we think it’s something that’s affecting the care of children, we’ll lobby appropriately.

This column, "Leaders," appears regularly in Hospitalist News, a publication of Elsevier.