Assessing the value of pediatric hospitalist programs: the perspective of hospital leaders

Abstract

Objective: There has been a rapid increase in the number of pediatric hospitalist programs in the United States. As most pediatric hospitalist services are believed to be subsidized by hospitals, gaining a better understanding of the rationale for these subsidies is critical to the future success and existence of these programs. Our objective was to determine the rationale for pediatric hospitalist program subsidies from the perspective of hospital leaders.

Methods: A survey was mailed to hospital executives from a national sample of 112 hospitals between October 2007 and February 2008.

Results: The overall response rate was 69% (N = 77). Twelve hospitals no longer used hospitalists to provide care for children, leaving 65 hospitals for the analysis. The majority of hospital leaders indicated they subsidize their pediatric hospitalist program (78%, n = 51) and the average proportion subsidized was 49% of program costs. The majority of hospitals (82%, n = 40) do not plan to phase out the subsidy of hospitalists over time, as they do not anticipate their program will be able to cover its costs. Hospital leaders provided a broad rational for this subsidization but most commonly cited the nonmonetary benefits of patient (83%, n = 39) and referring physician satisfaction (81%, n = 38) as reason for their investment.

Conclusions: Despite the fact that most pediatric hospitalist programs are unable to cover their costs, the majority of hospitals plan to continue subsidizing these programs. Discussions of the value added by hospitalists should not presume that hospital investment in hospitalist programs is based on monetary benefits alone.