PEDIATRIC SPECIAL SECTION: Sibling Rivalry

An important formal step in their collaboration is the computerized medical and order entry system scheduled for spring 2006 implementation. The hospitalists are working together to develop clinical pathways and standardized orders based on their culling through best practices and evidence-based medicine guidelines. A newly appointed chief quality officer will keep the project on track.

Atlanta’s growth presents other issues for the hospitalists. With a constant influx of new community-based pediatricians Dr. Taylor finds that the hospitalists sometimes have trouble communicating with them to coordinate care.

“There are now at least 1,000 primary care and subspecialty pediatricians in Atlanta,” she says. “Trying to build trust and to track personal preferences with so many doctors is difficult. Fortunately we have electronic medical records so we can share important data with them.”

The hospitals’ social workers and case managers represent added glue to hold the communication together. Another of Atlanta’s challenges: It has only two medical schools from which to draw local hospitalists and other pediatricians, Emory University and the smaller Morehouse University. While not insurmountable, it means that most pediatricians practicing in the area must relocate to Atlanta.

What the Future Holds

And then there are issues that transcend Atlanta. Dr. Snitzer feels the national movement for hospitalists to become a specialty will happen sooner rather than later. In line with that movement, Children’s Hospital of Atlanta will have its first hospitalist fellowship in 2007. (For more information on pediatric hospital medicine fellowships, see “Pediatric Fellowship Offered,” below.)

For Dr. Hall, hospitalist compensation in a boomtown rankles. “People can’t really make money being hospitalists,” he explains. “Most need some subsidy to keep the programs going.”

The pay issues are being addressed, albeit slowly. Dr. Hall is encouraged by the campaign of pediatric intensivists to have coding and payment upgrades; he sees it as a template for higher hospitalist reimbursement schedules. “We only get paid for one visit a day, but we often see a patient several times a day,” he says. “Reimbursement should reflect what we really do.”

Both hospitals will have new buildings, each with 250 beds, more surgical suites, and expanded emergency departments by early 2007. That should lead to more hospitalist hiring—not surprising for a hospital that pioneered having inpatient physicians more than 20 years ago. TH

Writer Marlene Piturro is based in New York.

Joseph Snitzer, MD: A hospital medicine pioneer

In 1983—13 years before Robert Wachter, MD, FACP, coined the term “hospitalist”—Egleston Children’s Hospital Department of Pediatrics Chairman Joseph Patterson, MD, asked a former trainee to establish an in-house general pediatric service. That young doctor, Joseph Snitzer III, had been splitting his time equally between a private practice and teaching at Egleston through his affiliation with the Emory University School of Medicine. He said yes to the new assignment.

Since becoming a full-time hospitalist more than two decades ago, Dr. Snitzer relishes both his time working with interns and residents and an ever-changing mix of treatment and diagnostic mysteries. He is now the chief, Division of General Pediatrics, Children’s Healthcare of Atlanta at Egleston, and professor of pediatrics, Emory School of Medicine.

“We see everything here, from Kawasaki syndrome to neonatal apnea, seizure disorders, tumors, dehydration, jaundice, and all kinds of infections,” he explains. “About 50% of the children admitted have chronic conditions and the rest have various acute illnesses. There are unique challenges every day.”

Dr. Snitzer trained both Dr. Hall and Dr. Taylor, transmitting knowledge from one generation of physicians to the next. His hospitalist team maintains excellent relationships with the community’s doctors, both general pediatricians and specialists.

What is the main strength of Dr. Snitzer and the other hospitalists? Coordination with Atlanta’s pediatricians on getting things done in the hospital. Phone consultations with Atlanta’s physicians and those in rural areas seeking Children’s Hospital of Atlanta’s expertise on complex diagnoses and cases also keep him busy.

“Our experience with complexity is overwhelming,” he says. “Perhaps we can’t offer a great deal with simple diagnoses, such as diarrhea or simple skin infections, but we can with tough cases.” —MP