Mirroring national trend, pediatric hospital medicine branches out at OHSU

Across the country, the field of pediatric hospital medicine is experiencing a growth spurt. In fact, it is the fastest growing pediatric specialty, according to a 2010 University of Toronto review published in the Current Opinion of Pediatrics. And at OHSU, this natural evolution has brought forth an administrative change. Effective July 1, the Division of Pediatric Hospital Medicine was established within the Department of Pediatrics; Tracy Bumsted, M.D., M.P.H., is interim division head.

"The knowledge and expertise of a pediatric hospitalist is increasingly distinct from general pediatrics, leading us to establish the division of pediatric hospital medicine at OHSU," said Stacy Nicholson, M.D., M.P.H., chair of pediatrics. "Our pediatric hospitalists have developed regional and national reputations for their exceptional care, service, and teaching. As we search for a permanent division head, I know Dr. Bumsted will continue to provide exceptional leadership."

Division of Pediatric Hospital Medicine facultyDr. Bumsted and her pediatric hospitalist colleagues (see below for a list) work primarily in the inpatient setting at Doernbecher Children's Hospital to provide care for children with increasing complexity and disease severity. The first pediatric hospitalist was hired at OHSU in 2003, and the section of pediatric hospital medicine was established in 2008, growing one hospitalist at a time until reaching its current size. Like the Division of Hospital Medicine within the Department of Medicine (see previous SoM News article), each physician takes an active part in all of OHSU's missions, while sharing attending and on-call duties to facilitate coordinated care for Doernbecher patients with complicated diagnoses, complex medical management needs or detailed discharge planning needs.

"I like to call us the 'quarterback' for the children admitted to our service," said Dr. Bumsted, clinical associate professor of pediatrics. "We are general pediatricians with the right network of disease- and organ-specific specialists to consult when needed, and we partner with nurses, pharmacists, social workers, and community providers, all with the goal of providing high-quality, coordinated care."

In true academic fashion, Dr. Bumsted has developed a hiring model to facilitate the growing field. Her paper "Hiring Pediatric Hospitalists: The Process Matters," was published earlier this year in Hospital Pediatrics, an official journal of the American Academy of Pediatrics.

"When I first submitted the paper, the journal reviewers seemed really excited about it," said Dr. Bumsted. "They said there was nothing in the literature about hiring pediatric hospitalists, and it would fit well in a young field with a lot of hiring activity."

As the title suggests, Dr. Bumsted's paper focuses on the process of hiring a pediatric hospitalist, and while it can be applied to other specialties, is based in experience that she and colleagues used in a recent hire at OHSU. Struggling with an existing hiring model that "didn't feel as objective as it could be," Dr. Bumsted said the concept of behavioral interviewing is integral to the model. Establishing a detailed job description, formulating structured questions for interviewers and asking interviewees to speak about real-life experience during the interview process are critical components of the process she describes in the paper.

A team of interdisciplinary interviewers whose diverse experience reflects the practice environment is also part of finding the right physician for the job. At OHSU, she enlisted the help of a transfer center operator, nurse case manager, two family medicine physicians, an emergency medicine physician, and an intensivist to help interview and evaluate candidates. Their expertise in various aspects of a pediatric hospitalist's day-to-day activities – and the attributes needed to successfully complete the work – helped ensure applicants were compared in a standardized way.

"Using a team of interdisciplinary interviewers broadened the validity of the process," said Dr. Bumsted. "We're not just asking questions within our own field or even among physicians, but in a team-based environment, which is how we work."

When asked whether her hiring model is too resource-intensive, Dr. Bumsted points out the alternative. As she wrote in her paper, "Anyone who has witnessed, or been a part of, an incorrect hiring decision knows how costly it can be, both in human and financial terms. There can be large negative effects on clinical performance, patient satisfaction, physician morale, and in some situations, these decisions may lead to physician turnover."

Dr. Bumsted's paper is available in full here. She is happy to speak with anyone who is interested in implementing the model.

The OHSU Division of Pediatric Hospital Medicine includes the following faculty in the Department of Pediatrics:

  • Jared Austin, M.D., F.A.A.P., assistant professor
  • Megan Aylor, M.D., assistant professor
  • Tracy Bumsted, M.D., M.P.H., F.A.A.P., clinical associate professor
  • Sarah Green, M.D., F.A.A.P., assistant professor
  • Windy Stevenson, M.D., assistant professor
  • Tamara Wagner, M.D., F.A.A.P., clinical associate professor


Pictured above (l to r): Drs. Austin, Stevenson, Wagner, Green, Aylor and Bumsted, colleagues (and friends) in the Division of Pediatric Hospital Medicine