Scope, Scholarship, Sustainability: Unpacking the Pediatric Hospitalist Workforce

As the landscape of pediatric hospital medicine (PHM) has evolved, the role of the hospitalist has become increasingly diverse. The broad scope of practice encompasses an assortment of clinical and nonclinical roles, with varied expectations in workloads, shift types, and administrative and scholarly responsibilities.1,2 The workforce has further evolved in the new era of PHM board certification and the expanding PHM fellowship, with an expected decrease in the number of residents entering PHM in the coming years despite growing demand in the PHM workforce.3–7 The full impact of fellowship training and board certification on the PHM workforce has yet to be fully realized but is expected to impact both hiring practices and graduating residents’ career decisions.3,5 Given concerns about workforce shortages and myriad changes within the field, there is a need to better understand the holistic experience of a hospitalist at an individual level. The PHM workforce survey published in this month’s issue of Hospital Pediatrics sheds light on the variety of individual experiences and perspectives of pediatric hospitalists, including their scopes of practice, factors correlating with scholarly and administrative activities, and projected workforce sustainability.8 Its companion article delves into factors associated with career satisfaction and workplace well-being, and it examines the association between the hospitalist’s experience of burnout with their plans to decrease clinical time in coming years.9This cross-sectional, survey-based study comprises the responses of the individual portion of the American Academy of Pediatrics Section on Hospital Medicine Workforce Taskforce survey from 2024 and describes the PHM workforce using responses from 1060 practicing pediatric hospitalists.8 This study represents the largest survey cohort of pediatric hospitalists published to date and is strengthened by the breadth of individual-level variables examined, as well as by its forward-looking focus on job sustainability and workforce concerns. The authors identify differences by board certification and eligibility status, gender, and employment setting. Board certification was associated with a higher likelihood of having an academic appointment and participation in nonclinical activities.8 There was no association between board certification and career satisfaction or perceived job sustainability.9 Regarding gender differences, although men and women were equally likely to report an academic appointment, men had a higher likelihood of having a position as full or associate professor even when adjusting for years since residency and had higher odds of perceiving their job as sustainable.8,9 Women had a higher likelihood of working part time and reporting symptoms of burnout.9 Employment setting, such as an academic institution or community hospital, also impacted the frequency and types of nonclinical activities reported.8 Hospitalists who work in a university setting were more likely to report involvement in teaching and scholarly work.8 Respondents reported compensation and staffing challenges as their most frequently anticipated workforce concerns over the next fever years.8 The overwhelming majority of hospitalists reported satisfaction with their career choice and would choose PHM again.9 However, over a third of hospitalists reported at least 1 symptom of burnout, and this correlated with plans to reduce clinical time, including night and/or evening shifts.9Although this study offers insight into the experiences of individual hospitalists, some limitations may preclude its generalizability. The relatively low response rate (36%) predominantly represented the academic hospitalist perspective. The survey was distributed via organizational listservs and promotion at the PHM conference, which likely heavily favored university-based hospitalist participation and hospitalists who were more engaged at the national level. Additionally, most respondents were white women physicians, so advanced practice providers, men, and physicians from other demographically diverse backgrounds were less accounted for in the survey results. Only 6.5% of respondents were med/peds hospitalists, which represents a unique population in the PHM workforce that is likely underrepresented in this survey sample.National surveys of pediatric hospital medicine program leaders in 2021 and 2024 described the baseline structure of the modern PHM workforce as well as the variability among programs and subsequent growth of the workforce.1,2 The current study enumerates the diversity of experiences and perspectives of individual pediatric hospitalists. Additionally, this study confirms findings of previous studies evaluating gender-based differences in pediatric hospital medicine that demonstrate a pattern of disparity in individually reported experience as well as career advancement.10,11 Kim et al found in 2024 that women in PHM report less satisfaction in work-life balance,10 and Allan et al demonstrated in 2021 that women are underrepresented in PHM leadership roles.11 These trends are not isolated to PHM and extend to other pediatric fields, as well.12 Career satisfaction is positively correlated with a perception of work-life balance.13 Additionally, factors associated with career satisfaction for tertiary care hospitalists (diversity in nonclinical responsibilities and career development) differ from those of community hospitalists (resource availability, work schedule, and clinical responsibilities).14 In addition to defining these factors at an individual level, this study is the first of its kind to assess individual perspectives on anticipated workforce concerns and plans for changes in their clinical time in the coming years.Because PHM was officially recognized as a board-certified subspecialty in 2016 and the practice pathway closed in 2024, the field has yet to fully see the impact of fellowship training and/or subspecialty board certification on hiring practices and decisions to pursue a career in PHM. Although institutions that have PHM fellowships are more likely to value fellowship training in the hiring process, most institutions do not currently require PHM board certification.3 Many residents report a decreased likelihood of pursuing a career in PHM following the implementation of the PHM fellowship requirement for subspecialty board certification, citing personal and financial opportunity cost as a primary barrier to additional training.5 This study offers a glimpse into the breadth of nonclinical activities of hospitalists with and without PHM board certification, including teaching responsibilities, administrative roles, and other scholarly activities. Although board-certified hospitalists were more likely to engage in these activities, many nonboard-certified hospitalists also reported these roles.8 Board certification and engagement in nonclinical activities are certainly not mutually exclusive, and career satisfaction among pediatric hospitalists is generally high. Importantly, the lack of association between board certification and career satisfaction or perceived job sustainability suggests that there are many rewarding paths to career in PHM. These findings should prompt individuals who are interested in PHM to self-reflect on their goals to determine which type of career might best suit their professional and personal interests.A better understanding of the nuances in clinical scope, satisfaction and sustainability at an individual level is increasingly important given projected staffing workforce shortages amid a growing need for pediatric hospitalists in coming decades.4,6 In a survey regarding the impact of the 2025 Accreditation Council for Graduate Medical Education changes to the pediatric residency curriculum on the PHM workforce, a majority of PHM program leaders anticipated additional staffing needs along with decreased career satisfaction of pediatric hospitalists.7 With many hospitalists reporting a plan to decrease clinical time and/or less desirable evening and overnight shifts in the next 5 years, inpatient staffing problems may be further exacerbated. Insights from this study can help inform trainees considering a career in PHM, as well as prompt institutions to develop strategies to mitigate workforce constraints.Further research is needed to give voice to a greater diversity of individual perspectives in the PHM workforce, including the perspectives of community hospitalists, those underrepresented in medicine, combined internal medicine/pediatric hospitalists, and APPs working in PHM. Additionally, it will be important to monitor changes in career satisfaction, well-being, and retention in light of the 2025 Accreditation Council for Graduate Medical Education pediatric residency curriculum changes. Programs will be challenged to fill the need for more clinical coverage while also maintaining existing workforce well-being and sustainability. The study authors suggest potential strategies for addressing gender disparities and improving retention, as well as ideas for balancing the increased staffing requirements of PHM programs with sustainability for individual clinicians.8 Many programs may choose to expand the amount of clinical coverage provided by nocturnists and/or APPs.15 Approaches to maintain and sustain these roles in the evolving PHM landscape will be a potential focus of future study.The results of this study underscore that the PHM workforce is not a uniform entity. Given ongoing workforce pressures, this study addresses a timely and important topic in PHM and has the potential to inform workforce planning and retention efforts. Wachter and Goldman, who coined the term hospitalist in 1996,16 theorized the importance of a systems-oriented “diastole” to complement and sustain the inpatient clinical effort or “systole” of each hospitalist.17 This requires hospitalist program leaders to protect time for nonclinical work based on individual interests in areas such as quality improvement, patient safety, research, education, and advocacy. This study helps describe the types of “active rest” in a hospitalist’s career, in addition to highlighting potential strategies to increase the workforce, improve retention, and maintain well-being.18,19 This snapshot of the diverse experiences within PHM helps illuminate who we are today and where we are headed as a field. As our field continues to evolve, cultivating a sustainable and well-supported workforce remains a critical priority for PHM’s continued growth and advancement.