Pediatric Emergency Medicine in the Community Hospital

Emergency Departments (ED) across the country are consistently being pushed beyond capacity. The recently passed federal healthcare bill will not likely reduce the stress placed on EDs and volumes may in fact increase as a result of the legislation. Community hospitals in outlying suburban areas have gradually stepped up their pediatric emergency and subspecialty services in response to the increasing demands of the population. As an initial step, many community hospitals have developed dedicated pediatric emergency department (PED) settings as separate entities from the general ED area, in order to provide a more child and family friendly environment and experience.

These PEDs are typically staffed with dedicated pediatric emergency nurses and are fully supplied with pediatric appropriate equipment. Community hospitals have also increased their recruitment of pediatric medical and surgical subspecialists. In areas where PED volumes are significantly high, community hospitals and emergency medicine group practices have sought the expertise of pediatric emergency medicine (PEM) specialists in order to provide the highest quality of emergency care to children in their communities. Community hospital PEM opportunities, which in the recent past were quite rare, have become increasingly available.

In high volume community hospitals, where both the hospital administration and the emergency medicine practice have pledged a commitment to providing the highest quality of emergency care to children, the PEM physician has found a niche within this practice model. PEM physicians in this role become leaders within their organization and community, continually educating their general emergency medicine colleagues as well as their community pediatrician referral base.

Although general emergency medicine physicians have required pediatric training during their residencies and are qualified to care for all age groups, most feel anxious at best and ill-prepared at worst when managing high volume or high acuity pediatric patients. In turn, PEM physicians garner the benefits of having such a cohesive relationship with their general emergency medicine colleagues, and continually learn and gain insight from them.

The PEM physician in the emergency medicine practice can become actively involved in administrative areas of the group, such as presiding over peer review of pediatric cases, directing pediatric simulation exercises, and acting as an advocate for continual improvement of pediatric emergency care within their institution and group practice.

The aim of this model is to encourage a teamwork approach, with the end result being physician enthusiasm and motivation while delivering the highest quality of care. It is clear that PEM specialists are no longer limited to purely academic careers. Similarly, families are no longer required to travel great distances to children’s hospitals or academic medical centers to ensure that their children receive state-of-the-art emergency care.

Community hospitals and emergency medicine practices are answering the call. The recruitment of PEM board-certified and board-eligible physicians to these positions has become essential as pediatric volumes at these centers continue to grow. Joining an emergency medicine practice and working in a community hospital setting has become not only a possibility for a PEM physician, but an attractive alternative to the conventional academic path, where one can thrive both personally and professionally.