A growing number of physicians are choosing to subspecialize in pediatric hospital medicine, and many of them are spending most of their time caring for newborns.

A group of researchers set out to learn more about the pediatric hospitalist workforce that cares for newborns during the birth hospitalization. They analyzed survey responses from 336 pediatric hospitalists during a 2-month window in 2024 and found that newborn care represented most of their daily clinical workload.

They published their findings in “Defining the Hospitalist Workforce in the Care of Newborns,” published in Hospital Pediatrics. According to the authors, the study is the first to define the pediatric hospitalist workforce in the care of newborns and the nursery sites for clinical practice.

Evolving Role of Pediatric Hospitalist

Pediatric hospital medicine is a relatively new subspecialty — in fact, it’s the newest subspecialty within the American Board of Pediatrics — and the numbers of pediatric hospitalists are on the rise.

“It’s exciting to see the growth of the field,” said Richard S. Engel, MD, associate division chief of hospital medicine at Phoenix Children’s Hospital in Phoenix, who was not involved in the study. Two decades ago, when he began working at Phoenix Children’s Hospital, he was one of about 10 pediatric hospitalists. Today, the hospital has about 75.

The pediatric hospitalist role is also one that continues to evolve in various clinical settings.

For example, hospitalists working at freestanding children’s hospitals and in nurseries within university-based hospitals were more likely to have newborn-only roles than hospitalists working at community hospital sites, who were more likely to have broad service-line coverage, according to the study. The researchers noted that hospitalists attended deliveries at 45% of sites, with the greatest percentages in community sites, rural settings, and sites with lower annual delivery volumes.

The study also described the level of care provided by pediatric hospitalists. About 97% of the hospitalists surveyed independently managed infants in level I nurseries, while 38% managed infants in level II special care nurseries.

Also, many of the respondents indicated that that the newborn hospitalist role was a deliberate career choice, not a “steppingstone to another career path in pediatrics.”

Collaborative Nature of the Role

The newborn hospitalist doesn’t replace the general pediatrician nor does the newborn hospitalist replace the neonatologist, whose job is to provide critical care to sicker infants. Instead, they can be collaborators, said Pediatric Hospitalist Neha Shirish Joshi, MD, MS, one of the study’s coauthors and an instructor in the Division of Pediatric Hospital Medicine at Stanford University, Stanford, California.

“We are so excited to collaborate and partner and be at the table” in the care of newborns, she added.

In fact, it’s important to understand that the care for well babies is not a simplified version of the care provided to infants in the NICU.

“There are ways to optimize the care for these babies specifically that we miss out on if we lump them together with babies who are sicker or smaller,” said Joshi.

Newborn hospitalists also have the opportunity to care for new babies without overmedicalizing them, said Lynn McDaniel, MD, division chief of pediatric hospital and integrative medicine and medical director for Acute Pediatrics at UVA Children’s Hospital in Charlottesville, Virginia, who was not involved in the study. Parents of children who undergo more medical interventions begin to view them as more medically fragile, and that affects how they seek out care in the future, she said.

Engel pointed out that the newborn hospitalist can provide an especially valuable service for community pediatricians in busy practices who are short on time.

“In the old days, community pediatricians would even round on their patients hospitalized on the wards, but it became sort of untenable over time,” he said. “It became easier to hand that over to hospitalist pediatricians. As time has gone on, that has even come to apply to newborn care.”

The researchers also highlighted the evidence-based contributions that pediatric hospitalists are making to the care of newborns and advancing scholarship.

“[W]ith the growth of PHM [pediatric hospital medicine] as a field, many hospitalists are primed to serve as experts in the care of these newborns in level I and II nurseries during the birth hospitalization,” the researchers wrote. “Indeed, hospitalists have already led evidence development and implementation efforts for recent changes in newborn care such as seminal work establishing Eat, Sleep, Console, as an approach for opioid withdrawal syndrome, use of dextrose gel for hypoglycemia, prevention and treatment of hypothermia, evaluation for early-onset sepsis, management of hyperbilirubinemia, and promotion of an intact mother-infant dyad.”

“I see us as being the leaders in this space in the future,” said Juliann Kim, MD, a pediatric hospitalist for the Palo Alto Foundation Medical Group in Palo Alto, California, and one of the study’s co-authors.

Preparing the Future Newborn Hospitalist Workforce

According to the study, two thirds of survey respondents were either certified in pediatric hospital medicine or board-eligible, and about 13% of those had completed fellowship training in pediatric hospital medicine.

But that doesn’t mean that everyone needs to necessarily complete a fellowship, even if there were enough spots. “They’re not for everyone,” said Pediatric Hospitalist Leela Sarathy, MD, who co-authored a corresponding commentary titled “A Window Into Life as a Newborn Hospitalist: What Can the Next Generation Expect?” “To mandate it is not the best approach in terms of the patients’ best interest or in terms of preserving the physician workforce.”

However, as the role evolves, future newborn hospitalists may need certain training opportunities to make sure they’re ready to practice. The study authors suggested that future trainees may need some intentional skill building in certain arenas, depending on their location. For example, pediatric hospitalists planning to practice at sites lacking an on-site Level III/IV NICU may need to deliberately pursue training in neonatal resuscitation and stabilization of acutely ill newborns.

Training programs can also focus on identifying residents interested in hospital medicine and helping them pursue the clinical training opportunities necessary to help them prepare for the responsibilities ahead, according to Sarathy, medical director for newborn medicine at Massachusetts General Hospital in Boston.

“It is our responsibility to ensure that we adequately prepare them to fill these roles,” she said.