Late Career Pediatric Hospitalists: Programmatic Accommodations During the COVID-19 Pandemic

Background: Physicians are working to older ages, lending experience and knowledge that benefits patient care and education. Studies show advanced age as a risk factor for morbidity/mortality from acute respiratory syndrome-coronavirus-2 (COVID-19), placing older physicians at high-risk during this pandemic. As pediatric hospitalists (PH) care for children with respiratory illnesses, these providers may be exposed to patients with COVID-19 infection. The objective of this study is to describe current practice regarding modifications to work hour requirements and patient encounters for late career (≥50 years) PH during the COVID-19 pandemic.

Methods: This observational mixed-methods study used an anonymous cross-sectional survey sent to the American Academy of Pediatrics Hospital Medicine Division Chief listserv between May and June 2020. The survey used Yes/No, multiple choice, and open-ended questions to assess modifications made due to COVID-19 for late career PH. The Fisher exact test examined the association of program characteristics with COVID-19 accommodations. Grounded theory was used to analyze responses to open-ended questions, with questions coded, developed into themes, and compared until consensus was achieved (Table).

Results: Surveys were completed by directors of 47 programs, including 43 (91%) with PH ages 50-64 years, and 13 (28%) with PH ≥65 years. The corresponding total of 982 PH included 117 (12%) 50-64 years and 15 (1.5%) ≥65 years. Employer types included hospital, medical group, or academic center (Table). Accommodations were made by 52% of programs who employed PH up to 65 years of age and 77% of programs who employed PH >65 years (Figure). No statistical difference was noted in accommodations when compared by location, employer type, program size, or total number of PH employed ≥50 years or ≥65 years (Table). Qualitative analysis of responses related to method of accommodation revealed 2 themes: time (15%) and exposure-based (85%) modifications. Time-based example; “we offered those over 65 to move (clinical shifts) into next year”. Exposure-based example; “kept off of clinical service during COVID if ≥65 years”.

Conclusion: While nearly all responding programs employed PH ≥50 years, only 28% had PH ≥65 years. COVID-19 accommodations increased from 52% to 77% when PH ≥65 years were present. Modifications were time or exposure-based, with exposure-based changes having a higher prevalence. In order to retain the valuable input from late career PH, programs will need to consider how to extend safe use of these practitioners over the remaining course of the pandemic.