Childrens' Hospitals: Free-standing vs. Hospital-Within-A-Hospital Models

When looking at a pediatric residency, often the question is asked whether a program within a Childrens’ Hospital has an advantage or disadvantage over the Hospital in a Hospital model used by many programs. The truth is that both have their strengths and weaknesses. Both will provide excellent educational opportunities for their residents and the selection is really more of a personal choice. Program requirements for resident exposure ensure that neither environment can provide significantly more or less exposure to patients than the other.

Perceived Strengths for Childrens’ Hospitals vs. Hospital Within A Hospital Model

There certainly are differences in working in each setting. In general, free-standing childrens’ hospitals have larger volumes of patients, particularly in seasons where RSV, influenza and rotavirus are rampant. This does not typically lead to increased exposure of large variety of patients as the RRC limits the number of patients any resident can care for at one time. To deal with this, most hospitals have an uncovered service for at least part of the year. While hospital in a hospital systems typically do not have a large an influx of any one type of patient illness, they do tend to attract a diverse population of general pediatric and subspecialty patients. This supports an extensive and varied experience for pediatric residents.

Childrens' hospitals typically have age limits of 18 years of age. While having a dedicated hospital for children has certain intrinsic advantages, it limits ongoing care for patients whose diseases are typically cared for by pediatricians. The difficulty in transition of care has become a national issue not easily managed in the childrens’ hospital model. The hospital in a hospital model used here at Tulane and Ochsner are a much better answer for these patients with ongoing care provided for them with pediatric input. Care for children provided in the setting of a large multi-specialty hospital requires such institutions to have a large and diverse number of services for their sizable patient populations. The availability of unique cutting edge technology leads to economies of scale for such institutions with multiple diagnostic and interventional services not typically available to single free standing childrens’ hospitals.

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