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Leaders in the field of pediatric hospital medicine will meet with the American Board of Pediatrics this spring in an attempt to develop a pathway for standardized training and certification in the field.
Although pediatric hospitalists have been around for decades and have created large bodies of work in both research and quality improvement, training in the field is variable. Some pediatric hospitalists go through years of fellowship, while others get on-the-job training after residency.
With that in mind, a large group of pediatric hospitalists began meeting about 2 years ago to figure out if the time had come for some type of standardized training and certification and what that would look like.
"It’s still a little up in the air," said Dr. Christopher G. Maloney, who cochaired the strategic planning committee comprised of volunteers from the American Academy of Pediatrics Section on Hospital Medicine, the Academic Pediatric Association, and the Society of Hospital Medicine.
The committee of nearly 50 physicians was formed in December 2010 to evaluate a range of options that would set pediatric hospital medicine apart as a distinct specialty. The options included everything from a 3-year fellowship under the direction of the American Board of Pediatrics to a continuation of the status quo.
There was a lot of interest and excitement about finding a way forward, Dr. Maloney, chief of pediatric inpatient medicine at the University of Utah and Primary Children’s Medical Center in Salt Lake City, said in an interview.
The committee held conference calls and meetings for several months to look at the pros and cons of various options. What developed was a general consensus that additional training is needed for pediatric hospitalists, said Dr. Suzanne Swanson Mendez, committee cochair and a pediatric hospitalist at Santa Clara Valley Medical Center in San Jose, Calif.
But how to operationalize that idea is still an open question.
In addition to the 3-year fellowship option, the committee also considered 2 years of fellowship, a hospital medicine residency track combined with 1 year of fellowship, or a fast-track approach that would require 2 years of residency and 2-3 years of fellowship training.
And they considered options outside of the traditional fellowship, such as creating a hospital medicine track during general pediatric residency. Other possibilities include a mandatory mentorship program after training or a Recognition of Focused Practice for pediatric hospital medicine, similar to what is offered by the American Board of Internal Medicine for hospitalists.
One of the reasons that reaching agreement on a specific option has been so difficult is that whatever is chosen must meet the needs of both academic and community hospitalists, Dr. Mendez said in an interview.
Another problem is that adding more training could impact interest among debt-burdened medical students.
One reason that hospital medicine is so attractive is that physicians can enter without completing fellowship training, said Dr. Tamara D. Simon, a pediatric hospitalist at Seattle Children’s Hospital who was closely involved in the strategic planning committee process. But on the other hand, there are additional skills necessary to care for hospitalized children, she said.
"I do think that there are specific skills learned in the course of fellowship that can really facilitate our ability to care for hospitalized children in both academic and community settings," Dr. Simon said in an interview.
Members of the strategic planning committee aren’t the only ones struggling with this issue.
During a 2-week period in July 2011, the committee surveyed pediatric hospitalists who were on listservs sponsored by the American Academy of Pediatrics Section on Hospital Medicine, the Academic Pediatric Association, and the Society of Hospital Medicine. Of the 132 respondents to the convenience sample, 33% preferred Recognition of Focused Practice, 30% favored a 2-year fellowship with subspecialty designation, and 17% selected a hospital medicine track within a pediatric residency (Hospital Pediatrics 2012;2:187-90).
Polls taken at last summer’s Pediatric Hospital Medicine meeting in Kentucky showed that physicians continue to be all over the map on this issue.
Among 109 audience members who attended a presentation about the strategic planning committee’s work and responded to questions, 27% said a 2-year fellowship under the American Board of Pediatrics guidelines was the best option. Another 18% favored the Recognition of Focused Practice, 14% selected a hospital medicine residency track with a 1-year fellowship, and 13% chose the status quo with the option for specialized training. The rest of the respondents were split among other training options or were undecided, according to Dr. Simon.
Dr. Erin Stucky Fisher, who runs the pediatric hospital medicine fellowship program at Rady Children’s Hospital in San Diego, offered her views while the committee was gathering comments. She said there’s a need for codified, credible training for everyone who cares for hospitalized children. That would let hospitals and patients know that training in pediatric hospital medicine results in a certain specific set of skills.
"That’s what I think kids need. We need to ask, ‘What is best for the hospitalized child?’ " Dr. Fisher said.
But while that training could lead to subspecialty board certification, it doesn’t have to, she said. However, the training program does need to teach the core competencies of the specialty. What a program looks like, and what form of certification should be considered, is under review, she said. The only option she would rule out is doing nothing.
"Staying still is hard and isn’t what pediatric hospitalists have done," Dr. Fisher said.
But Kenneth Pituch, director of the division of pediatric hospital medicine at C.S. Mott Children’s Hospital in Ann Arbor, Mich., is on the other end of the spectrum. He told the committee it’s too early to consider carving out a certification pathway that potentially requires 2 or 3 additional years of training. "We’re not quite there yet for a couple of reasons," he said.
For instance, requiring additional years of training for pediatric hospital medicine could make the specialty significantly less attractive to young doctors, he said. That would put a drain on the workforce needed to care for sick children in the hospital.
He’s also concerned about widening the gap in training between pediatricians working in the hospital and those in the outpatient setting at a time when collaboration in the care of chronically ill children is so important.
Right now, there are outpatient physicians who see a high volume of relatively healthy children, and pediatric hospitalists who care for acutely ill children. The problem is that there is little going on to address the care for the chronically ill children who bounce back and forth between the two settings, Dr. Pituch said. There could be a role for pediatric hospitalists in improving that care, but moving forward now with certification could make it more difficult to figure out what this other model would look like, he said.
"I’m just saying, let’s hold off," he added.
Leaders in the field of pediatric hospital medicine will meet with the American Board of Pediatrics this spring in an attempt to develop a pathway for standardized training and certification in the field.
Although pediatric hospitalists have been around for decades and have created large bodies of work in both research and quality improvement, training in the field is variable. Some pediatric hospitalists go through years of fellowship, while others get on-the-job training after residency.
With that in mind, a large group of pediatric hospitalists began meeting about 2 years ago to figure out if the time had come for some type of standardized training and certification and what that would look like.
"It’s still a little up in the air," said Dr. Christopher G. Maloney, who cochaired the strategic planning committee comprised of volunteers from the American Academy of Pediatrics Section on Hospital Medicine, the Academic Pediatric Association, and the Society of Hospital Medicine.
The committee of nearly 50 physicians was formed in December 2010 to evaluate a range of options that would set pediatric hospital medicine apart as a distinct specialty. The options included everything from a 3-year fellowship under the direction of the American Board of Pediatrics to a continuation of the status quo.
There was a lot of interest and excitement about finding a way forward, Dr. Maloney, chief of pediatric inpatient medicine at the University of Utah and Primary Children’s Medical Center in Salt Lake City, said in an interview.
The committee held conference calls and meetings for several months to look at the pros and cons of various options. What developed was a general consensus that additional training is needed for pediatric hospitalists, said Dr. Suzanne Swanson Mendez, committee cochair and a pediatric hospitalist at Santa Clara Valley Medical Center in San Jose, Calif.
But how to operationalize that idea is still an open question.
In addition to the 3-year fellowship option, the committee also considered 2 years of fellowship, a hospital medicine residency track combined with 1 year of fellowship, or a fast-track approach that would require 2 years of residency and 2-3 years of fellowship training.
And they considered options outside of the traditional fellowship, such as creating a hospital medicine track during general pediatric residency. Other possibilities include a mandatory mentorship program after training or a Recognition of Focused Practice for pediatric hospital medicine, similar to what is offered by the American Board of Internal Medicine for hospitalists.
One of the reasons that reaching agreement on a specific option has been so difficult is that whatever is chosen must meet the needs of both academic and community hospitalists, Dr. Mendez said in an interview.
Another problem is that adding more training could impact interest among debt-burdened medical students.
One reason that hospital medicine is so attractive is that physicians can enter without completing fellowship training, said Dr. Tamara D. Simon, a pediatric hospitalist at Seattle Children’s Hospital who was closely involved in the strategic planning committee process. But on the other hand, there are additional skills necessary to care for hospitalized children, she said.
"I do think that there are specific skills learned in the course of fellowship that can really facilitate our ability to care for hospitalized children in both academic and community settings," Dr. Simon said in an interview.
Members of the strategic planning committee aren’t the only ones struggling with this issue.
During a 2-week period in July 2011, the committee surveyed pediatric hospitalists who were on listservs sponsored by the American Academy of Pediatrics Section on Hospital Medicine, the Academic Pediatric Association, and the Society of Hospital Medicine. Of the 132 respondents to the convenience sample, 33% preferred Recognition of Focused Practice, 30% favored a 2-year fellowship with subspecialty designation, and 17% selected a hospital medicine track within a pediatric residency (Hospital Pediatrics 2012;2:187-90).
Polls taken at last summer’s Pediatric Hospital Medicine meeting in Kentucky showed that physicians continue to be all over the map on this issue.
Among 109 audience members who attended a presentation about the strategic planning committee’s work and responded to questions, 27% said a 2-year fellowship under the American Board of Pediatrics guidelines was the best option. Another 18% favored the Recognition of Focused Practice, 14% selected a hospital medicine residency track with a 1-year fellowship, and 13% chose the status quo with the option for specialized training. The rest of the respondents were split among other training options or were undecided, according to Dr. Simon.
Dr. Erin Stucky Fisher, who runs the pediatric hospital medicine fellowship program at Rady Children’s Hospital in San Diego, offered her views while the committee was gathering comments. She said there’s a need for codified, credible training for everyone who cares for hospitalized children. That would let hospitals and patients know that training in pediatric hospital medicine results in a certain specific set of skills.
"That’s what I think kids need. We need to ask, ‘What is best for the hospitalized child?’ " Dr. Fisher said.
But while that training could lead to subspecialty board certification, it doesn’t have to, she said. However, the training program does need to teach the core competencies of the specialty. What a program looks like, and what form of certification should be considered, is under review, she said. The only option she would rule out is doing nothing.
"Staying still is hard and isn’t what pediatric hospitalists have done," Dr. Fisher said.
But Kenneth Pituch, director of the division of pediatric hospital medicine at C.S. Mott Children’s Hospital in Ann Arbor, Mich., is on the other end of the spectrum. He told the committee it’s too early to consider carving out a certification pathway that potentially requires 2 or 3 additional years of training. "We’re not quite there yet for a couple of reasons," he said.
For instance, requiring additional years of training for pediatric hospital medicine could make the specialty significantly less attractive to young doctors, he said. That would put a drain on the workforce needed to care for sick children in the hospital.
He’s also concerned about widening the gap in training between pediatricians working in the hospital and those in the outpatient setting at a time when collaboration in the care of chronically ill children is so important.
Right now, there are outpatient physicians who see a high volume of relatively healthy children, and pediatric hospitalists who care for acutely ill children. The problem is that there is little going on to address the care for the chronically ill children who bounce back and forth between the two settings, Dr. Pituch said. There could be a role for pediatric hospitalists in improving that care, but moving forward now with certification could make it more difficult to figure out what this other model would look like, he said.
"I’m just saying, let’s hold off," he added.
Leaders in the field of pediatric hospital medicine will meet with the American Board of Pediatrics this spring in an attempt to develop a pathway for standardized training and certification in the field.
Although pediatric hospitalists have been around for decades and have created large bodies of work in both research and quality improvement, training in the field is variable. Some pediatric hospitalists go through years of fellowship, while others get on-the-job training after residency.
With that in mind, a large group of pediatric hospitalists began meeting about 2 years ago to figure out if the time had come for some type of standardized training and certification and what that would look like.
"It’s still a little up in the air," said Dr. Christopher G. Maloney, who cochaired the strategic planning committee comprised of volunteers from the American Academy of Pediatrics Section on Hospital Medicine, the Academic Pediatric Association, and the Society of Hospital Medicine.
The committee of nearly 50 physicians was formed in December 2010 to evaluate a range of options that would set pediatric hospital medicine apart as a distinct specialty. The options included everything from a 3-year fellowship under the direction of the American Board of Pediatrics to a continuation of the status quo.
There was a lot of interest and excitement about finding a way forward, Dr. Maloney, chief of pediatric inpatient medicine at the University of Utah and Primary Children’s Medical Center in Salt Lake City, said in an interview.
The committee held conference calls and meetings for several months to look at the pros and cons of various options. What developed was a general consensus that additional training is needed for pediatric hospitalists, said Dr. Suzanne Swanson Mendez, committee cochair and a pediatric hospitalist at Santa Clara Valley Medical Center in San Jose, Calif.
But how to operationalize that idea is still an open question.
In addition to the 3-year fellowship option, the committee also considered 2 years of fellowship, a hospital medicine residency track combined with 1 year of fellowship, or a fast-track approach that would require 2 years of residency and 2-3 years of fellowship training.
And they considered options outside of the traditional fellowship, such as creating a hospital medicine track during general pediatric residency. Other possibilities include a mandatory mentorship program after training or a Recognition of Focused Practice for pediatric hospital medicine, similar to what is offered by the American Board of Internal Medicine for hospitalists.
One of the reasons that reaching agreement on a specific option has been so difficult is that whatever is chosen must meet the needs of both academic and community hospitalists, Dr. Mendez said in an interview.
Another problem is that adding more training could impact interest among debt-burdened medical students.
One reason that hospital medicine is so attractive is that physicians can enter without completing fellowship training, said Dr. Tamara D. Simon, a pediatric hospitalist at Seattle Children’s Hospital who was closely involved in the strategic planning committee process. But on the other hand, there are additional skills necessary to care for hospitalized children, she said.
"I do think that there are specific skills learned in the course of fellowship that can really facilitate our ability to care for hospitalized children in both academic and community settings," Dr. Simon said in an interview.
Members of the strategic planning committee aren’t the only ones struggling with this issue.
During a 2-week period in July 2011, the committee surveyed pediatric hospitalists who were on listservs sponsored by the American Academy of Pediatrics Section on Hospital Medicine, the Academic Pediatric Association, and the Society of Hospital Medicine. Of the 132 respondents to the convenience sample, 33% preferred Recognition of Focused Practice, 30% favored a 2-year fellowship with subspecialty designation, and 17% selected a hospital medicine track within a pediatric residency (Hospital Pediatrics 2012;2:187-90).
Polls taken at last summer’s Pediatric Hospital Medicine meeting in Kentucky showed that physicians continue to be all over the map on this issue.
Among 109 audience members who attended a presentation about the strategic planning committee’s work and responded to questions, 27% said a 2-year fellowship under the American Board of Pediatrics guidelines was the best option. Another 18% favored the Recognition of Focused Practice, 14% selected a hospital medicine residency track with a 1-year fellowship, and 13% chose the status quo with the option for specialized training. The rest of the respondents were split among other training options or were undecided, according to Dr. Simon.
Dr. Erin Stucky Fisher, who runs the pediatric hospital medicine fellowship program at Rady Children’s Hospital in San Diego, offered her views while the committee was gathering comments. She said there’s a need for codified, credible training for everyone who cares for hospitalized children. That would let hospitals and patients know that training in pediatric hospital medicine results in a certain specific set of skills.
"That’s what I think kids need. We need to ask, ‘What is best for the hospitalized child?’ " Dr. Fisher said.
But while that training could lead to subspecialty board certification, it doesn’t have to, she said. However, the training program does need to teach the core competencies of the specialty. What a program looks like, and what form of certification should be considered, is under review, she said. The only option she would rule out is doing nothing.
"Staying still is hard and isn’t what pediatric hospitalists have done," Dr. Fisher said.
But Kenneth Pituch, director of the division of pediatric hospital medicine at C.S. Mott Children’s Hospital in Ann Arbor, Mich., is on the other end of the spectrum. He told the committee it’s too early to consider carving out a certification pathway that potentially requires 2 or 3 additional years of training. "We’re not quite there yet for a couple of reasons," he said.
For instance, requiring additional years of training for pediatric hospital medicine could make the specialty significantly less attractive to young doctors, he said. That would put a drain on the workforce needed to care for sick children in the hospital.
He’s also concerned about widening the gap in training between pediatricians working in the hospital and those in the outpatient setting at a time when collaboration in the care of chronically ill children is so important.
Right now, there are outpatient physicians who see a high volume of relatively healthy children, and pediatric hospitalists who care for acutely ill children. The problem is that there is little going on to address the care for the chronically ill children who bounce back and forth between the two settings, Dr. Pituch said. There could be a role for pediatric hospitalists in improving that care, but moving forward now with certification could make it more difficult to figure out what this other model would look like, he said.
"I’m just saying, let’s hold off," he added.
