Pediatric hospital medicine marches toward subspecialty recognition

Is the fellowship good for the field?

The subspecialty development process clearly is moving forward. Those in favor believe it will increase scholarship, research, and recognition for the subspecialty by the public for its specialized body of knowledge. But not everyone in the field agrees. Last fall The Hospitalist published³ an opinion piece questioning the need for fellowship-based board certification in pediatric hospital medicine. The author recommended instead retaining the current voluntary approach to fellowships and establishing a pediatric “focused practice” incorporated into residency training, much as the American Board of Internal Medicine and the American Board of Family Medicine have done for hospitalists in adult medicine.

Weijen Chang, MD, SFHM, chief of the division of pediatric hospital medicine at Baystate Children’s Hospital in Springfield, Mass., wrote an introduction for that article. He wonders if board certification will eventually become necessary to continue seeing pediatric patients in the hospital. “This process leaves that question to local hospitals as the decision makers. But we can’t know what your local hospital credentialing committee will do,” he said.

“Will it lead to uncertainty among those currently in residency programs? If you are a pediatric resident and you want to become a board-certified pediatric hospitalist, you’ll need at least 2 years more of training. Is that going to deter qualified individuals?” Dr. Chang said. “The people this decision will impact the most are med-peds doctors – who complete a combined internal medicine and pediatrics residency – and part-timers. They may find themselves in a difficult position if the number of hours don’t add up for them to sit for the boards. For the most part, we’ll have to wait and see for answers to these questions.”

Brian Alverson, MD, FAAP, current chair of the AAP’s Section on Hospital Medicine and associate professor of pediatrics at Brown University, Providence, R.I., says he can see both sides of the debate.

“I think for the field of pediatric hospital medicine, as far as advancing our knowledge and the care of children in the hospital, this is a very good thing,” he said. “It will push academic children’s hospitals that don’t have a division of hospital medicine to invest in one. All of the really sick children are in the hospital, and if we’re going to attend to those children at their most vulnerable time, we need to address the existing knowledge gap in pediatric hospital medicine.”

But at the same time, there is a significant opportunity cost for doing 2 more years of fellowship training, Dr. Alverson said.

“We don’t know how much the board certification test will improve actual care,” he noted. “Does it truly identify higher quality doctors, or just doctors who are good at taking multiple choice exams? There are a number of people in pediatrics who do a lot of different things in their jobs, and it’s important that they not lose their ability to practice in the field. Two-thirds of our work force is in community hospitals, not academic medical centers. They work hard to provide the backbone of hospital care for young patients, and many of them are unlikely to ever do a fellowship.”

Nonetheless, Dr. Alverson believes pediatric hospitalists needn’t worry. “You still have plenty of time to figure out what’s going to happen in your hospital,” he said.

References

1. Section on Hospital Medicine. Guiding principles for pediatric hospital medicine program. Pediatrics; 2013; 132:782-786.

2. Stucky E. The Pediatric Hospital Medicine Core Competencies. Wiley-Blackwell; 2010.

3. Feldman LS, Monash B, Eniasivam A. Why required pediatric hospital medicine fellowships are unnecessary. The Hospitalist Magazine, October 8, 2016.