Pediatric hospitalists ponder training, certification options
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.
