Society of Hospital Medicine Position on the American Board of Pediatrics Response to the Pediatric Hospital Medicine Petition

The petition, posted on the AAP SOHM listserv and signed by 1,479 individuals,⁷ raised concerns of anecdotal evidence that the practice pathway criteria disproportionately disadvantaged women, although intentional bias was not suspected by the signers of the letter. The petition’s signers submitted the following demands to the ABP:

• “Facilitate a timely analysis to determine if gender bias is present or perform this analysis internally and release the findings publicly.
• Revise the practice pathway criteria to be more inclusive of applicants with interrupted practice and varied clinical experience, to include clear-cut parameters rather than considering these applications on a closed-door ‘case-by-case basis...at the discretion of the ABP’.
• Clarify the appeals process and improve responsiveness to appeals and inquiries regarding denials.
• Provide a formal response to this petition letter through the PHM ListServ and/or the ABP website within one week of receiving the signed petition.”⁶

A formal response to the petition was released on the AAP SOHM Listserv on August 29, 2019, to address the concerns raised and is published in this issue of the Journal of Hospital Medicine.⁴ In response to the allegation of gender bias, the ABP maintained that the data did not support this, as the denial rate for females (4.0%) was not significantly different than that for males (3.7%). The response acknowledged that once clear-cut criteria were decided upon to augment the general practice pathway criteria published at the outset, these criteria should have been disseminated. The ABP maintained, however, that these criteria, once established, were used consistently in adjudicating all applications. To clarify and simplify the eligibility criteria, the percentage of the full-time equivalent and practice interruption criteria were removed, as the work-hours criteria (direct patient care of hospitalized children ≥450-500 hours per year every year for the preceding four years)⁸ were deemed sufficient to ensure adequate clinical participation.

The Society of Hospital Medicine (SHM), through pediatric hospitalists and pediatricians on its Board, committees, and the Executive Council of the Pediatric Special Interest Group, has followed with great interest the public debate surrounding the PHM certification process and the subsequent PHM petition to the ABP. The ABP responded swiftly and with full transparency to the petition, and SHM supports these efforts by the ABP to provide a timely, honest, data-driven response to the concerns raised by the PHM petition. SHM recognizes that the mission of the ABP is to provide the public with confidence that physicians with ABP board certifications meet appropriate “standards of excellence”. While the revisions implemented by the ABP in its response still may not satisfy the concerns of all members of the PHM community, SHM recognizes that the revised requirements remain true to the mission of the ABP.

SHM applauds the authors and signatories of the PHM petition for bravely raising their concerns of gender bias and lack of transparency. The response of the ABP to this petition by further improving transparency serves as an example of continuous improvement in collaborative practice to all medical specialty boards.

While SHM supports the ABP response to the PHM petition, it is clear that excellent physicians caring for hospitalized children will be unable to achieve PHM board certification for a variety of reasons. For these physicians who are not PHM board certified as pediatric hospitalists by the ABP, SHM supports providing these physicians with recognition as hospitalists. These include “niche” hospitalists, such as newborn hospitalists, subacute hospitalists, and subspecialty hospitalists. SHM will also continue to support and recognize community-based hospitalists, family medicine-trained hospitalists, and Med-Peds hospitalists whose practice may not comply with criteria laid out by the ABP. For these physicians, receiving Fellow designation through SHM, a merit-based distinction requiring demonstration of clinical excellence and commitment to hospital medicine, is another route whereby physicians can achieve designation as a hospitalist.