The History of Pediatric Hospital Medicine in the United States, 1996-2019

In 2009, PHM leaders within SHM, APA, and AAP held a pivotal strategic planning “roundtable” to discuss the future of the field.¹⁴ A vision statement was developed, serving as a guide to the tasks needed to achieve the vision: “Pediatric hospitalists will transform the delivery of hospital care for children.” Five areas were considered: clinical, quality, research, workforce, and structure. Clinical practice was defined as including both “direct patient care and leadership of the inpatient service.” It was recognized that standardizing, disseminating, and increasing knowledge to improve clinical care was important, but so, too, was taking on leadership roles to improve systems and extend into areas such as sedation. Quality improvement was identified as the measure by which the value of PHM would be assessed. To further efforts in this area, a PHM Quality Improvement (QI) Collaborative work group was created. Research was clearly a necessary component to establish and advance the field. The Children’s Hospital Association had launched the Pediatric Health Information System (PHIS) database in 1993, and PHIS began to flourish as a research database when Samir Shah, MD, MSCE, and Matt Hall, PhD, headed the Research Groups in 2007. Discussions to form an independent research network began in 2001, and, in 2002, the Pediatric Research in Inpatient Settings network (PRIS) was launched, led by Christopher Landrigan, MD, MPH.¹⁵ The APA provided organization support in 2006, but a redesign was considered necessary to further move the research initiative forward.¹⁵ A Research Leadership Task Force was created, resulting in a new PRIS Network Executive Council, chaired by Rajendu Srivastava, MD, MPH, until 2016, when Karen Wilson, MD, MPH, became chair. Clinical and workforce issues focused on the need to supplement residency training with added skills and knowledge to practice as a pediatric hospitalist. An Education Task Force was created, charged with developing “an educational plan supporting the PHM Core Competencies and addressing hospitalist training needs, including the role as formal educators.” The task force was headed by Mary Ottolini, MD, MPH, MEd, who was aided by Jennifer Maniscalco, MD, MPH, MAcM. Regarding structure of PHM, the decision was made not to develop an independent society but to continue to function within and benefit from the resources of SHM, AAP, and APA, with a Joint Council on Pediatric Hospital Medicine (JCPHM). Established in 2011, the JCPHM included representatives of the AAP, APA, SHM, PRIS, VIP, community hospitals, and the Education Task Force. Erin Stucky Fisher, MD, MHM, served as the first chair. The JCPHM was replaced in the fall of 2016 by a Consortium on PHM, which consists of the chairs and chair elects of the AAP SOHM, the APA Hospital Medicine SIG, and the SHM pediatrics committee. The leadership rotates annually among the three organizations.

The American Board of Pediatrics (ABP) recognized the growing field of PHM and, through its foundation, commissioned a series of studies, the first of which was published in 2006 entitled “Hospitalists in children’s hospitals: What we know now and what we need to know.”¹⁶ It was not clear whether the PHM community would pursue subspecialty certification. The leaders of the 2009 “roundtable” meeting commissioned a Strategic Planning Committee (STP) led by Christopher Maloney, MD, PhD, and Suzanne Swanson Mendez, MD, to evaluate the best course of action: traditional ABP subspecialty certification, hospital medicine residency track (with or without additional fellowship), Recognition of Focused Practice (as implemented by the American Board of Internal Medicine and American Board of Family Medicine), mandatory mentorship program, or status quo with option for specialized training. There was considerable discussion of the alternatives in the PHM community. In 2012, the STP shared the results of Strengths-Weaknesses-Opportunities-Threats analyses—but did not issue a recommendation.¹⁷ The following year, a National PHM Leaders Conference was held to consider the various options. Participants concluded that the best path forward was to pursue subspecialty certification with a requirement for 2 years of fellowship (after a time-limited period for practice pathway eligibility). Two years of fellowship was a departure from the ABP’s standard 3 years, but seemed acceptable based on the expectation that the research component would be integrated with clinical activities (eg, QI), rather than separate bench research. The ABP Initiative on Subspecialty Clinical Training and Certification had recommended flexibility in the duration of fellowships,¹⁸ and PHM became the first discipline to take advantage of such flexibility. Following an 18-month review of multiple considerations, the ABP concluded that “children will be better served by establishing the discipline as a new subspecialty.”¹⁹