NEW ORLEANS – The process for creating a new pediatric hospital medicine subspecialty continues to move forward, but concerns are being raised that a PHM fellowship may not meet the needs of community hospitalists and could cut off the pipeline of potential talent.
A recent medical school graduate put a very real and poignant face to those concerns during a panel session at the Pediatric Hospital Medicine 2013 meeting, where experts spent the better part of an hour clarifying and updating the subspecialty process. With $500,000 in medical school debts at more than 6% interest for himself and his physician spouse, the fellowship is not an option.
"I see (the fellowship) as a potential risk for our subspecialty to join the other subspecialties as being one that is in shortage in rural areas and unattractive to a large portion of our workforce," he said.
Ultimately, the goal of the PHM fellowship track is to provide the best patient care for hospitalized children and to move the field forward, panel members stressed. In April 2013, national PHM leaders convened to review multiple sources of data and debate options, before overwhelmingly agreeing that the practice of pediatric hospital medicine requires postresidency training (16 for, 1 against, 1 abstain) and that a 2-year accredited fellowship would be the best option (16 for, 2 abstain).
"I see (the fellowship) as a potential risk for our subspecialty to join the other subspecialties as being one that is in shortage in rural areas and unattractive to a large portion of our workforce..."
An audience member said the new fellowship is a good idea and will be particularly beneficial to pediatric hospitalists in the community setting both for patient trust and peer recognition. She went on to say, however, that the skill set for community pediatric hospitalists is unique in terms of the breadth of knowledge and services they provide and that a strong working relationship will be needed with hospitalists in the university setting, where the fellowship programs will be based, to ensure that community hospitalists get the skill sets they need.
Panelist Dr. Rebecca Blankenburg of Stanford (Calif.) University, said the issue has been a "huge area of conversation" for the group and "what we realized, certainly in fellowship, people have different training goals and training needs. But in all fellowships, we should have very strong community partnerships and so the university programs are really exploring that."
Dr. Blankenburg said the group would welcome input on community hospitalists’ skill sets and that a subgroup is also looking at how those skills should look in residency as well as in fellowship training.
Having worked in both the community and university setting, panelist Dr. Mary Ottolini, vice chair of medical education, Children’s National Medical Center, Washington, D.C., said PHM certification will offer enrichment to both groups.
"The more we can have our training programs bridge these two types of hospital medicine settings, it is just going to strengthen pediatric hospital medicine as a whole," she said.
Panelist Daniel Rauch, associate director of pediatrics at Elmhurst Hospital Center, Queens, N.Y., said there was strong feeling that a 3-year fellowship would be more appropriate for hospitalists to be prepared for work in the community setting. Ultimately, though, they had to balance this with workforce issues and people’s willingness to endure more training after residency.
A 2-year program is not the current standard for fellowships at the American Board of Pediatrics, so the ABP may not accept the group’s petition to create the new subspecialty. Even if it does, it will take awhile. The process for petitioning the ABP for subspecialty status typically takes 6 years, and it could be another 1-2 years once a certifying examination has been implemented before the Accreditation Council for Graduate Medical Education begins the fellowship program accreditation process.
Pediatric hospitalists who are currently in practice or in a currently nonaccredited fellowship will be "grandfathered" in and will be able to sit for the exam the first three test dates, if they meet experiential standards, according to the panel, led by Dr. Jeffrey Simmons, director of pediatric hospital medicine fellowship, Cincinnati Children’s Hospital and Medical Center.
The test will be given every other year, so there will be 4 years from the first test for non–fellowship-trained individuals to be eligible to take the exam. This process allows everyone currently practicing PHM and, most future pediatric hospitalists for at least the next 7-8 years, the ability to sit for the exam, according to the panel.
An audience member expressed concern about meeting the standards for certification, and asked whether the group had considered offering 6 months intensive training in specific areas such as pediatric sedation or pediatric lines for early career hospitalists like himself, whose nearest academic center is 150 miles away and who can’t take 2 years off the job for a fellowship.