In reflecting on the history of pediatric hospital medicine (HM), I have identified a widening schism between inpatient and outpatient pediatrics as the major threat to HM. Here, I follow Bob Wachter’s lead from SHM’s May annual meeting and detail key steps for pediatric HM in the upcoming 10 years.
Define the field: The SHM Pediatric Committee and the Ambulatory Pediatric Association’s (APA) hospital medicine special interest group are collaborating to publish a list of core clinical procedural and systems domains for pediatric hospital medicine.
This will provide a blueprint of how we have defined our field and supply a framework for pediatric acute care residency tracks, hospitalist electives, hospitalist fellowships, and maintenance of certification (MOC). Related characterizations of the field are available through pediatric hospital medicine textbooks. The Pediatric Research in Inpatient Settings (PRIS) network is studying the epidemiology of pediatric HM practice to provide an evidence basis for these expert decrees.
Individual programs should use these resources to help develop program-specific hospitalist privilege materials based on documented patient acuity, volume, and hospital medicine CME activities. The specific criteria and privileges will differ based on differences in job description between and within tertiary care centers and community hospitals—but all will include the general pediatric ward.
Develop MOC Appropriate for Pediatric Hospitalists: The American Board of Internal Medicine has officially approved the creation of a Focused Recognition of Hospital Medicine through its MOC system. A final decision rests with the American Board of Medical Specialties.
Pediatric hospitalists will do well to wait several years to examine the results of these efforts before deciding whether to pursue a similar designation from the American Board of Pediatrics. In the meantime, we should be on a fast track to create specific pediatric HM materials that will meet the 2010 MOC requirements.
There are at least 1,500 practicing pediatric hospitalists. This is equal to the number of board-certified pediatric ED physicians (1,446) and considerably more than the number of pulmonologists (821). Certainly these numbers merit development of MOC materials specifical to pediatric HM. The American Academy of Pediatrics (AAP) is developing an inpatient Education in Quality Improvement for Pediatric Practice (eQIPP) asthma model. SHM may be able to develop a transitions-of-care personal information manager and/or self-evaluation program (SEP) module appropriate for adult and pediatric hospitalists.
The only things missing are a comprehensive inpatient SEP and a closed-book exam. Pediatric hospitalists are here to stay. The American Board of Pediatrics (ABP) will best fulfill its responsibility to the public by creating an MOC program germane to pediatric HM. The actual designation on the MOC doesn’t need to be changed in 2010, but hospitalists recertifying in 2010 should be participating in relevant activities.
Expand pediatric HM (post-) graduate medical education: The increasing number of hospitalists will undoubtedly influence pediatric graduate medical education.
The ABP’s Residency Review and Redesign in Pediatrics project, which looks at global reform of pediatric residency training, should allow for acute care pediatric residency tracks. These would be amenable to pediatricians planning careers in HM, emergency medicine, and critical care.
Overall, most pediatric hospitalists will continue to begin their careers directly out of residency. Although pediatric hospitalist fellowship programs are likely to increase in number, formal fellowship training will not be required for one to practice as a pediatric hospitalist. These programs will benefit individuals choosing either an academic or administrative career. Frontline hospitalists should be able to gain suitable experience through appropriately mentored and supported clinical practice and focused CME activities—much as a new office-based pediatrician matures during his or her initial years in practice.