Future fellowship requirement for inpatient pediatrics

[gentlebalogna]

Hey everyone,

I am a first-year medical student interested in inpatient pediatrics. Not something I would have expected before school, and I still might change my mind, but I really like it!

I keep hearing that, increasingly, a fellowship will be needed to be competitive to practice inpatient peds. I have to say, adding on a fellowship for something that's currently done with just a residency does not sound very appealing. It's also unclear if that will come with a pay boost, since peds is not a particularly lucrative specialty.

Right now, my dream job would be at a community Children's hospital in a mid-sized city on the West Coast. There are other academic children's hospitals in my state, but I like the mid-sized city I currently live in and would love to return here to practice after residency.

Where do you see this requirement going in the future? Will it only really affect academic centers, or will it trickle into community hospitals too?

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[GoSpursGo]

Right now, with pediatric hospitalist medicine (PHM) fellowships still being pretty scarce and the demand for inpatient hospitalist DJM the community being high, in the short and medium term I don’t think it will be a strict requirement for community hospitals. It likely will be required for academic centers. Of course none of us have a crystal ball

 

[gentlebalogna]

Right now, with pediatric hospitalist medicine (PHM) fellowships still being pretty scarce and the demand for inpatient hospitalist DJM the community being high, in the short and medium term I don’t think it will be a strict requirement for community hospitals. It likely will be required for academic centers. Of course none of us have a crystal ball

Hey thank you for sharing your perspective! I really appreciate that. I guess we will have to see where things are at in 6 years - when I theoretically pop out of residency 😜

Thank you!

 

[mvenus929]

Hard to predict the future, but I imagine only the prestigious large Children's Hospitals will require board certification to work, and currently a large amount of the currently practicing workforce will be able to do so without the fellowship. If fellowship spots don't respond to demand, you can probably get a job at a community hospital without issue. But yeah... this is all crystal ball stuff.

 

[SurfingDoctor]

I strongly suspect in the longterm, it will be a requirement globally. Not saying that I agree with it, but I think it will be. I think had the initial fellowship not been popular but instead hard to fill, then it probably would have died the painful death. Actually, since the fellowship had been around since 2008, that was the general trend, until it became a board certified subspecialty. That changed the trajectory and quite dramatically, so instead you have what is currently the most competitive specialty in all of pediatrics. Hospitals and programs will see this demand as an opportunity (I mean, being honest, it's always beneficial to have experience but cheap, warm bodies for patient care) and likely open more programs which will help the competition from a fellowship standpoint, but essentially make it the standard of care (there are currently 18 new fellowship programs in development FYI). Community hospitals will then have the choice of either a) choose to practice within that standard and hire BE/BC hospitalists or b) ship patients off to a tertiary center where that will be a requirement anyway... especially considering that community pediatric hospitalist positions only make up 1/3 of the workforce. In fact, since the fellowship curriculum is geared toward academics but also managing community issues without supporting subspecialities (there's stuff in the curriculum like intubation, chest tube, CVLs, etc.... though I don't think any program will provide sufficient proficiency) there is a very collective effort to make this desirable for the community hospital setting. Either way, the idea of a non-BE/BC fellowship trained pediatric hospitalist is going the way of the dodo. What's that trajectory? That's hard to predict, but I would say easily within the next decade.

I mean, it's kinda a shame and I would hope/love if the ABP/AAP actually collected data that this made a lick of difference, but I don't think they really care. Just be glad its only a 2 year fellowship... for now.

If you want some perspective of how resident/trainees concerns regarding hospitalist fellowship are dismissed and how much of an uphill battle you've got, you're all welcome read this...

PHM Fellowships: Advanced Training for an Evolving Field

We read with interest “A Changing Landscape: Understanding Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships.”1 The publication is timely, given the recent designation of Pediatric Hospital Medicine (PHM) as a subspecialty by the American Board of Medical Specialties and...

hosppeds.aappublications.org

However, given that the number of responses only represents 8% of Pediatrics and Med-Peds residents nationally, it is challenging to extrapolate this information to pediatric residency trainees at large. As PHM and PHM fellowship programs continue to grow, it is important to keep exploring the related perspectives of all pediatric residents and proactively address their needs and concerns. It is incumbent on PHM fellowship programs to continue including residents who have goals of working in the community or as Med-Peds hospitalists and to ensure that PHM programs can provide the robust clinical and scholarly experiences those trainees require.

 

[oldbearprofessor]

I strongly suspect in the longterm, it will be a requirement globally. Not saying that I agree with it, but I think it will be. I think had the initial fellowship not been popular but instead hard to fill, then it probably would have died the painful death. Actually, since the fellowship had been around since 2008, that was the general trend, until it became a board certified subspecialty. That changed the trajectory and quite dramatically, so instead you have what is currently the most competitive specialty in all of pediatrics. Hospitals and programs will see this demand as an opportunity (I mean, being honest, it's always beneficial to have experience but cheap, warm bodies for patient care) and likely open more programs which will help the competition from a fellowship standpoint, but essentially make it the standard of care (there are currently 18 new fellowship programs in development FYI). Community hospitals will then have the choice of either a) choose to practice within that standard and hire BE/BC hospitalists or b) ship patients off to a tertiary center where that will be a requirement anyway... especially considering that community pediatric hospitalist positions only make up 1/3 of the workforce. In fact, since the fellowship curriculum is geared toward academics but also managing community issues without supporting subspecialities (there's stuff in the curriculum like intubation, chest tube, CVLs, etc.... though I don't think any program will provide sufficient proficiency) there is a very collective effort to make this desirable for the community hospital setting. Either way, the idea of a non-BE/BC fellowship trained pediatric hospitalist is going the way of the dodo. What's that trajectory? That's hard to predict, but I would say easily within the next decade.

I mean, it's kinda a shame and I would hope/love if the ABP/AAP actually collected data that this made a lick of difference, but I don't think they really care. Just be glad its only a 2 year fellowship... for now.

If you want some perspective of how resident/trainees concerns regarding hospitalist fellowship are dismissed and how much of an uphill battle you've got, you're all welcome read this...

PHM Fellowships: Advanced Training for an Evolving Field

We read with interest “A Changing Landscape: Understanding Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships.”1 The publication is timely, given the recent designation of Pediatric Hospital Medicine (PHM) as a subspecialty by the American Board of Medical Specialties and...

hosppeds.aappublications.org

Really good post and like it or not, I agree with this assessment entirely. I think the timeline may be a bit more like 10-15 years as it'll take a while to generate enough new BE/BC pedi hospitalists, but it's coming.

 

[Dr. Wexler]

6 years to be a pediatric hospitalist? Good grief. Don't do it.

Bronchiolitis that used to be admitted and flogged with albuterol is now sent home from the ER/office.

The next set of hyperbili guidelines will lead to less treatment, not more.

A confluence of factors will lead to even the youngest of febrile infants sent home from the ER rather than admitted.

Do what you love but be careful.

 

[BabyDoc86]

Agreed with what SurfingDoc posted above; hard to predict the future, but that's the way I see things going (whether I agree with it or not).

 

[gentlebalogna]

I strongly suspect in the longterm, it will be a requirement globally. Not saying that I agree with it, but I think it will be. I think had the initial fellowship not been popular but instead hard to fill, then it probably would have died the painful death. Actually, since the fellowship had been around since 2008, that was the general trend, until it became a board certified subspecialty. That changed the trajectory and quite dramatically, so instead you have what is currently the most competitive specialty in all of pediatrics. Hospitals and programs will see this demand as an opportunity (I mean, being honest, it's always beneficial to have experience but cheap, warm bodies for patient care) and likely open more programs which will help the competition from a fellowship standpoint, but essentially make it the standard of care (there are currently 18 new fellowship programs in development FYI). Community hospitals will then have the choice of either a) choose to practice within that standard and hire BE/BC hospitalists or b) ship patients off to a tertiary center where that will be a requirement anyway... especially considering that community pediatric hospitalist positions only make up 1/3 of the workforce. In fact, since the fellowship curriculum is geared toward academics but also managing community issues without supporting subspecialities (there's stuff in the curriculum like intubation, chest tube, CVLs, etc.... though I don't think any program will provide sufficient proficiency) there is a very collective effort to make this desirable for the community hospital setting. Either way, the idea of a non-BE/BC fellowship trained pediatric hospitalist is going the way of the dodo. What's that trajectory? That's hard to predict, but I would say easily within the next decade.

I mean, it's kinda a shame and I would hope/love if the ABP/AAP actually collected data that this made a lick of difference, but I don't think they really care. Just be glad its only a 2 year fellowship... for now.

If you want some perspective of how resident/trainees concerns regarding hospitalist fellowship are dismissed and how much of an uphill battle you've got, you're all welcome read this...

PHM Fellowships: Advanced Training for an Evolving Field

We read with interest “A Changing Landscape: Understanding Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships.”1 The publication is timely, given the recent designation of Pediatric Hospital Medicine (PHM) as a subspecialty by the American Board of Medical Specialties and...

hosppeds.aappublications.org

Thank you so much for this thoughtful reply! I really appreciate your insight. There’s no predicting the future, obviously, but your thoughts definitely help me understand some of the contours of what we might expect.

Thanks and best wishes!

 

[Staphylococcus Aureus]

Lol this will not result in a pay boost (though others will make money off you) it will be a financial loss. But hey you can say you’re fellowship trained in basic generalist floor care!

 

[DO2015CA]

Lol this will not result in a pay boost (though others will make money off you) it will be a financial loss. But hey you can say you’re fellowship trained in basic generalist floor care!

…that everyone resident graduating from residency can do