Pediatric Hospital Medicine

[SurfingDoctor]

Two points:
1) I would agree that residency training is not adequate nor designed to teach the skills of hospital system administration, function or analysis. So it regard to that skill set, they are correct

2) I would disagree that the safe management of complex pediatric inpatients has anything to do with inadequate residency training. Residency training allows for more than enough time co-managing complex pediatric patients. The issue instead boils down to one issue and one issue alone, nurse staffing. Most complex patients have inhospital morbidity or require transfer to higher level of care not because floor management was inadequate, but because the newly graduated nurse had to cover 8 patients who were all requiring too much time to safely manage. This seems like the ABP recognizes that complex inpatients have a higher rate of inhospital morbidity, but it is addressing the wrong reason. I suspect there’s nothing they can do about nursing shortages, but I think this line of thinking doesn’t reflect reality.

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[RoboChicken]

If you actually look at what the peds hospitalist fellowships application says, it contradicts your point about being an academic hospitalist:


"Certification will assure the public that the title ‘Board Certified Pediatric Hospitalist’ indicates a proficient level of skill and knowledge has been attained and validated. " (in other words, that non pediatric hospitalist trained person taking care of your child in the hospital may not have that proficient level of skill or knowledge)

" As a new subspecialty, pediatric hospital medicine (PHM) should further accelerate improvements and innovation in quality improvement (QI) science as applied to pediatric inpatient care, create a new and larger cadre of QI experts and mentors, and enhance development of professionals skilled in addressing child health safety issues within the context of health care systems. Certification will raise the level of care of all hospitalized children by establishing best practices in clinical care and disseminating them to all settings caring for hospitalized children." ([citation needed])

"Graduating residents are prepared to care for common problems in the in-patient setting, but it is not the role of categorical training to prepare pediatricians to care for the wider population of hospitalized children with complex disease or to specifically improve the hospital system." (Oh reallly???? What about my rotation in...OH EVERY INPATIENT ROTATION???)

"All residents must have a minimum of 9 months (out of 36 months total training) of experiences in inpatient settings such as inpatient ward, NICU, PICU" (Which residencies only have 9 months total of inpatient experiences including NICU, PICU AND wards?...)

"Without a certification process, patients, families, medical colleagues and hospital administrators have no way of identifying a physician who has the appropriate training and the expert knowledge and skills to provide care to hospitalized patients. " (Boom, right there....residency is not enough to learn the skills in taking care of the hospitalized patient...from their own document)

I encourage people to read that whole application. It's just ridiculous and pretty much an craps all over residency training. It basically implies that we don't train our residents well enough to manage complex inpatient problems, so instead of maybe fixing that (I think most pediatrics programs do just fine in management of complex problems - that's pretty much my entire residency), they are just going to push the buck down. It also talks about "procedures"...like NG tube placement and

I am not going into hospitalist medicine - I am doing a specialty, but this whole document is an absolute insult to all the hard work I've put into being a competent pediatrician and the excellent training that I've received.

I'm sorry this document is an insult to all of the hard work you have put in...but this document was an application for Hospital Medicine to become its own specialty and I'm sure they were listing all of the arguments they could think of. It in no way reflects the amazing programs I have encountered in real life, nor their mission statements or the type of training they provide. And your arguments (and other people's arguments), quite frankly, are a little insulting to all of the amazing applicants I have met along the way...some who have done a chief year, and all who have gone to top pediatric programs (where they ALSO got top notch clinical training) but still are passionate about hospital medicine as a field and don't see it as a backup career the way many seem to. This idea of it being a backup for many is part of the reason I think people are freaking out about the idea of hospital med fellowships. Again, don't worry, anyone can still go work as a hospitalist out of residency, but yeah, the days of being able to snag a faculty spot right out of residency are long gone--it isn't even a guarantee for fellowship trained pediatricians. Medicine as a field is becoming more and more competitive, I'm sure if you go far back enough, the specialty you're going into was not its own fellowship either.

 

[MEN2C]

It's NOT a backup career. I never implied it was. It's a wonderful, challenging and rewarding career that you should be prepared for coming out of residency. Just like you should be prepared for an outpatient pediatrics career - another wonderful, challenging and rewarding career. And if you are not, that's the problem that needs to be looked into. The point of residency should be to prepare you for an outpatient pediatrics job or an inpatient hospitalist job. To give you the tools and knowledge needed to start off your career being a pediatrician. Not just a pathway into more training so you can do the job you should have been training for.

Can you make a good argument about why, if hospitalist medicine should be a fellowship with a separate board certification - that outpatient pediatrics shouldn't?

The document represents the position of the leaders in the field - how can you say that it's not representative? Why did they write it then? What were their true motives when they made an insulting statement that hospitals and patients have "no way of knowing" whether a board certified pediatrician is capable of taking care of hospitalized children?? I don't know how to take that except as an insult.

 

[Perrotfish]

your arguments (and other people's arguments), quite frankly, are a little insulting to all of the amazing applicants I have met along the way...some who have done a chief year, and all who have gone to top pediatric programs (where they ALSO got top notch clinical training)

We're not saying they're bad clinicians. We're saying they're being taken advantage of.

 

[Perrotfish]

but yeah, the days of being able to snag a faculty spot right out of residency are long gone--it isn't even a guarantee for fellowship trained pediatricians.

Source?

 

[BigRedBeta]

The issue instead boils down to one issue and one issue alone, nurse staffing. Most complex patients have inhospital morbidity or require transfer to higher level of care not because floor management was inadequate, but because the newly graduated nurse had to cover 8 patients who were all requiring too much time to safely manage.

...and you just touched the third rail.

We can't ever say that nurses are at fault in this day and age where the most powerful administrators are those with RN in their string of letters. At the same time when nurses, CRNA's and NP's (and DNP's) are pushing for ever increasing scope of practice with less supervision, it's all fine and dandy until something goes wrong. Then it's a physician problem, that we - the group with the most education and the most training - still don't know enough.

 

[SurfingDoctor]

...and you just touched the third rail.

We can't ever say that nurses are at fault in this day and age where the most powerful administrators are those with RN in their string of letters. At the same time when nurses, CRNA's and NP's (and DNP's) are pushing for ever increasing scope of practice with less supervision, it's all fine and dandy until something goes wrong. Then it's a physician problem, that we - the group with the most education and the most training - still don't know enough.

I mean, most places I’ve been realize an overworked and undertrained nursing staff leads to patient-related problems. But to fix it, that costs money and in hospital administration when it comes to safety... money is a four letter word.

 

[NurWollen]

I think one of the interesting things about this whole process is that they decided to move this along so quickly that they're not waiting for thr ACGME to develop an accreditation process for fellowships. So board certification will be dependent on completing a non-accredited fellowship. Is there any precedent for this? Is that hoe it happened with critical care and EM fellowships?

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[NurWollen]

I came across this. http://www.nrmp.org/wp-content/uplo...ties-Fall-Match-Results-Statistics-AY2018.pdf

Looks like hospital medicine was quite competitive this year.

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[mvenus929]

I came across this. http://www.nrmp.org/wp-content/uplo...ties-Fall-Match-Results-Statistics-AY2018.pdf

Looks like hospital medicine was quite competitive this year.

Well, if you don't start practicing hospitalist medicine full time by next year and don't do a fellowship, you won't be eligible to sit for the boards. People who want to work at academic centers are scrambling for fellowships, which aren't as common as the demand.

 

[NurWollen]

Well, if you don't start practicing hospitalist medicine full time by next year and don't do a fellowship, you won't be eligible to sit for the boards. People who want to work at academic centers are scrambling for fellowships, which aren't as common as the demand.

Yeah, I figured as much. I'm just hoping more fellowships open up. I was a little surprised it was this competitive this year before it's even a requirement for board certification.

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[Perrotfish]

Well, if you don't start practicing hospitalist medicine full time by next year and don't do a fellowship, you won't be eligible to sit for the boards. People who want to work at academic centers are scrambling for fellowships, which aren't as common as the demand.

Wow. So almost every Peds sepecialty has a.huge number of programs going unfilled with the exception of PICU (about 1 applicant per fellowship), ER (lots of unmatched applicants), and hospitalist (lots of unmatched applicants).

So this is the state of Pediatrics. The only competitive specialties are.the ones that shouldn't be specialties in the first place.

 

[SurfingDoctor]

Wow. So almost every Peds sepecialty has a.huge number of programs going unfilled with the exception of PICU (about 1 applicant per fellowship), ER (lots of unmatched applicants), and hospitalist (lots of unmatched applicants).

So this is the state of Pediatrics. The only competitive specialties are.the ones that shouldn't be specialties in the first place.

PICU shouldn't be a subspecialty? Most residents are woefully undertrained to take care of critically ill children and gearing residency training toward taking care of critically ill children could be achieved, but then other training is sacrificed.

 

[Stitch]

PICU shouldn't be a subspecialty? Most residents are woefully undertrained to take care of critically ill children and gearing residency training toward taking care of critically ill children could be achieved, but then other training is sacrificed.

Running a vent is easy. Until something happens...

And congenital heart disease? Piece of cake.

 

[Perrotfish]

PICU shouldn't be a subspecialty? Most residents are woefully undertrained to take care of critically ill children and gearing residency training toward taking care of critically ill children could be achieved, but then other training is sacrificed.

PICU isn't competitive. It's filling, but will almost exactly one applicant per fellowship position. And apparently NICU isn't even filling their positions anymore.

The only competitive fellowships, as in you might not get a fellowship despite wanting one, are ER and Hospitalist. Which are both fields a 3 year Pediatric residency should prepare you for.

 

[SurfingDoctor]

PICU isn't competitive. It's filling, but will almost exactly one applicant per fellowship position. And apparently NICU isn't even filling their positions anymore.

The only competitive fellowships, as in you might now get a fellowship despite wanting one, are ER and Hospitalist. Which are both fields a 3 year Pediatric residency should prepare you for.

I would agree with the hospitalist aspect and urgent care aspects of ER, not the severely injured, critically ill, and medical transport aspects of ER though.

 

[Perrotfish]

I would agree with the hospitalist aspect and urgent care aspects of ER, not the severely injured, critically ill, and medical transport aspects of ER though.

Just going to have to disagree here. If a peds residency doesn't teach you to stabilize a critically ill child enough for transport then then:
1) you can't work on a hospital floor either and
2) your residency failed you.

Seriously, if all a Peds residency qualifies you to do is see healthy children in clinic then why not just get rid of the residency and just have everyone do family medicine? They have just as much clinic time with Peds patients as we do. The difference between the two residencies is the time a Peds residency invests in hospitalist and critical care.medicine.

 

[SurfingDoctor]

Just going to have to disagree here. If a peds residency doesn't teach you to stabilize a critically ill child enough for transport then then:
1) you can't work on a hospital floor either and
2) your residency failed you.

Seriously, if all a Peds residency qualifies you to do is see healthy children in clinic then why not just get rid of the residency and just have everyone do family medicine? They have just as much clinic time with Peds patients as we do. The difference between the two residencies is the time a Peds residency invests in hospitalist and critical care.medicine.

I didn't say it taught one to just see well children. It teaches one to see sick children who have a moderate illness and recognize diverse pathophysiology. It should also teach pediatricians how to recognize a severely ill child when they see one and how to get help to a higher level of care. Nothing is worse than having someone with inadequate skill levels (which is gained through experience) trying to monkey around a severely ill child. There is no residency out there that teaches residents to independently manage critically ill people. Internal Medical, Surgery, Anesthesia, all have ICU fellowships.

Personally, if it were my kid, I wouldn't want the least experienced independent practitioners attempting to intubate my kid because they did it a couple of times in residency...

 

[calvnandhobbs68]

I didn't say it taught one to just see well children. It teaches one to see sick children who have a moderate illness and recognize diverse pathophysiology. It should also teach pediatricians how to recognize a severely ill child when they see one and how to get help to a higher level of care. Nothing is worse than having someone with inadequate skill levels (which is gained through experience) trying to monkey around a severely ill child. There is no residency out there that teaches residents to independently manage critically ill people. Internal Medical, Surgery, Anesthesia, all have ICU fellowships.

Personally, if it were my kid, I wouldn't want the least experienced independent practitioners attempting to intubate my kid because they did it a couple of times in residency...

We could do it more than a couple times in residency if the ER and PICU fellows wouldn’t steal all our intubations....

 

[SurfingDoctor]

We could do it more than a couple times in residency if the ER and PICU fellows wouldn’t steal all our intubations....

Well, it’s their job to learn those specific procedures... that’s the point of fellowship. Again, the most experience the better. I would rather have a fellow that did 100, than a resident that did not 5 but 15 attempted intubation if it were on my own child.

If a resident wants to learn, they can take the initiative and learn in a controlled setting. Having an 5 yo with ARDS and saturations in the 70s for practice is not a good precedence.

Even attendings are suppose to have 20+ intubation a year to maintain proficiency. How would a general pediatrician manage that?

 

[BigRedBeta]

Just going to have to disagree here. If a peds residency doesn't teach you to stabilize a critically ill child enough for transport then then:
1) you can't work on a hospital floor either and
2) your residency failed you.

Seriously, if all a Peds residency qualifies you to do is see healthy children in clinic then why not just get rid of the residency and just have everyone do family medicine? They have just as much clinic time with Peds patients as we do. The difference between the two residencies is the time a Peds residency invests in hospitalist and critical care.medicine.

While there is certainly a greater proportion of urgent care level cases in the peds ED, taking this thought to it's logical conclusion would argue against the whole field of Emergency Medicine as its own separate boarded specialty. I don't think you would find many takers on that argument.

To be clear, I'll be the first to tell you that many PEM people overstate their skills and their overall utility, but they do still provide value.
Further, as someone who went to an extremely ED heavy residency (I had in the ballpark of 60 twelve hour shifts in the ED as an intern), I can tell you there are a lot of places that don't provide very good ED experience. Used to be the program at my medical school only put residents in the ED for a total of 20 shifts during their residency (10 shifts per month, 1 month each in the 2nd and 3rd years, along with 5 urgent care shifts each month). I'd argue that is barely adequate to ready a person for day one of a PEM fellowship, let alone as an attending unsupervised.

 

[oldbearprofessor]

When I was a neonatology fellow in the 80's, folks would argue that pediatricians learned tons of neonatology in residency and that no one needed a neo fellowship for that. Some arguments never die.

 

[mvenus929]

(I had in the ballpark of 60 twelve hour shifts in the ED as an intern)

Our interns get in the ballpark of 12-14 10-hour shifts. They do another 2.5 months during residency (averaging 16 shifts per month). I can't imagine doing the equivalent of an entire residency experience in the ED, and then some, in intern year...

 

[BigRedBeta]

Not sure I actually got to 60, but it's not that far off. We had 4 "outpatient" months as an intern. Time was split between the ED and the general peds clinic. Generally did a week of nights in the ED (this was the old work hour rules before the 6 night in a row limit), and then got another 5-9 day shifts in the ED. I was already thinking PICU and started asking the Chiefs to give me more ED shifts than clinic days, which they were happy to oblige.

 

[shepardsun]

A fun thought experiment- what would medicine do if they were suddenly told they needed a two year hospitalist fellowship to get into academics/get boarded/demonstrate they provided the "best/highest quality care"/[insert any of the other arguments for it here]? They would absolutely riot. Why are we as a specialty such pushovers?

 

[shepardsun]

There is no residency out there that teaches residents to independently manage critically ill people. Internal Medical, Surgery, Anesthesia, all have ICU fellowships.

Actually, with anesthesia we learn to manage critically ill patients in the OR all the time, no fellowship required

 

[SurfingDoctor]

Actually, with anesthesia we learn to manage critically ill patients in the OR all the time, no fellowship required

No one is talking about the OR...

 

[Perrotfish]

.

 

[MEN2C]

PICU isn't competitive. It's filling, but will almost exactly one applicant per fellowship position. And apparently NICU isn't even filling their positions anymore.

The only competitive fellowships, as in you might not get a fellowship despite wanting one, are ER and Hospitalist. Which are both fields a 3 year Pediatric residency should prepare you for.

Interestingly, the number of applicants to Neonatolgy has remained remarkably stable from 2014-2018, the following numbers of people have applied: 248, 295, 249, 248, 243. Aside from the bump in 2015, it's been +/- five people! That's kind of crazy. The reason for 13% of positions going unfilled (though 22% of programs had at least one spot) is that the number of first year fellowship positions grew by ~10% in the past five years.

 

[NurWollen]

Well, 33% of hospitalist fellowship applicants went unmatched this year. Got even more competitive than last year.

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[Oso]

Well, 33% of hospitalist fellowship applicants went unmatched this year. Got even more competitive than last year.

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That's crazy. And makes it even more ****ing stupid that this is a thing.

 

[NurWollen]

That's crazy. And makes it even more ****ing stupid that this is a thing.

The fellowship isn't even required for board certification yet. Next year will be interesting.

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[MEN2C]

I don't understand why there isn't a outpatient pediatrics fellowship. As a graduate of a pediatrics residency, I feel far more comfortable running a hospitalist floor than doing clinic.

 

[Ladholyman]

Congratulations, now there is a General Pediatrics Fellowship! Fellowship in Academic General Pediatrics

What a load of bullcrap, Stanford.

 

[SurfingDoctor]

Congratulations, now there is a General Pediatrics Fellowship! Fellowship in Academic General Pediatrics

What a load of bullcrap, Stanford.

Those fellowships exist everywhere and have been around for at least a decade. I mean, if you don’t what to be a general pediatrician at an academic center, then you don’t have to take it. It isn’t a fellowship to do general pediatrics.

 

[Vandalia]

Congratulations, now there is a General Pediatrics Fellowship! Fellowship in Academic General Pediatrics

What a load of bullcrap, Stanford.

Keyword: ACADEMIC. It is not for clinical medicine.

Were you able to write and win enough proposals to have been able to completely support yourself in a tenure-track academic position before residency graduation? I am not aware of any pediatrics residency program that contains a year of dedicated research. How much training did you get in bio-statics and research program design?

 

[NurWollen]

Keyword: ACADEMIC. It is not for clinical medicine.

Were you able to write and win enough proposals to have been able to completely support yourself in a tenure-track academic position before residency graduation? I am not aware of any pediatrics residency program that contains a year of dedicated research. How much training did you get in bio-statics and research program design?

On the other hand, a lot of people are saying you won't need a Hospitalist Fellowship unless you want to do academics. But what is academics? It's much more broad than "being able to completely support yourself in a tenure-track academic position." For a lot of people, it might be teaching residents in a community residency program, or doing QI stuff, etc.

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[Perrotfish]

Those fellowships exist everywhere and have been around for at least a decade. I mean, if you don’t what to be a general pediatrician at an academic center, then you don’t have to take it. It isn’t a fellowship to do general pediatrics.

You don't need any additional training to do academic pediatrics just like you don't need any additional training to be a hospitalist. Generations of academics and hospitalists have practiced safely without the additional training. These additional certifications don't add competence, or at least not any more competence than you get from working as an attending for the same amount of time. You don't need to agree every tie someone invents another new hoop for you to jump through.

On the other hand, a lot of people are saying you won't need a Hospitalist Fellowship unless you want to do academics. But what is academics? It's much more broad than "being able to completely support yourself in a tenure-track academic position." For a lot of people, it might be teaching residents in a community residency program, or doing QI stuff, etc.

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For Pediatrics I think its pretty clear that it means 'working in a children' s hospital', or maybe 'working with really sick children'. The real reason there is a hospitalist fellowship is a supply and demand issue. In Pediatrics all the real pathology concentrates in a few tertiary care centers and the hospitalist community is betting that since there are more applicants than jobs they will be able to get another few years of unpaid work out of their applicants. 'Community hospitalist' in pediatrics mostly means nursery and perinatal care, along with some very bread and butter issues like asthma/bronchiolitis/FTT.

Now practically this is stupid. A pediatric residency program, as it is currently structured, should prepare absolutely anyone to practice inpatient Peds in a tertiary care center and in many cases doesn't adequately prepare people to manage the perinatal emergencies that they are going to be dealing with in a community hospital. But this isn't about the training that people need, its about the years of unpaid labor that that they can get out of you.

 

[SurfingDoctor]

You don't need any additional training to do academic pediatrics just like you don't need any additional training to be a hospitalist. Generations of academics and hospitalists have practiced safely without the additional training. These additional certifications don't add competence, or at least not any more competence than you get from working as an attending for the same amount of time. You don't need to agree every tie someone invents another new hoop for you to jump through.


For Pediatrics I think its pretty clear that it means 'working in a children' s hospital', or maybe 'working with really sick children'. The real reason there is a hospitalist fellowship is a supply and demand issue. In Pediatrics all the real pathology concentrates in a few tertiary care centers and the hospitalist community is betting that since there are more applicants than jobs they will be able to get another few years of unpaid work out of their applicants. 'Community hospitalist' in pediatrics mostly means nursery and perinatal care, along with some very bread and butter issues like asthma/bronchiolitis/FTT.

Now practically this is stupid. A pediatric residency program, as it is currently structured, should prepare absolutely anyone to practice inpatient Peds in a tertiary care center and in many cases doesn't adequately prepare people to manage the perinatal emergencies that they are going to be dealing with in a community hospital. But this isn't about the training that people need, its about the years of unpaid labor that that they can get out of you.

Clinical competence, no you don’t need extra training. However you don’t get promoted in academics because you made the best diagnosis. Other, non-clinical skills are required for that.

 

[NurWollen]

You don't need any additional training to do academic pediatrics just like you don't need any additional training to be a hospitalist. Generations of academics and hospitalists have practiced safely without the additional training. These additional certifications don't add competence, or at least not any more competence than you get from working as an attending for the same amount of time. You don't need to agree every tie someone invents another new hoop for you to jump through.


For Pediatrics I think its pretty clear that it means 'working in a children' s hospital', or maybe 'working with really sick children'. The real reason there is a hospitalist fellowship is a supply and demand issue. In Pediatrics all the real pathology concentrates in a few tertiary care centers and the hospitalist community is betting that since there are more applicants than jobs they will be able to get another few years of unpaid work out of their applicants. 'Community hospitalist' in pediatrics mostly means nursery and perinatal care, along with some very bread and butter issues like asthma/bronchiolitis/FTT.

Now practically this is stupid. A pediatric residency program, as it is currently structured, should prepare absolutely anyone to practice inpatient Peds in a tertiary care center and in many cases doesn't adequately prepare people to manage the perinatal emergencies that they are going to be dealing with in a community hospital. But this isn't about the training that people need, its about the years of unpaid labor that that they can get out of you.

Never thought of this before but it absolutely rings true. I'm half way through peds residency and I feel fairly comfortable on the inpatient floor at night without and attending in house (or with them asleep in a call room, at least.) I'd struggle with emergencies in the delivery room.

 

[Vandalia]

You don't need any additional training to do academic pediatrics just like you don't need any additional training to be a hospitalist. A pediatric residency program, as it is currently structured, should prepare absolutely anyone to practice inpatient Peds in a tertiary care center and in many cases doesn't adequately prepare people to manage the perinatal emergencies that they are going to be dealing with in a community hospital. But this isn't about the training that people need, its about the years of unpaid labor that that they can get out of you.

Fellowships, traditionally, have had nothing to do with clinical practice. The purpose of a fellowship was to build the publication and research record to enable the fellow to obtain a pure, academic, tenure-track position, as opposed to a "clinical track" position. The fellowships in question make it clear that their goal is build research skills and a research record. That is traditionally not taught or developed in the vast majority of residency programs. Completely different use of the term "fellowship."

There is also a huge difference between a "tenure-track" and a "clinical track"/"School of Medicine" (or whatever else it is called) attending position. A very small fraction of the attendings are "tenure-track" at most academic residency programs.

A post-doc doesn't do a post-doc to learn more chemistry - for example - but to add publications and proposal preparation skills.

 

[Perrotfish]

Fellowships, traditionally, have had nothing to do with clinical practice.

What are you talking about? Medical fellowships have always been about teaching or refining clinical skills. You do a cardiology fellowship to learn how to manage complex heart disease. You do heme/onc fellowship to learn how to manage heme/onc. You don't do a fellowship for academic pediatric clinic because you already have the necessary clinical skills.,

More generally, you don't need a fellowship for to learn how to write an IRB, QI project, or a grant proposal. I promise you if I can figure it out you can too. Generations of academic physicians have learned these skills with the help of mentors after they start working in academics. Formal training programs exist because some skills aren't safe to learn without them. You need a cardiology fellowship because if you try to teach yourself in the cath lab you will kill whoever you are practicing on. If you f--k up your first grant proposal then... you don't get the grant. Some things you can do without someone holding your hand.

A post-doc doesn't do a post-doc to learn more chemistry - for example - but to add publications and proposal preparation skills.

BTW I think what we are all scared of is medicine going down the same road as university academics. We have seen the entire academy fall under the sway of parasite administrators and senior faculty who prey on the good intentions of doctoral students. What once was a 4 year doctoral degree followed by a good middle class job has morphed into a 15+ year nightmare of PhD + post doc indentured servitude that probably ends in a minimum wage job as an adjunct. We do not need that in medicine.

 

[SurfingDoctor]

Just a point of clarification, nearly every funded academic physician scientist has had mentorship with extra non-clinical training. I don’t know any physician who got an MD and just got NIH funding without any mentorship or training. That is a receipe for failure.

Now, whether or not, the attainment of non-clinical skills should be a goal or purpose of fellowship is an entirely different discussion. I would argue it depends on one’s career goals but for reasons that still aren’t entirely clear to me and other PDs (at least at my home institution), the ABP doesn’t feel that way and I doubt it will change in the near future.

 

[Staphylococcus Aureus]

BTW I think what we are all scared of is medicine going down the same road as university academics. We have seen the entire academy fall under the sway of parasite administrators and senior faculty who prey on the good intentions of doctoral students. What once was a 4 year doctoral degree followed by a good middle class job has morphed into a 15+ year nightmare of PhD + post doc indentured servitude that probably ends in a minimum wage job as an adjunct. We do not need that in medicine.

This is painfully true in academia as the PhD route is all but dead, I only hope medicine will take heed this advice.

 

[Perrotfish]

Just a point of clarification, nearly every funded academic physician scientist has had mentorship with extra non-clinical training. I don’t know any physician who got an MD and just got NIH funding without any mentorship or training. That is a receipe for failure.

Now, whether or not, the attainment of non-clinical skills should be a goal or purpose of fellowship is an entirely different discussion. I would argue it depends on one’s career goals but for reasons that still aren’t entirely clear to me and other PDs (at least at my home institution), the ABP doesn’t feel that way and I doubt it will change in the near future.

Which leads to the question: how do we change the ABP? Are there any boards whose members are democratically elected by its members? Who decides who leads our board? Has anyone ever discussed creating a competitive board?

 

[SurfingDoctor]

Which leads to the question: how do we change the ABP? Are there any boards whose members are democratically elected by its members? Who decides who leads our board? Has anyone ever discussed creating a competitive board?

I don’t know, though I’ll admit, it’s not a big concern of mind. The extra time spent learning non-clinical activities amounts to 1 to 1.5 years of time. That seems like a lot of time, but I’m the grand scheme, it’s really not that much. However, if others what to climb the ranks of the ABP to change it, they should though.

If people want to go the Rand Paul pathway to board certification, they can try but I doubt many programs or hospitals will support it. It would be a interesting thing to see what happened though.

 

[SurfingDoctor]

Just for those interested... PHM is now the most competitive fellowship (for three years in a row) amongst all pediatric fellowships if looking by % who applied but did not match... this year at 32%.

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/12/PSM_MRS.pdf

 

[NurWollen]

Just for those interested... PHM is now the most competitive fellowship (for three years in a row) amongst all pediatric fellowships if looking by % who applied but did not match... this year at 32%.

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/12/PSM_MRS.pdf

Which is exactly why this fellowship isn't going anywhere. I just wish we could get everyone to boycott it.

 

[SurfingDoctor]

Which is exactly why this fellowship isn't going anywhere. I just wish we could get everyone to boycott it.

Well, people are clearly not going to boycott it. It appears its just quite the opposite.

It'll be very interesting to see how this fleshes itself out. I don't think it will have the beneficial impact the senior people who thought it up will be. However, I don't think it will ever go away either, like the concept of "scholarly activity" in fellowship training that is mostly a joke, but has zero momentum for change. Like you said, it's here to stay and the "competitiveness" of the fellowship just reinforces that notion of its importance to the powers that be.

Ah well, sucks to want to be a pediatric hospitalist for sure.

 

[DO2015CA]

Well, people are clearly not going to boycott it. It appears its just quite the opposite.

It'll be very interesting to see how this fleshes itself out. I don't think it will have the beneficial impact the senior people who thought it up will be. However, I don't think it will ever go away either, like the concept of "scholarly activity" in fellowship training that is mostly a joke, but has zero momentum for change. Like you said, it's here to stay and the "competitiveness" of the fellowship just reinforces that notion of its importance to the powers that be.

Ah well, sucks to want to be a pediatric hospitalist for sure.

Certainly sucks.

I think it’s so popular, not because people think it helps, but new grads are so scared of not being able to get a job.