Identifying and Supporting the Needs of Internal Medicine and Pediatrics Residents Interested in Pediatric Hospital Medicine Fellowship

Abstract

BACKGROUND: Pediatric hospital medicine (PHM) became a subspecialty of the American Board of Pediatrics (ABP) in 2016. Starting in 2019, residency graduates are required to complete fellowship training to qualify for PHM board eligibility. These requirements pose unique challenges to internal medicine–pediatrics (med-peds) residents interested in practicing combined adult hospital medicine (HM) and PHM. OBJECTIVE: To describe the needs of med-peds residents interested in PHM fellowship training and how the current PHM training environment can meet these needs. METHODS: We conducted two cross-sectional electronic survey studies: one of med-peds residents and one of PHM fellowship program directors (FDs). Surveys were distributed to resident and FD listservs. Questions were designed using an iterative consensus process among authors. Responses were analyzed with descriptive statistics. RESULTS: Four hundred sixty-six residents responded to the resident survey. Ninety-six percent (n = 446) had considered a career in HM. Almost all (n = 456, 97.9%) respondents indicated a preference for a fellowship with both adult HM and PHM clinical training. Subspecialty designation decreased desire to pursue a career including PHM for 90.1% of respondents. Twenty-eight (58.3%) FDs responded to the FD survey. Fifteen (53.6%) programs reported being able to accommodate adult HM and PHM clinical time. CONCLUSION: The majority of resident respondents reported a desire for a PHM fellowship with clinical time in both PHM and adult HM. Approximately 30% of current US PHM fellowship programs can accommodate adult HM practice for med-peds fellows, and many other programs would be willing to explore such opportunities.

Workforce Characteristics of Med-Peds Hospitalists

“…The growing number of practicing med-peds hospitalists demands a better understanding and distinction of the unique needs of these doctors in order to better identify career opportunities and areas for improvement. Prior literature reviewed the combined med-peds hospital medicine workforce via the lens of graduate medical education [ 2 , 3 ], and current trainee perspectives [ 6 ]; this survey adds the perspective of the active med-peds hospitalist workforce.…”

“…As the field continues to evolve, future studies will need to further evaluate the impact these changes have on the med-peds workforce regarding the number of graduates who enter hospital medicine and whether these providers decide to pursue PHM fellowship. The future requirements for pediatric hospitalist fellowship training may impede the presence of med-peds hospitalists who have a unique skill set not provided by either of the categorical specialties [ 6 ].…”

“…The recent subspecialty certification recognition of pediatric hospital medicine in 2016 has impacted those practicing or entering the field of hospital medicine [ 5 ]. While over 97% of residents have considered a career in hospital medicine, subspecialty designation decreased their desire to pursue a career, including pediatric hospital medicine, for 90% of respondents [ 6 ]. In addition to the changes in graduate medical training, the COVID-19 pandemic has had a significant impact on current practice patterns and demands [ 7 ].…”

Benefits of the medicine–pediatrics trained hospitalist

“…Current med-peds residents interested in hospital medicine indicate that accreditation of PHM negatively affected their desire to pursue PHM as a career. 18 Further, the requirements of the practice pathway for PHM board eligibility can present barriers for practicing med-peds hospitalists, especially those whose pediatric care hours were shifted to adult care during the COVID-19 pandemic. Most med-peds residents still indicate that they desire a career that includes caring for both adults and children, however, estimates from this study are concerning for a downward trend in practicing med-peds hospitalists.…”

“…In 2015, the American Board of Pediatrics recognized pediatric hospital medicine (PHM) as an accredited subspecialty. Current med‐peds residents interested in hospital medicine indicate that accreditation of PHM negatively affected their desire to pursue PHM as a career 18 . Further, the requirements of the practice pathway for PHM board eligibility can present barriers for practicing med‐peds hospitalists, especially those whose pediatric care hours were shifted to adult care during the COVID‐19 pandemic.…”