Like many of my hospitalist colleagues, I am a frequent recipient of this question from residents with an interest in pediatric hospital medicine (PHM) planning their careers. PHM was recognized as a sub-specialty by the American Board of Pediatrics relatively recently in 2015. Current residents considering a career in PHM must decide on whether to pursue a PHM fellowship or not and how that decision will affect future job prospects in the field.
Authors of an article in this month’s Hospital Pediatrics (10.1542/hpeds.2020-0034), shed some light on the perspectives of residents navigating this decision. In a survey of US pediatric residents in 2018, investigators found that despite interest in acquiring new skills in a PHM fellowship, some residents felt discouraged to apply, in part due to planning to work in a community hospital setting or as a temporary hospitalist, concerns for personal and financial cost and feeling adequately prepared to practice hospital medicine with residency training alone. Among respondents, residents training in medicine and pediatrics combined (Med-Peds) were less likely to pursue a PHM fellowship.
Authors of an accompanying commentary in this month’s Hospital Pediatrics question the generalizability of the survey study and offer some additional perspective on the value of a PHM fellowship (10.1542/hpeds.2020-004432). Authors lay out the work completed by many experienced medical educators and Pediatric and Med-Peds hospitalists to create a targeted curriculum framework to address gaps in residency during a PHM fellowship, a comprehensive certification exam and the development of PHM Core Competencies. Authors highlight the importance of evaluating the outcomes of PHM fellowship in the coming years to better inform residents on the added value of additional training to their careers.
Both articles provide valuable information for those of us providing guidance to residents considering a career in PHM. We must be prepared to listen to concerns and provide information to help residents make an informed personal decision. We can all agree that a skilled PHM workforce is desirable for many reasons. We may not all agree that a PHM fellowship is entirely necessary to get there. At my own institution, we made a deliberate decision to not limit candidates for pediatric hospitalist jobs to just PHM fellowship trained individuals and maybe, that flexibility is key for our trainees.
