Society of Hospital Medicine Position on the American Board of Pediatrics Response to the Pediatric Hospital Medicine Petition

The first Pediatric Hospital Medicine (PHM) fellowships in the United States were established in 2003;¹ and since then, the field has expanded and matured dramatically. This growth, accompanied by greater definition of the role and recommended competencies of pediatric hospitalists,² culminated in the submission of a petition to the American Board of Pediatrics (ABP) in August 2014 to consider recognition of PHM as a new pediatric subspecialty.³ After an 18-month iterative process requiring extensive input from the Joint Council of Pediatric Hospital Medicine, ABP subcommittees, the Association of Medical School Pediatric Department Chairs, the Association of Pediatric Program Directors, and other prominent pediatric professional societies, the ABP voted in December 2015 to recommend that the American Board of Medical Subspecialties (ABMS) recognize PHM as a new subspecialty.³

The ABP subsequently announced three pathways for board certification in PHM:

• Training pathway for those completing an Accreditation Council for Graduate Medical Education–accredited two-year PHM fellowship program;
• Practice pathway for those satisfying ABP criteria for clinical activity in PHM for four years prior to exam dates (in 2019, 2021, and 2023), initially described as “direct patient care of hospitalized children ≥25% full-time equivalent (FTE) defined as ≥450-500 hours per year every year for the preceding four years”;⁴
• Combined pathway for those completing less than two years of fellowship, who would be required to complete two years of practice experience that satisfy the same criteria as each year of the practice pathway.⁵

While the training pathway met near-uniform acceptance, concerns were raised through the American Academy of Pediatrics Section of Hospital Medicine (AAP SOHM) Listserv regarding the practice pathway, and by extension, the combined pathway. Specifically, language describing the necessary characteristics of acceptable PHM practice was felt to be vague and not transparent. Listserv posts also raised concerns regarding the potential exclusion of “niche” practices such as subspecialty hospitalists and newborn hospitalists. As applicants in the practice pathway began to receive denials, opinions voiced in listserv posts were increasingly critical of the ABP’s lack of transparency regarding the specific criteria adjudicating applications.

A group of hospitalists, led by Dr. David Skey, a pediatric hospitalist at Arnold Palmer Children’s Hospital in Orlando, Florida, created a petition which was submitted to the ABP on August 6, 2019, and raised the following issues:

• “A perception of unfairness/bias in the practice pathway criteria and the way these criteria have been applied.
• Denials based on gaps in employment without reasonable consideration of mitigating factors.
• Lack of transparency, accountability, and responsiveness from the ABP.”⁶