Pediatric Hospital Medicine Board-Certified and Non–Board-Certified Hospitalists Are Welcome Here

The Consortium of Pediatric Hospital Medicine, representing elected leaders in the field of Pediatric Hospital Medicine (PHM), proudly welcomes and fully supports every pediatric hospitalist, sub-board certified and non–sub-board certified alike, as integral contributors to our community. PHM as a subspecialty is at an exciting time of growth and opportunity. This perspective describes the growing demand for hospitalists, outlines the reasons hospitalists may or may not pursue PHM board certification, and proposes strategies to support hospitalists regardless of board certification.The hospitalist workforce will include both sub-boarded and non–sub-boarded groups in order to meet the growing demand for hospitalists over the next few decades as two-thirds of PHM programs currently have staffing shortages.1–3 The number of graduating PHM fellows who will be eligible for board certification will not make up those shortages or meet the ongoing growth of the field. This growing demand comes from a reduction of inpatient resident rotations from recent Accreditation Council for Graduate Medical Education changes requiring hospitalists to care for patients previously cared for by residents. There is also increasing demand for pediatric hospitalists as medical complexity of admitted pediatric patients rises and with the expansion of subspeciality hospitalists in areas such as newborn medicine, hematology-oncology, and critical care.1Residents or practicing physicians interested in PHM may not pursue fellowship for a variety of reasons. These may include the financial and personal opportunity costs associated with delayed entry into the job market, familial factors, the competitiveness of limited fellowship positions, and, for many, a view that residency training alone has sufficient inpatient clinical training to support a successful and fulfilling career.2–6 This may be particularly salient for internal-medicine pediatrics residents who already undergo 4 years of primarily inpatient training and who may choose to prioritize more internal medicine clinical time over pursuit of a PHM fellowship.7 Furthermore, there are several clinical groups within PHM, such as neonatal/newborn hospitalists, whose clinical and career goals are not met by the fellowship and therefore choose not to pursue one.8 On the other hand, many graduating residents interested in PHM will decide to pursue fellowship. In addition to eligibility for the PHM sub-board certification and additional clinical experience, PHM fellowship offers different career development opportunities including formal professional mentorship and advanced training in areas such as research, quality improvement, leadership, and medical education.4Supporting both sub-boarded and non–sub-boarded pediatric hospitalists will require a deliberate commitment to understanding the evolving needs of the workforce. Important gaps remain in our understanding of sub-boarded hospitalists that are fellowship trained compared with those that are not fellowship trained. Some recent studies have begun to describe the experiences of fellowship-trained pediatric hospitalists; for example, many graduating PHM fellows report feeling underprepared for aspects of community-based clinical practice, highlighting the need to better align training with the realities of diverse practice environments.9 Likewise, there is limited literature describing the professional development needs, career trajectories, and challenges faced by early-career non–sub-boarded hospitalists who enter practice directly from residency. Continued workforce assessments and needs analyses will be essential to inform educational programming, mentorship opportunities, and workforce planning efforts that support pediatric hospitalists across the spectrum of training backgrounds.As these needs are identified, professional development opportunities should remain accessible and relevant to all pediatric hospitalists. Institutional and national organizations can play a critical role by providing inclusive pathways for growth in clinical leadership, quality improvement, research, patient safety, advocacy, and medical education. Support for scholarly activity should not be limited by board certification status, although that status may help guide what support is needed. Mentorship programs, collaborative research networks, quality improvement initiatives, and leadership development programs can help hospitalists of all backgrounds develop expertise and contribute meaningfully to the advancement of the field. The field should also continue to emphasize competency development throughout a hospitalist’s career, recognizing that expertise is cultivated through both formal fellowship training and longitudinal clinical experience. Educational resources that support maintenance and advancement of clinical skills, particularly in areas such as newborn medicine, procedural competency, patient safety, and systems-based practice, will benefit all hospitalists and ultimately improve care for hospitalized children.Equally important is fostering a culture of inclusion within PHM. The language we use, the opportunities we create, and the leaders we elevate all communicate who belongs within our community. Concerns about a “two-tiered” workforce are not new to PHM. The field’s longstanding discussions about “academic” vs “community” practice have underscored the importance of recognizing the many ways pediatric hospitalists contribute to the field.10 Over time, PHM has increasingly acknowledged that many community-based hospitalists make substantial contributions to scholarship, quality improvement, medical education, and leadership, while many university-based hospitalists practice in community settings or across hybrid clinical environments. These experiences have demonstrated that traditional labels do not fully capture the breadth of contributions made by pediatric hospitalists. Similar attention should be paid to ensuring that discussions surrounding PHM board certification do not inadvertently create a perceived two-tiered workforce. Rather, as with the academic-community discussion, the field should recognize that sub-boarded and non–sub-boarded hospitalists bring complementary strengths and valuable perspectives that advance the care of hospitalized children.Creating an inclusive culture also requires intentional efforts to ensure equitable access to opportunities for engagement, advancement, and leadership. National meetings, professional societies, leadership structures, and institutional programs should remain welcoming to all who practice inpatient pediatrics. Institutions should ensure that promotion, compensation, and leadership selection processes recognize contributions in clinical excellence, quality improvement, education, advocacy, scholarship, and program development, regardless of fellowship training status. Representation of both sub-boarded and non–sub-boarded hospitalists in society leadership, special interest groups, committees, division leadership, and clinical leadership roles will help ensure that the future direction of PHM reflects the breadth of experiences and perspectives within the field.We must identify ways to support all hospitalists who will meet the growing demand for our field and must prioritize sustainability to continue attracting talented graduating residents who see PHM as a long and fulfilling career. There is an opportunity to be intentional about the way we study the workforce, support ongoing learning for hospitalists, and create an inclusive culture across our field. Ultimately, we hope for all members of the PHM community to experience vitality and satisfaction through work while providing the best possible care to our hospitalized patients.