Hospitalist Residency Track + 1-year Fellowship

Pros:

• Focused residency training that would allow trainee to gain PHM competencies in common clinical diagnoses and conditions as well as to gain PHM Core Skills
• Extra year may allow for training in Specialized Clinical Services (Hospice and Palliative care, sedation, etc.)
• Less time than 2- or 3-year fellowship (less funding needed, less opportunity cost to the physician)
• Allows for broad range of rotations--PICU, NICU, sedation etc. than Residency Track alone
• PGY-3 year and extra year can be dedicated to formal research training and work 
• Research project can begin during 2nd or 3rd year of residency and extend into fellowship year 
• May have enough time to work on creating educational material and peer-reviewed workshops
• Can develop a longitudinal administrative skill curriculum: early involvement on hospital committees, followed by focused workshops during fellowship year (Leadership training; APA, PAS workshops) 
• Meets workforce needs

Cons: 

• Extra year may deter some good physicians from entering PHM 
• Not all residency programs can offer this track; may hurt smaller residencies when competing for applicants 
• Still would compete with other residents for sufficient procedures
•  Early career decision needed. (Exact timing depends on when track starts in residency, but those who decided to enter PHM late in residency or after residency would need to find other ways of training. Also, if the physician changed his/her mind, it may be difficult to catch up in other fields.)
• Funding required for fellowship program 
• Programs need to develop 1-year fellowships; may be difficult to match number of programs to need 
• Not all PHM physicians focus on general inpatient pediatric care (e.g., neonatal hospitalists). That type of training would need to be incorporated into the curriculum. 
• Potentially lower chance of ABP subspecialty certification