Status Quo or Optional Extra Training

No Change/Optional Extra Training Pros and Cons

Pros:

• Meets current market needs for additional hospitalists, especially as ACGME Duty- hours rules change that require additional inpatient coverage
• Does not require additional funds or curricular changes 
• Keeps the field open to all those who are interested
• Financial benefit to the physician, who is able to make attending-level salary out of residency rather than waiting until after fellowship (no opportunity cost) 
• Even after fellowship, most academic subspecialist salaries are lower than private practice general pediatricians 
• There are other ways of enhancing educational skills outside of residency or fellowship (through the APA and the AAP, e.g.) 
• There are other ways of collaborating and gaining research skills outside of residency and fellowship (through the PRIS and VIP networks, e.g.) 
• Nationally, other opportunities exist for additional training to gain skills in teaching, research and administration following residency that do not require a formal fellowship 
• Mechanisms can be placed for Maintenance of Certification (MOC) and Focused practice in Pediatric Hospital Medicine.

Cons:

• We do not have explicit competencies in most residency programs regarding Pediatric Hospital Medicine core skills so physicians complete residency with different skill sets.
• Some graduating residents may not have the clinical experience necessary to begin work as a pediatric hospitalist without additional formal training.
• There are few opportunities for those who have not practiced Hospital Medicine to learn the required skills except on-the-job training.
• May not be the best option for the hospitalized pediatric patient (wide range of competencies in PHM physicians)
• Some may not have the teaching, research or administrative experience necessary to begin work as a pediatric hospitalist without additional formal training.
• We may lose graduating residents to other fellowships due to the perception that Pediatric Hospital Medicine is just resident work.
• Most graduating pediatric residents do not have the necessary skills to produce high- quality academic scholarship without formal training
• Without additional training, subspecialists may be preferentially selected for academic leadership positions.
• Focus of practice in Pediatric Hospital Medicine may not be viewed as an additional skill set*

*Also see "Focus of Practice" Pros and Cons List