3-year Fellowship Option with ABP subspecialty certification

Pros:

• Traditional and accepted model for developing a subspecialty 
• Further develops identity and standardization of Pediatric Hospitalists 
• Will create recognition for pediatric hospitalist amongst various organizations 
• May improve reimbursement rates 
• Improves value (quality/cost) of hospital medicine clinical care 
• Able to monitor and gauge clinical progression of trainees with direct observation over a period of time. 
• Opportunity to teach/hone/expose to medical procedures that may be limited duringresidency
• Develop a standardized curriculum in hospital medicine for areas of clinical practice, administration/ leadership, and scholarship/ Quality Improvement 
• Provide a safe environment to learn pediatric hospitalist skills 
• Provide protected time to learn about leadership/administrative theory 
• Provide protected time to be on hospital/university committees 
• Fellow-trained graduates will more likely contribute in areas of administration and leadership at the start of the job. 
• Help ensure “qualified” people every year to provide leadership and mentorship 
• Provide protected time to adequately train for and pursue research and QI project 
• Pediatric Hospitalists would be better prepared to compete for funding opportunities 
• May lead to more hospitalists in future leadership/administrative positions. 
• Accelerate opportunities for research collaboration with other subspecialties 
• Better help identify research needs in the field of pediatrics hospital medicine and thus concentrate research endeavors to relevant high-yield efforts

Cons:

• Large opportunity cost for trainee (3 years loss of time / loss of revenue) 
• Lack of significant prospective financial benefits for additional training 
• Lack of current number of fellowship program for projected demand 
• Currently no standardization of fellowship training
• Lack of standardization of clinical responsibilities in hospitalist work may make it difficult to standardize curriculum.
• Ability for administrative and leadership standardized experience may be difficult to mandate in a fellowship program
• May risk producing lower-quality research in order to simply meet PHM fellowships or credentialing agency requirements
• Not a route of specialization in Internal Medicine or Family Medicine 
• Current GME funding environment is poor, may be difficult to fund the fellowships 
• Increase cost for training to the enter GME system 
• Perception by graduating pediatric residents that additional 3 years of fellowship may not be necessary due to multitude of current pediatric hospitalists without formal fellowship training 
• May create more barriers for general pediatrician to practice inpatient medicine