Background: In October 2016, the American Board of Medical Specialties (ABMS) officially recognized subspecialty certification for Pediatric Hospital Medicine (PHM). The American Board of Pediatrics (ABP), which sponsored the subspecialty application, has established Training and Practice Certification Pathways for current fellowship trainees and practicing clinicians, respectively. However, for individuals beginning pediatrics residency on or after July 1, 2017, certification eligibility criteria will include successful completion of a two-year Accreditation Council for Graduate Medical Education (ACGME)-accredited PHM fellowship program. Of note, the American Board of Internal Medicine (ABIM) has no plans to pursue subspecialty certification for Hospital Medicine (HM), instead offering a Focused Practice in HM tied to Maintenance of Certification (MOC) for those individuals seeking distinction.
The group of trainees most negatively affected by the ABMS and ABP decision is internal medicine-pediatrics (med-peds) residents hoping to pursue a career as a med-peds hospitalist. Current estimates place the number of med-peds hospitalists in the United States caring for both children and adults at 350-400; these physicians may also comprise as much as 10 percent of the PHM workforce. There is considerable fear that adoption of subspecialty certification in PHM will reduce the med-peds hospitalist pipeline as well as put certain patient populations, specifically adults who are survivors of congenital or childhood diseases, at risk.

Purpose: To develop and implement a two-year internal medicine-pediatrics hospital medicine (IMPHM) fellowship program that would satisfy the requirements of the curricular framework for PHM fellowships set forth by the Council of PHM Fellowship Directors most likely to be adopted by the ACGME.

Description: Akron Children’s Hospital (ACH) is an independent, 268-bed, tertiary care hospital which introduced a PHM fellowship program in 2014. In March 2017, ACH reached an affiliation agreement with Cleveland Clinic Akron General (CCAG), a 532-bed teaching hospital that serves as the hub for the Clinic’s southern region, to sponsor the first publicized IMPHM fellowship program. The established curriculum (Table 1) satisfies proposed PHM fellowship requirements for core clinical rotations, systems and scholarship, and individualized curriculum and thus allows med-peds trainees to remain eligible for PHM subspecialty certification while gaining additional, mentored clinical experience in adult HM.

Conclusions: For med-peds residents seeking a career as a med-peds hospitalist, a training program which meets PHM certification eligibility criteria while incorporating robust clinical activity in adult HM has been established.

IMAGE 1: Solomon_ACH_CCAG IMPHM Fellowship Curriculum