Pediatric hospital medicine fellowship applicants 2020-2021. Read this!

[blue.jay]

I don't agree with PHM board certification being a requirement for current(and prospective) residents especially candidates who can't qualify for practice pathway by 2023. PHM fellowship seems to be cheap labor for academic places instead of hiring staff hospitalists (heck they even have to pay PA/NPs more than fellows). In reality, even for adult hospitalists our jobs are being replaced by NP/PA in some settings, as it's cheaper for the employers. I don't understand how pediatric residents and medical students are okay with 4 yrs of medschool+5 yrs of GME (earning 50-60k) for a job that pays 170-200k at the most. You will probably come out ahead being a PNP or PA. Being a hospitalist you are a generalist, you don't learn any skill or subject matter or procedure enough to be called a specialist. A fellowship in PHM won't make you consult less for complicated patients. All this is pure stupidity. If your board feels like they need a fellowship to do a job which can be done by a PA then they need to reform residency curriculum (which is good enough for being a hospitalist). If this is because of research requirement, or leadership roles then not everyone likes research or QI. I am not opposing PHM fellowship or having a board certification exam but it should not be mandatory. If big centers like CHOP, CHB want hospitalists with fellowship that's fine. It's not fair for us to have more and more added requirements while making things easier for NP/PA. PHM looks as competitive as PEM in NRMP match stats, I don't know if people are naive or really interested to go into this. It's clearly an act of resident/fellow abuse. You really don't need a fellowship to do this job. You are losing 200-400k income or loan repayment by doing this useless fellowship. I know this is already discussed in reddit, sdn etc. What are we doing to oppose this? Can we start a change.org petition to voice our opinion or start a email thread with signatures from all pediatric residents all over the US. If your only job opportunity is being a primary care physician after 4+3 yrs what makes you sure you won't lose your job to a PNP in 10 years? Can your board control midlevel encroachment in PHM or primary care pediatrics? They can't control who employers choose to hire but by having these addition requirements (more training) will only deter medical students from choosing pediatrics.

Reference

The evolving role of the pediatric nurse practitioner in hospital medicine - PubMed

There is evidence to suggest that PNP hospitalists provide inpatient care comparable to resident teams at a lower cost for patients with uncomplicated bronchiolitis, pneumonia, and asthma.

pubmed.ncbi.nlm.nih.gov

Why Required Pediatric Hospital Medicine Fellowships Are Unnecessary - The Hospitalist

A few reasons why a required pediatric hospital medicine fellowship is unnecessary and potentially harmful

www.the-hospitalist.org

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[SurfingDoctor]

Did you bother to search the other threads related to this topic, or no?

 

[blue.jay]

Did you bother to search the other threads related to this topic, or no?

Yes, I did. I know people have complained since 2018. I'm asking what can we do to oppose this mandatory pathway.

 

[SurfingDoctor]

Yes, I did. I know people have complained since 2018. I'm asking what can we do to oppose this mandatory pathway.

Climb the ranks and get on the board of directors. Or don’t become a hospitalist. Or wait it out and see if the people care about the negative financial impact (or maybe they don’t).

 

[blue.jay]

I posted this for my SO. I'm a adult hospitalists. I just felt this is very unfair for our pediatric colleagues. 90% of the patients I see are much more complicated that regular community pediatric patients. I am certain we can learn all the skills we need on the job and do research/QI on weeks off if someone is passionate. This won't affect me directly in anyway. It just makes my blood boil seeing all this ridiculous requirement by pediatric leaders. I advised my SO not to PHM to be a part of this movement. A fellowship (with 8 extra months of floors) won't drastically improve gen peds knowledge. We all learn something new everyday on the job.

 

[mvenus929]

You should probably change your status if you're an adult hospitalist.

None of us disagree with you. But there's a strong enough lobby that the certification and fellowship became a thing in the first place. Your SO can protest it by either not doing PHM, or by getting a job and experience at a place that doesn't require the certification. If your SO doesn't want to do academics, this should be a non-issue.

 

[blue.jay]

That's our plan. We are looking for jobs in community hospitals and hoping they won't ask for board certification after 2023. It's also reasonable if they remove practice pathway deadline and allow anyone with 4 years of community experience at anytime to be eligible for board examination.

 

[ftcm68]

"PHM fellowship seems to be cheap sustainable labor for academic places"

Wow. It's funny how it residency starts to feel likes a cheap labor pool with more experience.
But now that I spent a night with the fellow on call instead of an attending, I see exactly what you mean.

So none of this was about QI. It was all about taking less night call? Genius!

 

[DO2015CA]

You should probably change your status if you're an adult hospitalist.

None of us disagree with you. But there's a strong enough lobby that the certification and fellowship became a thing in the first place. Your SO can protest it by either not doing PHM, or by getting a job and experience at a place that doesn't require the certification. If your SO doesn't want to do academics, this should be a non-issue.

Are you referring to the practice pathway? I haven’t heard of it before but I also haven’t been following hospitalist fellowship closely. If so what does that include for criteria to qualify

 

[NurWollen]

Are you referring to the practice pathway? I haven’t heard of it before but I also haven’t been following hospitalist fellowship closely. If so what does that include for criteria to qualify

The practice pathway refers to people who will have finished residency in time to gain 4 years of experience as a peds hospitalist prior to by 2023. In other words, people graduating residency in 2019 are the last class who can do it. I'm graduating from my peds residency this year. I'm too late, by one year.

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[blue.jay]

The practice pathway refers to people who will have finished residency in time to gain 4 years of experience as a peds hospitalist prior to by 2023. In other words, people graduating residency in 2019 are the last class who can do it. I'm graduating from my peds residency this year. I'm too late, by one year.

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This is what I don't get, I understand deadlines and I know this was established even before 2020 graduating class applied for residency. You all signed up for this knowing about this PHM requirement. How does this 4 yr experience change the timeline? Do they mean the 2020 and later graduates are not adequately trained enough to take the boards after 2023 with 4 yrs experience in community setting? This is just a manipulative tactic by academia to control our lives.
The best solution is to have 0 applications for this useless fellowship next cycle. There are people who are still going to apply, there is nothing to stop them. The truth is most doctors have poor financial literacy. There is no guarantee that you will get into leadership positions. It's rather easier to focus on MBA and get into leadership roles. Don't waste 2 years worth of salary, your life being a slave when you're not going to learn any new skill.

 

[blue.jay]

Technically one can save 200-300k by skipping the fellowship for two years, and get MBA/MHA and invest the remaining in stock market for good returns.

 

[sliceofbread136]

Ridiculous. I’ll serve burgers before I do a hospitalist fellowship

 

[mvenus929]

This is what I don't get, I understand deadlines and I know this was established even before 2020 graduating class applied for residency. You all signed up for this knowing about this PHM requirement. How does this 4 yr experience change the timeline? Do they mean the 2020 and later graduates are not adequately trained enough to take the boards after 2023 with 4 yrs experience in community setting? This is just a manipulative tactic by academia to control our lives.
The best solution is to have 0 applications for this useless fellowship next cycle. There are people who are still going to apply, there is nothing to stop them. The truth is most doctors have poor financial literacy. There is no guarantee that you will get into leadership positions. It's rather easier to focus on MBA and get into leadership roles. Don't waste 2 years worth of salary, your life being a slave when you're not going to learn any new skill.

No, the intent of the practice pathway was to allow the older hospitalists working in children's hospitals, etc, to get the board certification without going back to fellowship for it. They gave a set deadline for it, which allowed anyone within a couple years of announcing the board certification to also get it without doing a fellowship (which is the way you become eligible for any other board certification).

Again, if your SO doesn't want to work in academia, this is a non-issue--community hospitals desperate for peds hospitalists are not going to require board certification to work there.

No one is arguing that it isn't stupid. No one. But people are still going to do it because it's a prestige thing. But if it's not right for your SO, then all they have to do is not do the fellowship and either take a community job, or do something other than hospitalist.

 

[Staphylococcus Aureus]

Physicians have the power here. Don’t do it.

 

[ftcm68]

Physicians have the power here. Don’t do it.

If you want to be in an academic pediatric hospitalist setting, for whatever personal or intrinsic interest, you're screwed. Because the numbers don't play out well - there's enough demand for PHM fellowship according to match data that abstainers won't come out ahead if they really want to be in academic settings - Fellowship Match Data and Reports - The Match, National Resident Matching Program

There is a small pro, which is that hospitalist night call will be reduced with this new, cheap fellow labor pool. Less night call may improve hospitalist quality of life in the long run. The people who benefit the most are those who grandfathered into hospitalist fellowship without "paying their dues." I don't think this is a primary motivation, or all that significant. But I noticed being on with a fellow - the PHM back up attending gets to sleep in all night

 

[blue.jay]

"There is a small pro, which is that hospitalist night call will be reduced with this new, cheap fellow labor pool. Less night call may improve hospitalist quality of life in the long run."

Is it worth 300k loss in post-tax income which you could potentially invest in stock market? Pay off some debts?
NP/PA can take night calls and still can improve hospitalists quality of life. The truth is your ABP or hospital administrators don't care about our well being or job satisfaction. They can happily send out burn out surveys but they won't do anything about it. Post this thread in PHM fellowship applicants 2021 thread and discourage anyone from applying. There are still people who don't care about money or being abused for cheap labour who will fill these spots and saturate the job market in 5 years. Glad I didn't choose the crazg pediatric world.

 

[Staphylococcus Aureus]

If you want to be in an academic pediatric hospitalist setting, for whatever personal or intrinsic interest, you're screwed. Because the numbers don't play out well - there's enough demand for PHM fellowship according to match data that abstainers won't come out ahead if they really want to be in academic settings - Fellowship Match Data and Reports - The Match, National Resident Matching Program

There is a small pro, which is that hospitalist night call will be reduced with this new, cheap fellow labor pool. Less night call may improve hospitalist quality of life in the long run. The people who benefit the most are those who grandfathered into hospitalist fellowship without "paying their dues." I don't think this is a primary motivation, or all that significant. But I noticed being on with a fellow - the PHM back up attending gets to sleep in all night

Yes, those that are masochistic enough to subject themselves to two more years of labor (at less money and worse lifestyle than the NP hired for the same work) in exchange for, I don't even know, prestige peanuts? research "opportunities"? They are indeed screwed. But for those that simply want to be staff pediatric hospitalists, they need to stand up for their own training and say no to this scheme. Again one wonders why adult hospitalists would never subject themselves to a two year "fellowship".

 

[sliceofbread136]

Soon there will be newborn nursery and minute clinic fellowships. Probably a $10k board exam to go with it.

 

[NurWollen]

Minute Clinic fellowships, with one-on-one mentoring from NPs with weeks of experience.

Soon there will be newborn nursery and minute clinic fellowships. Probably a $10k board exam to go with it.

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[DeadCactus]

I don't think you understand how board certification works. The only thing that makes a hospitalist fellowship mandatory is if enough people are willing to do the fellowship to shut those who have not done the certification out of the job market. Emergency medicine has been around since the 80's and people still practice it without board certification but they're not doing it at academic centers let alone ones in desirable locations at well-known institutions. I absolutely agree the fellowship exists as a tool to milk cheap labor from new graduates. But if there's a mass of people willing to pay that tax to get an academic job at a major institution and your wife isn't, I don't really see why everyone else needs to start marching with picket signs. People go into pediatrics, practice in the northeast, go into academics, and make all sorts of financial sacrifices in return for something else they value. This isn't unique to pediatrics. Academic positions across specialties increasingly require fellowship training. Pediatrics just hit their saturation point sooner than other specialties. There would be an IM hospitalist fellowship developed in a second if there was a surplus of IM physicians wanting to be academic hospitalists and a small number of academic hospitals.

 

[tantacles]

"There is a small pro, which is that hospitalist night call will be reduced with this new, cheap fellow labor pool. Less night call may improve hospitalist quality of life in the long run."

Is it worth 300k loss in post-tax income which you could potentially invest in stock market? Pay off some debts?
NP/PA can take night calls and still can improve hospitalists quality of life. The truth is your ABP or hospital administrators don't care about our well being or job satisfaction. They can happily send out burn out surveys but they won't do anything about it. Post this thread in PHM fellowship applicants 2021 thread and discourage anyone from applying. There are still people who don't care about money or being abused for cheap labour who will fill these spots and saturate the job market in 5 years. Glad I didn't choose the crazg pediatric world.

Sort of similar to you, I'm a med-peds resident who essentially is peacing out of peds (not even taking boards) because of this scheme; I will be an adult hospitalist next year. And that's all it is, in my opinion: a scheme. Children and adults are two completely different entities in terms of medical care, but the adult patients are sicker, often require more chart review, and have a higher chance of just flat-out dying on you in the middle of the night. Ergo, a pediatric hospitalist should not need this extra training, particularly if it's not being required of adult hospitalists.

I wish I had a better way of rebelling, but this honestly seems like the best option, and I regret doing a four year residency now that my options post-residency without fellowship, assuming I want to practice internal medicine and pediatrics, are limited to primary care. 80% of my training has focused on inpatient medicine and ICU care, and I feel most prepared to tackle that entity, but they're willing to allow me into a primary care clinic with no extra training? A crock, I say. Take this ridiculous requirement away immediately, pediatrics. You're ruining everything.

 

[blue.jay]

There would be an IM hospitalist fellowship developed in a second if there was a surplus of IM physicians wanting to be academic hospitalists and a small number of academic hospitals

Isn't that why people do an extra chief resident year? Just because people are willing to make poor financial decisions in life, like working in the northeast or in a big academic center; ABP shouldn't enforce some weird scheme of certification exam. Forcing 2 year pediatric hospital fellowship for academic/research reasons won't work well long term if medical students are discouraged from choosing pediatrics.

 

[blue.jay]

This is based off an online calculator with some assumptions.
Assuming 7% returns if you invest in sp500 index and assuming your salary is 200-220k right after fellowship; if you live like a resident and save 100k per year post-tax.

"If you spend $200,000.00 on an unnecessary product or service, and you could otherwise invest that money for 30 years, then spending the $200,000.00 could cost you $1,423,299.50 in forgone interest earnings. This would bring the real price-tag of what you are spending your money on to $1,623,299.50. So the question you should ask yourself is: Is what I am spending my money on worth $1,623,299.50?"

If your dream is to work in a prestigious academic children's hospital as a general non-specialized pediatric hospitalists losing about 1 million dollor; this is an option. May be 2-3 graduates might end up becoming the CEO of a big stand alone children's hospital and get more returns on their investment. Good luck!

 

[blue.jay]

Job ad:

Pediatric Hospitalist | Cleveland Clinic Children's | Physician Jobs | PracticeMatch.com | 585511

Pediatric Hospitalist ID:585511 - Hospitalist job opportunity in Cleveland OH

www.practicematch.com

Cleveland Clinic Children’s Hospital announces a search for Pediatric Hospital Medicine subspecialists to expand the group. The current 27 physicians and 19 nurse practitioners of the Cleveland Clinic Children’s Pediatric Hospital Medicine (PHM) group provides care for newborns, and inpatient general and subspecialty pediatric patients.

That's almost 1:1 doctor to NP staffing and now they will have fellows too.

The require BC/BE pediatric hospital medicine subspecialist candidate.

After 4 yrs of med school 3 yrs of pediatric residency and 2 more yrs of fellowship to get paid 200k (while NP works half the load with 2 yr of training getting 80-100k) your pediatric hospital board should atleast do something to guard your turf and prevent midlevel encroachment. They are saying 3 yrs of residency (which is heavily inpatient) is not good enough for inpatient medicine but NPs with 500 hr clinical shadowing exposure can do whatever they want in pediatric wards??

 

[SurfingDoctor]

Going into pediatrics in general is a money losing option in comparison to other specialties. You can parse apart this fellowship versus that fellowship and lost income but they already did that study a decade ago.

The bottom line is if your life goal is to make as much money as possible in medicine, then pediatrics probably isn’t for you. If you think $200K/year isn’t being well off, then you don’t know the meaning of the phrase.

 

[blue.jay]

Going into pediatrics in general is a money losing option in comparison to other specialties. You can parse apart this fellowship versus that fellowship and lost income but they already did that study a decade ago.

The bottom line is if your life goal is to make as much money as possible in medicine, then pediatrics probably isn’t for you. If you think $200K/year isn’t being well off, then you don’t know the meaning of the phrase.

I know people who go into pediatrics don't do it for the money. This fellowship is another slap in their face. Atleast for me and my wife 80-100k per year is good enough, we live a very simple life. I said she can do any fellowship other than PHM. I just can't stand how they are abusing residents and fellows in the name of education/training. If the training is so hard that it needs 4 yrs of education and 5 yrs of GME then how can it be done by midlevels with 500 hrs of training. If the speciality becomes saturated I don't think these hospitals will stop hiring NPs to save few bucks but then these doctors will have to displace their families to some not very desirable place.

 

[SurfingDoctor]

I know people who go into pediatrics don't do it for the money. This fellowship is another slap in their face. Atleast for me and my wife 80-100k per year is good enough, we live a very simple life. I said she can do any fellowship other than PHM. I just can't stand how they are abusing residents and fellows in the name of education/training. If the training is so hard that it needs 4 yrs of education and 5 yrs of GME then how can it be done by midlevels with 500 hrs of training. If the speciality becomes saturated I don't think these hospitals will stop hiring NPs to save few bucks but then these doctors will have to displace their families to some not very desirable place.

I mean, this was literally the argument for every subspecialty ever. And of course, there’s always been the choice not to do it.

 

[tantacles]

I know people who go into pediatrics don't do it for the money. This fellowship is another slap in their face. Atleast for me and my wife 80-100k per year is good enough, we live a very simple life. I said she can do any fellowship other than PHM. I just can't stand how they are abusing residents and fellows in the name of education/training. If the training is so hard that it needs 4 yrs of education and 5 yrs of GME then how can it be done by midlevels with 500 hrs of training. If the speciality becomes saturated I don't think these hospitals will stop hiring NPs to save few bucks but then these doctors will have to displace their families to some not very desirable place.

Here's the problem: You're right, and my colleagues in peds don't seem to care to advocate for my peers. The people advocating for this fellowship continually express the tone-deaf notion that 3 years of training is not enough while simultaneously and conveniently "forgetting" or rationalizing the fact that they only did three years too. The most common argument, the fact that pediatrics has too little autonomy, is a problem created by those in power who are, in many settings, advocating for in-house nocturnists (and sometimes two at a time!) for supervision.

It's yet another cry to screw the younger generation of doctors who "have it too easy," and I've started to view the whole thing as simply veiled jealousy. If they want to subject others to making $60,000/year for 2 extra years of training, they need to do it too. They need to feel that hardship again. Because in my institution, the hospitalist fellows are just acting as attendings who make less with minimal supervision during the first few months and zero supervision after that. In other words, they are attendings, and they need to be paid as such.

I agree with the above posters that people simply need to not apply to these positions. It is imperative that each and every one be boycotted. Unfortunately, the promise of an academic spot (which, by the way, is not guaranteed!) is a motivator for many, or at least that much I can infer. A little empathy would go a long way in this case.

 

[DeadCactus]

Isn't that why people do an extra chief resident year? Just because people are willing to make poor financial decisions in life, like working in the northeast or in a big academic center; ABP shouldn't enforce some weird scheme of certification exam. Forcing 2 year pediatric hospital fellowship for academic/research reasons won't work well long term if medical students are discouraged from choosing pediatrics.

Just because an exam exists, doesn't mean you're being forced to take it. You literally say in your first post "I am not opposing PHM fellowship or having a board certification exam but it should not be mandatory." Board certification is only "mandatory" if there are enough board certified positions to meet the demand. If enough people are willing to do a fellowship for a certain job and you or your wife are not, too bad for you. I don't know what you want. A fellowship is increasingly required for academic positions across specialties and this is a natural extension of that. You're mad about supply and demand economics.

 

[blue.jay]

Found this MGMA salary survey data. Pediatric hospitalists compensation is lower than outpatient gen peds.

 

[Splenda88]

I guess we will need a primary care fellowship for FM doctors...

 

[SurfingDoctor]

View attachment 307104
Found this MGMA salary survey data. Pediatric hospitalists compensation is lower than outpatient gen peds.

Of course it is. I assumed every knew that. General Peds is far more eat what you kill and has the ability to generate higher billable RVUs... assuming you see enough patients. Hospitalist have a fixed number of patients... you get what you get.

Needless to say, a ten thousand dollar difference pretax doesn’t mean a whole lot to your pocket when the tax man comes.

 

[ftcm68]

"There is a small pro, which is that hospitalist night call will be reduced with this new, cheap fellow labor pool. Less night call may improve hospitalist quality of life in the long run."

Is it worth 300k loss in post-tax income which you could potentially invest in stock market? Pay off some debts?

I was going to say, not all physicians are great at investing. I must be one of them because even I had some sticker shock @
""If you spend $200,000.00 on an unnecessary product or service, and you could otherwise invest that money for 30 years, then spending the $200,000.00 could cost you $1,423,299.50 in forgone interest earnings. This would bring the real price-tag of what you are spending your money on to $1,623,299.50. So the question you should ask yourself is: Is what I am spending my money on worth $1,623,299.50?""

This line sums up the cynical thoughts in me "fellowship exists as a tool to milk cheap labor from new graduates" - but that labor is not all clinical, some QI projects will move further because of fellowship. That will improve care.

But I know too many excellent med-peds graduates who are leaving pediatric practice because of it. That part is sad

 

[blue.jay]

If they can do this to fellowship trained PICU docs, pediatric hospitalists are easily replaced by midlevels after being a cheap slave for 2 years. Save your dignity and no one should apply for this bull**** fellowship this year, that's how you protest against this nonsense.

 

[NurWollen]

.

 

[mvenus929]

If they can do this to fellowship trained PICU docs, pediatric hospitalists are easily replaced by midlevels after being a cheap slave for 2 years. Save your dignity and no one should apply for this bull**** fellowship this year, that's how you protest against this nonsense.

The Anesthesia and PICU attendings were the only attendings NOT employed by the hospital (they had a private practice group that was contracted with the hospital). The hospital just made the decision to hire them directly rather than contracting out.

To be clear, the many peds hospitalists and NICU attendings are already employed by the hospital directly.

 

[Funke]

Agreed, to be fair to Children's Mercy, they are not replacing the doctors with midlevels. They are trying to save money by directly employing the intensivists (whether that is right or wrong).