What are the pathways to become a pediatric hospitalist?

[gus7826]

I am a pgy 2 in pediatric in NY. I usually enjoy all my floor rotations. However I am aware that many hospitals are now requiring you to do a pediatric hospital medicine fellowship in order to get a hospitalist job.
Is there any alternative pathway that you can work as a floor attending for example like doing another fellowship that requires you to be most of your time inpatient like hem/onc, nephro, or PICU?

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[Goneril]

I think it is mostly the academic institutions that prefer a fellowship trained hospitalist. The average community hospital won’t push for fellowship training.

 

[FrkyBgStok]

I guess I am not sure what you are asking. you want to do a PICU fellowship to work on the floor? or you are interested in a fellowship that is mostly inpatient? many specialties obviously have inpatient components, but I imagine it would be a pretty unique job to work as a nephrologist for all the inpatient stuff only. or a heme/onc attending in the same way.

but as above, the community places are likely going to pass on the fellowship training requirements.

 

[NurWollen]

I guess I am not sure what you are asking. you want to do a PICU fellowship to work on the floor? or you are interested in a fellowship that is mostly inpatient? many specialties obviously have inpatient components, but I imagine it would be a pretty unique job to work as a nephrologist for all the inpatient stuff only. or a heme/onc attending in the same way.

but as above, the community places are likely going to pass on the fellowship training requirements.

I guess I am not sure what you are asking. you want to do a PICU fellowship to work on the floor? or you are interested in a fellowship that is mostly inpatient? many specialties obviously have inpatient components, but I imagine it would be a pretty unique job to work as a nephrologist for all the inpatient stuff only. or a heme/onc attending in the same way.

but as above, the community places are likely going to pass on the fellowship training requirements.

I think he's talking about specialties that would allow you to spend most of your time in the hospital... but I'll answer the question both ways.

OP, obviously, PICU or NICU would allow you to spend most of your time in the hospital, but those fields are pretty different from being a pediatric hospitalist.

Honestly, an intensivist could work as a hospitalist (partly because anybody with general peds training should be able to, hospitalist should not be a subspecialty). I imagine a PICU fellowship would open some hospitalist doors that are closing to gen peds, but a PICU fellowship is a pretty brutal thing to go through for someone who doesn't want to be a PICU doctor. I wouldn't recommend that.

Of the non-ICU other specialties, you might want to look at ID. I think they spend more time in the hospital and less time in clinic than other subspecialties like nephro or GI. I certainly felt a lot like I was on the inpatient floor when I was on my ID month in residency.

 

[GoSpursGo]

I am a pgy 2 in pediatric in NY. I usually enjoy all my floor rotations. However I am aware that many hospitals are now requiring you to do a pediatric hospital medicine fellowship in order to get a hospitalist job.
Is there any alternative pathway that you can work as a floor attending for example like doing another fellowship that requires you to be most of your time inpatient like hem/onc, nephro, or PICU?

If you want to be a gen peds hospitalist, and the main aversion to going that route is that major academic med centers are requiring a PHM fellowship... why would doing another fellowship be more attractive than a PHM fellowship?

FWIW, peds heme/onc as a specialty is starting to have a number of heme/onc hospitalist positions open up for people who want to just take care of patients and are less interested in chasing external grant funding/research. You have to be willing to do some of the less-desirable shifts, such as nights. But again... I'm not sure why that would be preferable to just doing a PHM fellowship.

 

[deleted480308]

I am a pgy 2 in pediatric in NY. I usually enjoy all my floor rotations. However I am aware that many hospitals are now requiring you to do a pediatric hospital medicine fellowship in order to get a hospitalist job.
Is there any alternative pathway that you can work as a floor attending for example like doing another fellowship that requires you to be most of your time inpatient like hem/onc, nephro, or PICU?

What job do you actually want?

 

[hmockingbird]

Unfortunately the last year to grandfather in was graduating in 2019. Places are still hiring without the fellowship, though.


Re: the heme onc hospitalist jobs... there are also similar NICU hospitalist jobs. We had that at my residency and the thing about it is it looked like perpetually being a resident/fellow/mid level to me. If I wasn’t going to continue training I’d rather be independent.

So I think you need to decide if you want to be a hospitalist or do another inpatient specialty. I honestly do think it’s early enough that you’d be able to find a hospitalist job without the fellowship as long as you are ok with not going to a big name academic centre (or maybe working at a satellite hospital for one of those).

 

[gus7826]

Unfortunately the last year to grandfather in was graduating in 2019. Places are still hiring without the fellowship, though.


Re: the heme onc hospitalist jobs... there are also similar NICU hospitalist jobs. We had that at my residency and the thing about it is it looked like perpetually being a resident/fellow/mid level to me. If I wasn’t going to continue training I’d rather be independent.

So I think you need to decide if you want to be a hospitalist or do another inpatient specialty. I honestly do think it’s early enough that you’d be able to find a hospitalist job without the fellowship as long as you are ok with not going to a big name academic centre (or maybe working at a satellite hospital for one of those).

What job do you actually want?

I just want to work as an inpatient pediatrician. I don't care if it's a big children's hospital or a community hospital

 

[deleted480308]

I just want to work as an inpatient pediatrician. I don't care if it's a big children's hospital or a community hospital

My understanding (I actually asked an academic pediatrician this last month) is that you can still find plenty of pediatric hospitalist jobs away from academia that don’t require a fellowship if you are open geographically. What are you seeing in job postings?

 

[gus7826]

My understanding (I actually asked an academic pediatrician this last month) is that you can still find plenty of pediatric hospitalist jobs away from academia that don’t require a fellowship if you are open geographically. What are you seeing in job postings?

Most of them tell you that they do not require fellowship. But I am afraid that in the near future most of the hospitalist jobs will require the fellowship in order to apply

 

[mvenus929]

Most of them tell you that they do not require fellowship. But I am afraid that in the near future most of the hospitalist jobs will require the fellowship in order to apply

There are currently far more applicants to hospitalist fellowships than there are positions, so there's a significant bottleneck in getting fellowship training. If I had to guess, for at least the next 10 years, you won't have issue getting a job as a hospitalist without fellowship as long as you don't care about being in a non-academic institution. That should be plenty of time for you to get through.

Of course, if you're geographically picky, you may have less opportunities, as the high demand areas may ask for a fellowship just to cull the applicant pool a bit.

 

[MedicineZ0Z]

Peds hospitalist? 4 years of med school, 3 years of peds residency, 2 years of fellowship OR just be an NP/PA and get the job off the bat.

 

[tantacles]

Peds hospitalist? 4 years of med school, 3 years of peds residency, 2 years of fellowship OR just be an NP/PA and get the job off the bat.

Uhhhhhh no? Like the peds hospitalist fellowship is complete bullcrap and everyone knows it except the idiots pushing hard for it but still no? Listen to the upswing of my voice despite the fact that I'm not asking you a question to realize how not correct your statement is?

 

[MedicineZ0Z]

Uhhhhhh no? Like the peds hospitalist fellowship is complete bullcrap and everyone knows it except the idiots pushing hard for it but still no? Listen to the upswing of my voice despite the fact that I'm not asking you a question to realize how not correct your statement is?

what

 

[tantacles]

what

correct

 

[NurWollen]

what

I think @tantacles is saying to that while we all agree the fellowship is dumb, it's not fair to compare it to what NPs do on an inpatient service. We had NPs on our inpatient service in residency. They were great, and basically functioned as eternal (but reliable) interns. I honestly don't think I had any loss of learning opportunities because of them.

 

[tantacles]

I think @tantacles is saying to that while we all agree the fellowship is dumb, it's not fair to compare it to what NPs do on an inpatient service. We had NPs on our inpatient service in residency. They were great, and basically functioned as eternal (but reliable) interns. I honestly don't think I had any loss of learning opportunities because of them.

Yes. I'd also like to suggest that we treat other people with respect. That includes nurse practitioners. We know they have less rigorous training than we do, and that doesn't mean they aren't doing an important job. I oppose midlevel independent practice, but I absolutely do not oppose NPs.

 

[NurWollen]

Yes. I'd also like to suggest that we treat other people with respect. That includes nurse practitioners. We know they have less rigorous training than we do, and that doesn't mean they aren't doing an important job. I oppose midlevel independent practice, but I absolutely do not oppose NPs.

Well said

 

[KP2AZ]

I think everyone else has touched on this pretty thoroughly- You don't need to do Pediatric Hospitalist fellowship unless you want to work in a major academic hospital. There are plenty of job offers out there that dont require the fellowship and will compensate you well. Most of the time I think it is another way for hospitals to get 2 more years out of you at the price of a resident (soon to be 3 from what I hear). Drink the Koolaid at your own risk I guess.

 

[NurWollen]

I think everyone else has touched on this pretty thoroughly- You don't need to do Pediatric Hospitalist fellowship unless you want to work in a major academic hospital. There are plenty of job offers out there that dont require the fellowship and will compensate you well. Most of the time I think it is another way for hospitals to get 2 more years out of you at the price of a resident (soon to be 3 from what I hear). Drink the Koolaid at your own risk I guess.

Wait they're going to make it three years?Where did you hear this?

 

[mvenus929]

Wait they're going to make it three years?Where did you hear this?

Some places already have 3 year fellowships. One of my friends who applied the same year I did intentionally didn't go to places that had 3 year fellowships for that reason.

 

[MedicineZ0Z]

Some places already have 3 year fellowships. One of my friends who applied the same year I did intentionally didn't go to places that had 3 year fellowships for that reason.

Trolling everyone and applicants will feed the troll.

 

[captianplanet]

Uhhhhhh no? Like the peds hospitalist fellowship is complete bullcrap and everyone knows it except the idiots pushing hard for it but still no? Listen to the upswing of my voice despite the fact that I'm not asking you a question to realize how not correct your statement is?

I am going to politely disagree with the sentiment that the fellowship is complete bullcrap. While I agree with you, using the fellowship in regards to obtaining a job especially community based is far fetched, the fellowship does provide a lot of potential for anyone interested in doing research.

One of the areas that is ripe for untapped potential in pediatric research is hospital medicine. The bread n butter of pediatrics hospital medicine is often neglected by subspecialty research and leads to opportunities for hospital medicine to look into. While QI is talked about as the predominant research pathway for HM that may be true at some places, but translational/bench research is increasing in addition to standard clinical research. It is these individuals who are interested in further research where the fellowship is a strong benefit. The trend of academic centers wanting more fellowship-trained is for the possible benefit of obtaining grant funding in a division that classically has never had it which for better/worse is a big driver in academic centers....

From the standpoint of research, I see the utility for the fellowship cause a resident coming out of residency to HM and actually obtain a K, gerber or thrasher is beyond improbable.

If you have no plans for research than I agree its kinda going through the motions....

 

[HemeOncHopeful19]

I am going to politely disagree with the sentiment that the fellowship is complete bullcrap. While I agree with you, using the fellowship in regards to obtaining a job especially community based is far fetched, the fellowship does provide a lot of potential for anyone interested in doing research.

One of the areas that is ripe for untapped potential in pediatric research is hospital medicine. The bread n butter of pediatrics hospital medicine is often neglected by subspecialty research and leads to opportunities for hospital medicine to look into. While QI is talked about as the predominant research pathway for HM that may be true at some places, but translational/bench research is increasing in addition to standard clinical research. It is these individuals who are interested in further research where the fellowship is a strong benefit. The trend of academic centers wanting more fellowship-trained is for the possible benefit of obtaining grant funding in a division that classically has never had it which for better/worse is a big driver in academic centers....

From the standpoint of research, I see the utility for the fellowship cause a resident coming out of residency to HM and actually obtain a K, gerber or thrasher is beyond improbable.

If you have no plans for research than I agree its kinda going through the motions....

If that’s the case call it a “research fellowship” and don’t make it a board certification.

 

[tantacles]

I am going to politely disagree with the sentiment that the fellowship is complete bullcrap. While I agree with you, using the fellowship in regards to obtaining a job especially community based is far fetched, the fellowship does provide a lot of potential for anyone interested in doing research.

One of the areas that is ripe for untapped potential in pediatric research is hospital medicine. The bread n butter of pediatrics hospital medicine is often neglected by subspecialty research and leads to opportunities for hospital medicine to look into. While QI is talked about as the predominant research pathway for HM that may be true at some places, but translational/bench research is increasing in addition to standard clinical research. It is these individuals who are interested in further research where the fellowship is a strong benefit. The trend of academic centers wanting more fellowship-trained is for the possible benefit of obtaining grant funding in a division that classically has never had it which for better/worse is a big driver in academic centers....

From the standpoint of research, I see the utility for the fellowship cause a resident coming out of residency to HM and actually obtain a K, gerber or thrasher is beyond improbable.

If you have no plans for research than I agree its kinda going through the motions....

Your comment supports my point more than it doesn't.

The result of the pediatric hospitalist fellowship is board certification, which has direct impact on your ability to find a job irrespective of your research acumen. I agree with you that pediatric hospital medicine has boundless potential for research, and I disagree with you that this should be the foundation for a clinical fellowship. So some questions (and my answers to them) that I think should sway any reasonable person my way:

1. Does the fellowship provide meaningful clinical training that a board certified pediatrician could not obtain on the job?

No. Once you've finished your pediatric residency, you are fully qualified to be a hospitalist.

2. Why don't we simply do a better job training attendings to do research?

Because we can simply create a fellowship and pay a fellow less to do our work. The driver for this, of course, being that the fellowship now holds the keys in terms of finding hospitalist jobs.

3. Why is there a board certification after the pediatric hospitalist fellowship?

Because this fellowship is not deemed to be a research fellowship but rather a clinical fellowship, and trainees are paid as fellows for their clinical work in addition to their research work.

The fellowship is bogus. Not because research isn't important, and not because you don't learn anything in it, but because it is simply a way to milk pediatric residency graduates, who already have decided to take a pay cut by pursuing pediatrics and often take a pay cut by pursuing hospital medicine when compared to primary care, who now have a job held over their head by a [ostensibly mandatory] fellowship. Total bullcrap.

A [one year] research fellowship (without subsequent board certification) would not be bullcrap, and it would still allow residency graduates who are interested in research to get further experience and then get paid for their clinical time as an attending. That's the T.

 

[captianplanet]

Your comment supports my point more than it doesn't.

The result of the pediatric hospitalist fellowship is board certification, which has direct impact on your ability to find a job irrespective of your research acumen. I agree with you that pediatric hospital medicine has boundless potential for research, and I disagree with you that this should be the foundation for a clinical fellowship. So some questions (and my answers to them) that I think should sway any reasonable person my way:

1. Does the fellowship provide meaningful clinical training that a board certified pediatrician could not obtain on the job?

No. Once you've finished your pediatric residency, you are fully qualified to be a hospitalist.

2. Why don't we simply do a better job training attendings to do research?

Because we can simply create a fellowship and pay a fellow less to do our work. The driver for this, of course, being that the fellowship now holds the keys in terms of finding hospitalist jobs.

3. Why is there a board certification after the pediatric hospitalist fellowship?

Because this fellowship is not deemed to be a research fellowship but rather a clinical fellowship, and trainees are paid as fellows for their clinical work in addition to their research work.

The fellowship is bogus. Not because research isn't important, and not because you don't learn anything in it, but because it is simply a way to milk pediatric residency graduates, who already have decided to take a pay cut by pursuing pediatrics and often take a pay cut by pursuing hospital medicine when compared to primary care, who now have a job held over their head by a [ostensibly mandatory] fellowship. Total bullcrap.

A [one year] research fellowship (without subsequent board certification) would not be bullcrap, and it would still allow residency graduates who are interested in research to get further experience and then get paid for their clinical time as an attending. That's the T.

Solid discussion point and I'll do my best to counter,

1. Agree when you graduate you shouldn't need all that much more training in HM. Counter point. I don't know if you are a sub specialist but outside of a the procedure specialties, one year is over kill in additional clinical time, realistically 6 months is truly sufficient for bread n butter of any specialty. So to say in any fellowship the clinical requirement is somewhat over the top and expected. Hm getting it's share is par for the course in my opinion. To say no learning would take place in clinical aka teaching during rounds or medically complex patients is a little overly confident. But again, agree a graduating resident should be able to manage bread n butter inpt peds no problem. While learning on the job is always a fair point, you could say that with diabetes glucose management or treatment of osteo/meningitis which I'm sure you could do but commonly involve subspecialists. So why consult anyone If you can quickly read on up-to-date and learn on the job..... There are additional nuances that I do think extra time and discussion with a teaching faculty do provide to hm fellows, that is superior to learning on the job.

2. Research education for a full time hm clinical attending..... Yeah 1.0 fte clinical and then learn research techniques I guess on your own time? Pro-bono research does exist but doesn't mean it's right. When it's not incorporated to the job itself it always feels like your being taken advantage of by admin. While your counter point is you are being low balled by a fellow salary is fair but you know you will get that education and research experience while as a full time attending is, realistically, highly unlikely. That is due to your senior faculty unlikely to have a robust research experience that can actually mentor you to where you want to be. To some extent you gotta give a little to gain these skills.

3. This is a lil funny to me cause in general all peds subspecialists are highly research oriented compared to our adult 2 year fellowship peers. I mean I did ID and it's a clinical fellowship ...... Lolz.......academic peds is heavily research oriented but if you want to call it clinical, go for it.

Your financial argument is fair, but you are arguing with someone who did peds id arguably the lowest of the low and largest sacrifice...... The endgame post fellow is still more than I will ever see so... Not the best argument towards me, but I get what you are saying

I don't think I will ever sway the majority opinion here, but from a subspecialty eyes I do see the draw and utility to the fellowship. I do not like how's it been portrayed like you can't practice without it, but acknowledge that academic jobs will start to restrict to fellow trained only once enough people are trained/grandfathered

Solid discussion, awaiting someone to counter above.

 

[tantacles]

Solid discussion point and I'll do my best to counter,

1. Agree when you graduate you shouldn't need all that much more training in HM. Counter point. I don't know if you are a sub specialist but outside of a the procedure specialties, one year is over kill in additional clinical time, realistically 6 months is truly sufficient for bread n butter of any specialty. So to say in any fellowship the clinical requirement is somewhat over the top and expected. Hm getting it's share is par for the course in my opinion. To say no learning would take place in clinical aka teaching during rounds or medically complex patients is a little overly confident. But again, agree a graduating resident should be able to manage bread n butter inpt peds no problem. While learning on the job is always a fair point, you could say that with diabetes glucose management or treatment of osteo/meningitis which I'm sure you could do but commonly involve subspecialists. So why consult anyone If you can quickly read on up-to-date and learn on the job..... There are additional nuances that I do think extra time and discussion with a teaching faculty do provide to hm fellows, that is superior to learning on the job.

But how much superior? At my institution, the fellows are the sole attending after six months, and they interact with other attendings in the same way new attendings do in questioning their decisions and seeking feedback. And pediatric hospital medicine is so consult heavy that it doesn't make sense.

Subspecialists are trained in such a way that they can deal with not only the basic diabetes management but also the complex panhypopit cerebral palsy patient who is septic from an endocrine standpoint. The hospitalist will likely still consult endocrine for these complex cases. And in fact, endocrine at my tertiary care hospital generally admits its own anyway. They're not making the endocrinologists do a hospitalists fellowship to manage their patients, and they are very rarely consulting the hospitalists, subspecialty trained or not, for their expertise.

2. Research education for a full time hm clinical attending..... Yeah 1.0 fte clinical and then learn research techniques I guess on your own time? Pro-bono research does exist but doesn't mean it's right. When it's not incorporated to the job itself it always feels like your being taken advantage of by admin. While your counter point is you are being low balled by a fellow salary is fair but you know you will get that education and research experience while as a full time attending is, realistically, highly unlikely. That is due to your senior faculty unlikely to have a robust research experience that can actually mentor you to where you want to be. To some extent you gotta give a little to gain these skills.

So gain them in a research fellowship. Don't make this fellowship a gatekeeper to being a hospitalist. Full time research with extra hospitalist shifts would make a lot of sense. In EM, ultrasound fellows do their fellowship where they are learning ultrasound exclusively and work generalist shifts on the side.

3. This is a lil funny to me cause in general all peds subspecialists are highly research oriented compared to our adult 2 year fellowship peers. I mean I did ID and it's a clinical fellowship ...... Lolz.......academic peds is heavily research oriented but if you want to call it clinical, go for it.

Your financial argument is fair, but you are arguing with someone who did peds id arguably the lowest of the low and largest sacrifice...... The endgame post fellow is still more than I will ever see so... Not the best argument towards me, but I get what you are saying

but again, the people doing actual subspecialties are gaining the ability to practice exclusively in that subspecialty, whereas we're now just restricting the practice of hospital medicine, a field that those coming from academic pediatric residencies are exquisitely prepared to do. I'm prepared to manage community acquired pneumonia; I'm not prepared to manage septic shock (PICU). I'm not prepared to independently manage fungemia in a pediatric patient (ID). I'm not prepared to independently manage pediatric lupus (rheum). But the PICU fellows, endocrine fellows, and rheumatology fellows generally feel pretty prepared to manage that community acquired pneumonia because it's considered to be general pediatrics.

So if you want it to really be about research, make it a research fellowship.

I don't think I will ever sway the majority opinion here, but from a subspecialty eyes I do see the draw and utility to the fellowship. I do not like how's it been portrayed like you can't practice without it, but acknowledge that academic jobs will start to restrict to fellow trained only once enough people are trained/grandfathered

Solid discussion, awaiting someone to counter above.

I acknowledge that they will restrict practice. I feel that they are wrong to do this. The whole point of my post is that they shouldn't. I maintain that the fellowship is unnecessary and just a way to force more work out of trainees who gain a minimal amount of new clinical skills compared to residency.

 

[SurfingDoctor]

Probably all subspecialty training needs to be broken down into a research track and a clinical track. Making people go through an additional 18 months of "training" to do some scholarly project that they don't have an interest in pursuing is a waste of time for everyone. Additionally, 18 months of training is probably insufficient do develop enough of a robust research skillset where one could be successful long-term. For hospitalist, the only real benefit is getting a secondary degree (MHA, MPH) as I agree that the clinical training aspect is superfluous. If one were to go out and just practice in a community setting or take a track at an academic hospital under the clinical practice track, then fellowship doesn't really add anything.

In general though, academic systems are starting to become swamped with subspecialist physicians and the job market is becoming tighter and tougher. It'll be interesting to see how this all unfolds because in the long-term, at least for hospital-based subspecialties, the number of fellows taught appears to be outstripping jobs.

 

[VA Hopeful Dr]

Probably all subspecialty training needs to be broken down into a research track and a clinical track. Making people go through an additional 18 months of "training" to do some scholarly project that they don't have an interest in pursuing is a waste of time for everyone. Additionally, 18 months of training is probably insufficient do develop enough of a robust research skillset where one could be successful long-term. For hospitalist, the only real benefit is getting a secondary degree (MHA, MPH) as I agree that the clinical training aspect is superfluous. If one were to go out and just practice in a community setting or take a track at an academic hospital under the clinical practice track, then fellowship doesn't really add anything.

In general though, academic systems are starting to become swamped with subspecialist physicians and the job market is becoming tighter and tougher. It'll be interesting to see how this all unfolds because in the long-term, at least for hospital-based subspecialties, the number of fellows taught appears to be outstripping jobs.

This may be beyond your immediate knowledge, but any idea what the demographics of your subspecialists are?

I ask because many fields (mine included) have a huge number of baby boomer physicians who are starting to retire in increasing numbers.

 

[SurfingDoctor]

This may be beyond your immediate knowledge, but any idea what the demographics of your subspecialists are?

I ask because many fields (mine included) have a huge number of baby boomer physicians who are starting to retire in increasing numbers.

Specific to age? Our current division of 18 or so, the median number of years out of training is probably 3 years. All physicians except for 2 and under the age of 50. I would say the older physicians are male and the younger ones are female.

I don't know if that is typical, but where I did training a decade ago, there were about 8 physicians and now there are 40 or more (mostly through hospital expansion). But I don't think there are that many baby boomers in critical care. Suffice it to say, the number of new graduates far outpace the number of older physicians retiring. Actually, probably the biggest saving grace for new graduates is that academic hospital systems keep expanding as community hospitals falter.

As for the Department of Pediatrics in general where I am at, there's several hundred physicians. In the 8 years I've been here, there have been only a handful of retirements, but lots of new hires. Most of those hires are through staffing urgent care clinics.

 

[Staphylococcus Aureus]

Really only two routes to board certified pediatric hospitalist jobs:

A: MD-> peds residency -> peds hospitalist fellowship ->BC

B: MD-> peds residency -> RN-> NP->BC

 

[tantacles]

Really only two routes to board certified pediatric hospitalist jobs:

A: MD-> peds residency -> peds hospitalist fellowship ->BC

B: MD-> peds residency -> RN-> NP->BC

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