You can be as dismissive as you want, but the main proof is the midlevels, who are supervised only in the most technical, legalistic sense of the term. No one is reading their charts while the patients are still in the hospital/clinic, and no physician 'supervisor' has the ability to fire a mid-level unless they own the clinic the mid-level works in. Even in the 50% of states where they can't practice under their own license legally, they are effectively practicing independently. If attendings really thought you needed 3 full years of residency training to be safe they wouldn't collaborate in that kind of care.
The second proof is that no one in academic medicine cares enough about this training to make themselves/their colleagues get it, if they weren't forced to get it in the first place. For everything from residency to fellowships to MOC they are grandfathered in. Everyone needs a hospitalist fellowship, unless they graduated before hospitalist fellowships.
The final proof is that the training isn't even internally consistent. To be a Pediatrician you need to train for 3 years. 3 years of what? It barely matters. 3-12 months of clinic. 2-7 months of NICU. 5-18 months of wards. They only have the vaguest idea of what you need, but they are sure you need exactly 3 years of it. That's a pretty good sign they believe not so much in the training as in the idea that you should serve out a term of indenture.
Umm, what?
Midlevels are irrelevant to the discussion. And even if they weren't, they are not equivalent to us. You're a pediatrician: do you truly believe that in a single day there is an NP that can round on inpatients, see mildly sick babies in the nursery, and spend a half day in clinic? Because that's what your training prepares you for. I've worked with a good half dozen NPs at this point and none of them came close to being as good at even basic general outpatient medicine as I am and that's the easy part of our training.
I don't know much about MOC in other specialties, but in mine there is no grandfathering in. So while I'm not a huge fan, there at least isn't any hypocrisy about the whole thing. The unneeded fellowship thing seems to be mostly a pediatric issue. I don't see the IM folks setting up one of those. Nor do I see them really doing any useless fellowships. So maybe the problem isn't as universal as you think it is.
Lastly, are you seriously trying to tell me that there aren't pretty strict curriculum rules for a pediatric residency? Because literally the 2nd google result for "acgme pediatrics requirements" gave me a PDF file dated July 1 2017 that spells out in some detail the curriculum (I'll highlight the key points):
The curriculum should be organized in educational units. (Core)
IV.A.6.a).(1)
An educational unit should be a block (four weeks or one month) or a longitudinal experience. (Core)
IV.A.6.a).(1).(a)
An outpatient educational unit should be a minimum of 32 half-day sessions. (Detail)
IV.A.6.a).(1).(b)
An inpatient educational unit should be a minimum of 200 hours. (Detail)
IV.A.6.b) The overall structure of the program must include: (Core)
IV.A.6.b).(1) a minimum of six educational units of an individualized curriculum; (Core)
IV.A.6.b).(1).(a) The individualized curriculum must be determined by the learning needs and career plans of each resident and must be developed through the guidance of a faculty mentor. (Core)
IV.A.6.b).(2)
a minimum of 10 educational units of inpatient care experiences, including: (Core)
IV.A.6.b).(2).(a)
inpatient pediatrics; (Core)
IV.A.6.b).(2).(a).(i) There must be five educational units. (Detail)
IV.A.6.b).(2).(a).(ii) No more than one of the five required educational units should be devoted to the care of patients in a single subspecialty. (Detail)
IV.A.6.b).(2).(b)
neonatal intensive care; (Core)
IV.A.6.b).(2).(b).(i) There must be two educational units. (Detail)
IV.A.6.b).(2).(c)
pediatric critical care; and, (Core)
IV.A.6.b).(2).(c).(i) There must be two educational units. (Detail)
term newborn care. (Core)
IV.A.6.b).(2).(d).(i) There must be one educational unit. (Detail)
IV.A.6.b).(3) a minimum of nine educational units of additional subspecialty experiences, including: (Core)
IV.A.6.b).(3).(a)
adolescent medicine; (Core)
IV.A.6.b).(3).(a).(i) There must be one educational unit. (Detail)
IV.A.6.b).(3).(b)
developmental-behavioral pediatrics; (Core)
IV.A.6.b).(3).(b).(i) There must be one educational unit. (Detail)
IV.A.6.b).(3).(c) four educational units of four key subspecialties from the following subspecialties: (Core)
IV.A.6.b).(3).(c).(i) child abuse; (Core)
IV.A.6.b).(3).(c).(ii) medical genetics; (Core)
IV.A.6.b).(3).(c).(iii) pediatric allergy and immunology; (Core)
IV.A.6.b).(3).(c).(iv) pediatric cardiology; (Core)
IV.A.6.b).(3).(c).(v) pediatric dermatology; (Core)
IV.A.6.b).(3).(c).(vi) pediatric endocrinology; (Core)
IV.A.6.b).(3).(c).(vii) pediatric gastroenterology; (Core)
IV.A.6.b).(3).(c).(viii) pediatric hematology-oncology; (Core)
IV.A.6.b).(3).(c).(ix) pediatric infectious diseases; (Core)
IV.A.6.b).(3).(c).(x) pediatric nephrology; (Core)
IV.A.6.b).(3).(c).(xi) pediatric neurology; (Core)
IV.A.6.b).(3).(c).(xii) pediatric pulmonology; or, (Core)
IV.A.6.b).(3).(c).(xiii) pediatric rheumatology. (Core)
IV.A.6.b).(3).(d) three additional educational units consisting of single subspecialties or combinations of subspecialties. (Core)
IV.A.6.b).(3).(d).(i) These should consist of experiences from either the list above or from the following:
child and adolescent psychiatry; (Detail)
IV.A.6.b).(3).(d).(i).(b) hospice and palliative medicine; (Detail)
IV.A.6.b).(3).(d).(i).(c) neurodevelopmental disabilities; (Detail)
IV.A.6.b).(3).(d).(i).(d) pediatric anesthesiology; (Detail)
IV.A.6.b).(3).(d).(i).(e) pediatric dentistry; (Detail)
IV.A.6.b).(3).(d).(i).(f) pediatric ophthalmology; (Detail)
IV.A.6.b).(3).(d).(i).(g) pediatric orthopaedic surgery; (Detail)
IV.A.6.b).(3).(d).(i).(h) pediatric otolaryngology; (Detail)
IV.A.6.b).(3).(d).(i).(i) pediatric rehabilitation medicine; (Detail)
IV.A.6.b).(3).(d).(i).(j) pediatric radiology; (Detail)
IV.A.6.b).(3).(d).(i).(k) pediatric surgery; (Detail)
IV.A.6.b).(3).(d).(i).(l) sleep medicine; or, (Detail)
IV.A.6.b).(3).(d).(i).(m) sports medicine. (Detail)
IV.A.6.b).(4)
a minimum of five educational units of ambulatory experiences, including: (Core)
IV.A.6.b).(4).(a)
ambulatory experiences to include elements of community pediatrics and child advocacy; and (Core)
IV.A.6.b).(4).(a).(i) There must be two educational units. (Detail)
IV.A.6.b).(4).(b)
pediatric emergency medicine and acute illness. (Core)
IV.A.6.b).(4).(b).(i) There must be three educational units of pediatric emergency medicine, at least two of which must be in the emergency department. (Detail)
IV.A.6.b).(4).(b).(ii) Residents must have first-contact evaluation of pediatric patients in the emergency department. (Detail)
IV.A.6.b).(5)
a minimum of 36 half-day sessions per year of a longitudinal outpatient experience. (Core)
So if we add up the 5 units of inpatient peds, 2 units of NICU, 2 units of PICU, 1 newborn nursery, 1 adolescent med, 1 developmental peds, 4 primary subspecialties, 3 secondary subspecialties, 2 units of clinic, 3 units of ER/urgent care we're up to 24 units which is either 24 months or 96 weeks (1.85 years) depending on how your program is set up. So basically 2/3rd of a peds residency is set in stone. But you're right, there's obviously no consistency to a pediatric residency. They are all only 2/3rds identical.
