Should pediatric hospitalists seek formal subspecialty status?

Is it time for pediatric hospital medicine (PHM) to become a full-fl edged subspecialty? Yes! The Accreditation Council for Graduate Medical Education (ACGME) defi nes a subspecialty as “That which provides advanced GME in a narrow fi eld of study within a medical specialty, eg, geriatric medicine within the fi eld of internal medicine.” In addition, many authorities feel that a robust research agenda may be the sine qua non of a subspecialty. Does PHM meet these defi nitions? In April 2010, the Pediatric Hospital Medicine Core Competencies were published as a supplement in the Journal of Hospital Medicine, codifying our contribution to advanced graduate medical education. Of course the words you are reading reside in the inaugural issue of Hospital Pediatrics, the only offi cial American Academy of Pediatrics (AAP)–sponsored journal other than the fl agship Pediatrics. While quality improvement literature from pediatric hospitalists has been appearing in journals such as Pediatrics and the Journal of Hospital Medicine the volume of research has reached a point where a specifi c journal for pediatric hospitalists is now viable. Surveys of pediatric hospitalists show that we are interested in research, but we need more skills and mentors. Where will these come from? We must create them in fellowships. Not every pediatric hospitalist has to be fellowship trained (look at the current state of pediatric emergency medicine), but we need a core of clinician investigators who can expand our knowledge and add to the evidence base of inpatient pediatrics. There can be no doubt that care in pediatric and neonatal intensive care units and emergency rooms has improved dramatically since the advent of these subspecialties. While the current generation of pediatric hospitalists is actively engaged in quality improvement in local, regional, and national venues, the discipline will not truly advance until we can begin generating new knowledge by performing high-quality research. National databases such as Kids’ Inpatient Database (KID) and Pediatric Health Information System (PHIS), and national research/quality improvement networks such as Pediatric Research in Inpatient Settings (PRIS) and Value in Inpatient Pediatrics (VIP) provide a data and research infrastructure waiting to be used by appropriately trained pediatric hospitalists.