Pediatric Hospital Medicine Certification

Eligibility Criteria for Certification in Pediatric Hospital Medicine (PHM)

The American Board of Pediatrics (ABP) has established a procedure for certification in Pediatric Hospital Medicine (PHM). In addition to the specific admission requirements listed below, general eligibility criteria for all ABP subspecialties must be fulfilled to be eligible for certification.

The first administration of the exam will occur on Nov. 12 and Nov. 13, 2019. The exam is 4.5 hours of actual testing time and will be offered throughout the day, allowing for morning or afternoon testing slots. Applicants may register for the exam on the ABP website from February through April 2019. Subspecialty examinations are given in alternate years; therefore, the exam is expected to be administered in odd years in the fall (e.g., fall 2021, fall 2023, etc.).

Admission Requirements

Training Pathway

Physicians may apply on the basis of the completion of two years of PHM training in a program supervised by a director who is certified in PHM or who possesses appropriate educational qualifications. The ABP will consider only fellows who complete training in PHM programs that are operated in association with general pediatrics residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the United States or the Royal College of Physicians and Surgeons of Canada (RCPSC).

Physicians who have completed a two-year fellowship in general academic pediatrics fellowship may be considered if the clinical training during the fellowship focused on the care of hospitalized children and provided the depth and breadth of clinical training experiences, supervised by qualified hospitalists, comparable to that offered in a PHM fellowship training program.

Training in global health, patient safety research fellowships, and clinical informatics does not qualify toward the training pathway. No credit will be given for training completed during the core general pediatrics residency or a chief residency. Training which qualifies a pediatrician for admission to one subspecialty examination cannot be double-counted toward certification in another subspecialty. Training may be completed on a part-time basis if the required two years of fellowship is completed over no more than a four-year period.

There will be a temporary period which includes the first three examination administrations (2019, 2021 and 2023) during which candidates who have completed two years of non-accredited PHM training within the previous seven years of the examination date may apply for the examination using the training pathway. Those individuals accepted for the exam have seven years from the time of initial acceptance for the examination to become certified.

Applicants for an examination scheduled during the temporary period (2019, 2021, 2023) who completed training more than seven years before the examination must apply through the practice pathway.

Accredited Training

An application has been submitted to the Accreditation Council for Graduate Medical Education (ACGME) to request that it begin a process to accredit PHM training programs. A fellow entering subspecialty training in PHM before completion of the accreditation process by ACGME is advised to enter those programs in which the director or senior faculty of the program possesses appropriate educational qualifications or is certified in PHM once certification is available. Only PHM training programs that are operated in association with general comprehensive pediatric programs accredited by the ACGME or RCPSC will be considered. A Verification of Competence Form must be completed by the program director(s) verifying satisfactory completion of the required training and evaluating clinical competence, including professionalism. The ABP will determine and publish the date after which fellows must enter accredited training to be eligible for the certifying examination. At that time, scholarly activity, as defined in the ABP’s General Criteria for Certification in the Pediatric Subspecialties, will be required.

Practice Pathway

When there is a new subspecialty certification, the ABP allows those individuals who are expert subspecialists and already practicing the discipline to have access to the examination without having to go back and complete formal fellowship training. Many of these individuals helped to “establish” the subspecialty and direct the non-accredited fellowship programs that already exist. The ABP will accept those who qualify for the practice pathway as defined in the eligibility criteria. This practice pathway is not meant to offer a means to informally train in the discipline or to serve as an apprentice outside of a formal fellowship program.

There will be a temporary period during which candidates may apply for the certifying examination based upon practice experience in PHM. This temporary period will span the first three examination cycles (2019, 2021, 2023). All practice experience must be accrued during the most recent four years prior to the examination. Residents graduating in 2019 may be able to accrue the four years of practice by 2023 if they start their practice experience in July 2019. Current general pediatrics residents interested in PHM must enter a PHM fellowship if they wish to become board-certified in pediatric hospital medicine.

Individuals have seven years from the time of initial acceptance for the examination to become certified. The final year to use the practice pathway as a means of eligibility will be 2023.

Four-Year Practice Pathway

The eligibility criteria are designed to be true to the mission of the ABP and seek parity with the requirements used by other subspecialties and by the PHM training pathway. The assumption is that competent PHM practice of sufficient duration and breadth that is attested to by a supervisor allows the ABP to represent to the public that the candidate is qualified to sit for the exam. The eligibility criteria focus on six practice characteristics (also see Table 1):

1. The “look-back window” refers to the years of recent experience a pediatric hospitalist must demonstrate to be eligible for the exam. The minimum duration for the PHM look-back window is set at four years.
2. The end date for the look-back window is June 30 of the exam year for the practice pathway (i.e., 2019, 2021, and 2023). The start date for the look-back window begins four years earlier. For instance, the start date for the 2019 exam year is July 2015.
3. The minimum PHM workhours for all PHM professional activities (i.e., patient care, research, education, PHM administration) must be ≥ 900 hours per year for each of the four years of the look-back window. (If the applicant’s PHM clinical practice is ≥ 900 hours per year, then other non-clinical PHM activities are not needed to satisfy eligibility requirements.) To satisfy this requirement, the professional activities must occur in the field of PHM. For example, serving as a pediatric department chair would not meet the criterion, whereas serving as a PHM division chief would qualify.
4. The minimum PHM workhours for direct patient care (as defined in item #5 below) must be ≥ 450 hours per year each year for four years. Every candidate must satisfy both the minimum hours for all PHM professional activities (item #3 above) and the minimum hours for the direct care of hospitalized children. Care of adult patients does not meet this criterion. Only the care of the hospitalized child qualifies. Applicants must meet or exceed the minima for all PHM professional activities and direct patient care if the ABP is to represent to the public that an applicant has the necessary experience to be called a subspecialist in PHM.
5. The scope of practice seeks to maintain parity with the training pathway by requiring care of the full spectrum of hospitalized children. This full spectrum is defined as children on general pediatric wards, ages birth to 21 years, and specifically includes children with complex chronic disease, surgical care and co-management, sedation, palliative care, and common procedures. Care devoted exclusively to a narrow patient population (“niched care”), such as newborns in the nursery, does not meet the eligibility requirements. Examples of exclusive practice in other niche areas that do not qualify include pediatric emergency medicine, pediatric critical care, bone marrow transplantation, etc.
6. The location for patient care must have occurred in the United States or Canada.

For an individual utilizing the practice pathway, an Evaluation Form(s) will be required from the PHM program director (if there is a subspecialty training program), or the PHM division director, the pediatric department chair, the chief of pediatrics, or the chief of staff in the hospital(s) where the applicant is now or has been practicing PHM.

Table 1. Eligibility Criteria for the PHM Exam

Approval of an application requires meeting all six of the criteria above as attested to by the applicant’s supervisor.

Individuals who are graduates of internal medicine-pediatrics programs who are practicing as hospitalists caring for both adults and children may qualify. A Med–Peds physician must spend ≥ 450 hours per year every year for four years of their full-time, professional activity in the direct clinical care of hospitalized children. The additional required workhours may consist of patient care of hospitalized children beyond 450 hours per year, however the clinical care of hospitalized adults cannot be counted toward the requirements. If less than 900 hours per year of practice activity is devoted to the clinical care of hospitalized children as described above, the additional, required hours of professional activity must include administrative, quality improvement, patient safety, research, or teaching activities related to the care of hospitalized children and/or adults.

Individuals who practice part-time may qualify for the practice pathway if all the eligibility criteria in Table 1 are met.

Combination Fellowship and Practice

An individual completing less than two years of fellowship may qualify with an additional two years of practice experience that meets the requirements stated above. The two years of practice experience may be completed at any time either before or after training within the four years prior to the examination.

For an individual utilizing the combination training and practice pathway, a Verification Form will be required from the director of the applicant's PHM training program, and an Evaluation Form will be required from the PHM program director (if there is a subspecialty training program), the PHM division director, the pediatric department chair, the chief of pediatrics, or the chief of staff in the hospital(s) where the applicant is now or has been practicing PHM.

Appeal Process

An applicant applying under the practice pathway who is denied entry to the examination may appeal.

PHM Petition Response

Notice: The American Board of Pediatrics (ABP) reserves the right to make changes in its policies and procedures at any time and will make every effort to give advance notice when such changes are made. It is the applicant’s responsibility to be aware of and to meet all requirements and deadlines.

Revised August 28, 2019