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). 

Pathways Leading to Certification (Admission Requirements)

• Practice Pathway
• Pandemic-Related Modifications to the Practice Pathway
• Five-Year Practice Pathway
• Medicine–Pediatrics Physicians
• Part-Time Physicians
• Training Pathway
• Non-Accredited and Accredited Fellowship Training
• Combination Fellowship and Practice
• The Exam
• Appeal Process

Practice Pathway

When there is a new subspecialty certification, the ABP allows expert subspecialists already practicing the discipline to have access to the examination for a limited period of time 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 prior to the start of accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in 2020. The ABP will accept those who qualify for the practice pathway as defined in the eligibility criteria (see Table 1 below). 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.

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Pandemic-Related Modifications to the Practice Pathway

The ABP acknowledges the COVID-19 pandemic, which started in 2020, has affected some physicians’ ability to meet the eligibility criteria for the practice pathway, specifically individuals who desire to apply for the next two exam cycles. Given the pandemic is occurring during the time period that a candidate will need to apply for a future exam, the final two exam dates for the practice pathway have been rescheduled to occur in the fall of 2022 and 2024.

In addition, the “look-back window” has been expanded from four years to five years to afford flexibility for applicants. However, practice experience need only be accrued during four of the most recent five years prior to the exam. This change acknowledges that some candidates may not be able to accumulate the necessary practice hours during the height of the pandemic in 2020.

It is mandatory that practice starts at the beginning of the look-back window. This means practice must begin no later than July 2017 for the 2022 exam, and that practice must begin no later than July 2019 for the 2024 exam. The final exam year in the practice pathway is 2024.

Graduates from general pediatrics or combined residency programs after June 2019 are not eligible for the practice pathway unless they begin practice in July 2019. Such individuals must enter a PHM fellowship and meet the training pathway requirements if they wish to become board-certified in PHM.

Individuals have seven years from the time of initial acceptance for the exam to become certified. For example, if an individual's application is accepted to take the PHM exam in 2024, his/her final date to achieve certification is Dec. 31, 2031. Please note the pediatric subspecialty initial exams are offered biennially (every two years). Therefore an individual's time limit (PDF) may expire in a year the exam is not offered.

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Five-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 take 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 five years. A year is defined as an academic year, starting in July and concluding in June of the following year. Each year is viewed as an individual period of time. The eligibility criteria (items 3-6 below) must be met in four of the five years of the window. This means an applicant may choose to not include the hours worked in practice for one year of the look-back window. A supervisor(s) must attest to the start and end dates of the five-year look-back window.
    
2. The end date for the look-back window is June 30 of the exam year for the practice pathway (i.e., 2022, and 2024). The start date for the look-back window begins five years earlier. For example, for the 2022 PHM exam, the start date is July 2017 and the end date for practice is June 30, 2022.
    
3. The minimum PHM workhours for all PHM professional activities (i.e., patient care, research, education, PHM administration) must be ≥ 900 hours per year in four years of the five-year look-back window. Each academic year is independent and there is no averaging of hours across the different years of the look-back window. If the applicant’s PHM clinical practice is ≥ 900 hours per year, then other nonclinical 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 in four years of the five-year look-back window. 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 in a setting described in item #5 below qualifies for this pathway. 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 well-baby nursery, does not meet the eligibility requirements. At least 450 hours per year in four out of the five years of the look-back window must be in the care of patients covering the full spectrum of PHM.
    
6. For candidates who wish to fulfill the entire 900 hours requirement with clinical care, the first 450 hours must be met in the full-spectrum of pediatric hospital medicine as described in item #5. The remaining 450 hours may be met in the newborn nursery. Other niche areas do not qualify for the pathway. The ineligible niche areas include pediatric emergency medicine, pediatric critical care, bone marrow transplantation, other ABP subspecialty certified areas of care, etc.
    
7. The location for patient care must have occurred in the United States or Canada.

Table 1. Eligibility Criteria for the PHM Exam, effective November 2020

PHM FAQs (PDF)

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

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Medicine–Pediatrics Physicians

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 out of the five years of the look-back window of their full-time, professional activity in the direct clinical care of hospitalized children as defined above. 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.

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Part-Time Physicians

Individuals who practice part-time may qualify for the practice pathway if all the eligibility criteria in Table 1 are met in four out of five years of the look-back window.

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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 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 for PHM training will be given for training completed during the core general pediatrics or combined pediatrics residency pathways. 
• Time spent in the chief residency year does not qualify for the training pathway. Time spent in the chief residency year may meet the practice pathway requirements if the candidate accumulated the necessary workhours practicing as an independent PHM physician. Routine activities for a chief resident (scheduling, mentoring, etc.) do not count for practice time. 
• Training which qualifies a pediatrician for admission to one subspecialty exam cannot be double-counted toward certification in another subspecialty. For example, time spent as a pediatric cardiology fellow cannot be double-counted as time spent in a PHM training program. 
• 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.

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Non-Accredited and Accredited Fellowship Training

Candidates with two years of non-accredited PHM training completed within seven years of the exam date may apply for the exam using the training pathway. Those individuals accepted for the exam have seven years from the time of initial acceptance for the exam to become certified. 

Applicants for an exam scheduled during the temporary period (2019, 2022, and 2024) who completed training more than seven years before the exam must apply through the practice pathway.

The ACGME started to process and accredit PHM training programs in January 2020. Starting in July 2022, individuals who start PHM fellowship as a first-year fellow must enter an ACGME-accredited PHM training program or RCPSC-accredited PHM training program in Canada. In addition, scholarly activity, as defined in the ABP’s General Criteria for Certification in the Pediatric Subspecialties, will be required for all individuals who commence training on or after July 1, 2022. 

A fellow entering subspecialty training in PHM before July 2022 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. 

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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 five years prior to the exam.

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.

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The Exam

The exam is 4.5 hours of actual testing time and will be offered throughout the testing days, allowing for morning or afternoon testing slots. Applicants may register for the 2022 exam on the ABP website from February through April 2022. Subspecialty exams are given in alternate years. Due to the COVID-19 pandemic, the PHM exam dates have been adjusted and are expected to be administered in the fall of 2022 and 2024.

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Appeal Process

An applicant applying under the practice pathway who is denied entry to the exam may appeal (PDF).

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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
Revised December 18, 2020