Pediatric Hospital Medicine Certification

Eligibility Criteria for Certification in Pediatric Hospital Medicine

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

To be eligible, an individual must:

• Hold a current ABP certification in general pediatrics.
• Satisfactorily meet either the training pathway requirements for pediatric hospital medicine or the practice pathway requirements or the combined pathway requirements.  If applying through the practice pathway, practice experience must be accrued by June 30th of the year of application.
• Possess a current (active), unrestricted medical license in the US or Canada. 

The first administration of the exam will occur on November 12 and November 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 - 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 2 years of pediatric hospital medicine training in a program supervised by a director who is certified in pediatric hospital medicine or, who possesses appropriate educational qualifications.   The ABP will consider only fellows who complete training in pediatric hospital medicine 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 2-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 pediatric hospital medicine 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 diplomate 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 2 years of non-accredited pediatric hospital medicine 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 7 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 pediatric hospital medicine training programs.   A fellow entering subspecialty training in pediatric hospital medicine 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 are certified in pediatric hospital medicine once certification is available.  Only pediatric hospital medicine 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, 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 (often for many years) 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.  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.  For individuals who are in residency, one way to assure eligibility for certification is to enter a fellowship training program and complete the required training. However, the ABP will accept those who qualify for the practice pathway as defined in the eligibility criteria.  There will be a temporary period during which candidates may apply for the certifying examination based upon practice experience in pediatric hospital medicine.  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.  During this temporary period, there will be two pathways used to apply for the examination for those who can demonstrate a significant practice concentrated in the discipline of pediatric hospital medicine.  Individuals have 7 years from the time of initial acceptance for the examination to become certified. Residents graduating in 2019 may be able to accrue the 4 years of practice by 2023 if they start their practice experience in July 2019. The final year to use the practice pathway as a means of eligibility will be 2023.  

Four-Year Practice Pathway

The most recent four years of full-time practice must have consisted of at least 50% time spent engaging in professional activities (clinical care, teaching, quality improvement, patient safety, research, administration, etc.) related to the care of hospitalized children. At least half of that time must be devoted to direct patient care of children, i.e., 25% of full-time professional practice.   Professional activities must be of such type and quality that they are sufficient to substitute for the breadth of experience one would encounter during formal subspecialty fellowship training. Unsupervised pediatric hospital medicine practice accrued during a chief residency can be recognized if it meets the requirements.  In general, for purposes of practice, full time is considered to be at least 40 hours per week.  Therefore, an applicant’s direct care of patients should average no less than 10 hours per week, or 450-500 hours per year over the most recent four years.  To qualify, the clinical time must average at least 10 hours per week directly caring for children whose diagnoses encompass the breadth of the discipline, including children from birth to 21 years of age and include the full spectrum of general pediatric inpatient medicine including but not limited to newborns, children with complex chronic diseases, surgical care and co-management, sedation, palliative care, and common procedures related to the practice of pediatric hospital medicine.  Practice experience must be accrued in the US or Canada.

Between 900-1000 hours per year over the most recent four years should be spent overall in the practice of pediatric hospital medicine when accounting for the overall requirement of spending at least 50% time in professional activities related to the care of hospitalized children. If your clinical practice is at least 50% of your full time professional activity and is spent in the care of hospitalized children (from birth to 21 years of age) in a general pediatrics setting, then you do not have to engage in other non-clinical activities related to the care of hospitalized children.  If you do not engage clinically as described for at least 50% time, but do meet the requirement for 25% clinical time, then you need to engage in other hospital medicine activities for an additional 25% of your time. These activities can focus on administrative, quality improvement, patient safety, research, or teaching activities related to the care of hospitalized children.  Examples of activities that are not applicable include administrative time as a residency or fellowship program director executing the routine activities of that position that do not directly relate to the care of hospitalized children. 

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 at least 25% of their full-time, professional activity in the direct clinical care of hospitalized children.  The additional required activities may consist of patient care of hospitalized children beyond 25%, however the clinical care of hospitalized adults cannot be counted toward the requirements.  If less than 50% of practice activity is devoted to the clinical care of hospitalized children as described above, the additional, required 25% 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 the minimum requirements are met.  The part-time practice must be equivalent to 50% of full time professional activity, with half of that time spent in the direct care of hospitalized children.   In general, full-time is considered at least 40 hours per week.  Therefore, an applicant’s direct care of patients should average at least 10 hours per week, or 450-500 hours per year over the most recent four years.  Between 900-1000 hours per year over the most recent four years should be spent in the overall practice of pediatric hospital medicine (clinical care, teaching, quality improvement, research, administration, patient safety, etc.).  A physician working less than half-time (i.e., < 20 hours per week) is unable to qualify through the practice pathway.   

For individuals who have interrupted practice during the most recent four years for family leave or other such circumstances, an exception may be considered if there is substantial prior experience in pediatric hospital medicine.  For example, if an individual interrupted practice for family leave or other such circumstances, but the previous practice experience amply fulfilled the requirements, it is possible that the ABP would approve the applicant.  Such exceptions are made at the discretion of the ABP and will be considered on a case-by-case basis. 

For individuals who practice exclusively in a niche area such as neonatal-perinatal medicine, pediatric emergency medicine, pediatric critical care, bone marrow transplant or well-baby nursery, such a niche practice limited to one population of hospitalized children will not qualify one for the practice pathway as that is not the intention of the hospital medicine certificate.

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

Combination Fellowship and Practice 

An individual completing less than 2 years of fellowship may qualify with an additional 2 years of practice experience that meets the requirements stated above. The 2 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 pediatric hospital medicine training program, and an Evaluation Form will be required from the pediatric hospital medicine program director (if there is a subspecialty training program), the pediatric hospital medicine division director, the pediatric department chair, the chief of pediatrics or chief of staff in the hospital(s) where the applicant is now or has been practicing pediatric hospital medicine.

More About Practice

Accrual Deadlines for the Practice Pathway

The specific deadline for each examination is noted below:

An applicant qualifying for the examination via either the four-year practice pathway or the combination training and practice pathway must complete an application and receive approval to take the examination no later than 2023.

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.

Approved by the Board of Directors June 2017

Frequently-Asked Questions