When I finished my pediatric residency almost 20 years ago, I embarked upon a career in general pediatrics because I didn’t enjoy any particular subspecialty enough to commit my career to it. After spending several years in a mostly outpatient setting (peppered with child abuse consults, circumcisions, and an unsatisfyingly small number of hospitalized patients), I knew I had to change and move across the country to pursue pediatric hospital medicine (PHM). I loved my new job as a private practice pediatric hospitalist in a giant urban setting. Every week was different. I worked in newborn nurseries, tertiary care hospitals, pediatric units in community hospitals, and long-term care facilities. I found my people and my place in pediatrics. I breathed a sigh of relief that I had become part of a field that would sustain me throughout the coming decades.

Fast forward ten years. I was now back in my hometown, working as an academic pediatric hospitalist and associate residency program director and mothering three young children. Although such a development had never occurred to me, word on the street was that PHM would become its own subspecialty. It was initially unclear what this meant to me, my colleagues, and the future of PHM. But over the next few years, the ramifications unfolded before our eyes. Those of us who had been in practice for enough years with enough hours and enough patient variety would be granted the opportunity to take the PHM certification exam (for the fee of $2,900.00) without committing two or more years of our lives to fellowship training. Several of my partners took the exam during its first offering, but I opted to wait to ensure that the bugs had been worked out. Sure enough, COVID came along and delayed the next board exam until 2022. Not having a good understanding of the benefits of taking/passing the exam nor the downsides of failing to do so (to this day, our hospital administration has not taken a stance on how becoming board certified in PHM will benefit us nor how the lack of certification will hinder us), I paid my $2,900.00 and waited to see if I would be deemed worthy of taking the test and if I would secure a spot at the local Prometric testing center. Lucky for me, I was, and I did. What follows are the stories of three of my partners who weren’t as fortunate.

Andrea is a med/peds hospitalist. She has been in practice for over a decade and is the program director for our medical center’s Med/Peds residency. She also paid her $2,900.00 and signed up to take the test in February 2022 (9 months before the test date). In March, she was able to reserve a spot at our local Prometric center. Five months later, Andrea was notified that she did not qualify to take the exam because her clinical time was diminished by her residency program director role. Andrea appealed this decision (which required extra time and effort and a whole lot of stress on her part) and was ultimately allowed to take the exam, which she passed.

Samantha is a pediatric hospitalist. She joined our group five years ago when she and her husband moved to our city for new career opportunities. Sam had worked as a pediatric hospitalist in Michigan for five years before moving to Atlanta and working as a pediatric neuro hospitalist for almost five years. Sam paid $2,900.00 to take the PHM board exam and secured a spot at Prometric for the November exam. She requested a breastfeeding accommodation because her second child was due in May. During Sam’s maternity leave, she took her new baby and toddler to daycare multiple times per week so she could study for the exam. Upon returning to work in October, Sam discovered email communication from the American Board of Pediatrics (ABP) that had been sent during her leave. She learned she was deemed ineligible to take the exam because of her previous neuro-hospitalist work. At that point, with two young children and a physician-husband exploring other job options, Sam decided to put her career on the back burner and didn’t appeal this decision.

Christine is a pediatric hospitalist. She has been part of our group since she completed her residency seven years ago. She also paid $2,900.00 to take the exam and obtained a spot at Prometric for the test date of November 9, 2022. She carefully planned her study sessions months in advance and carved out time around her work shifts and activities with her young children. Four days before the test (on the weekend), Christine received an email stating that her test reservation had been canceled. Apparently, the testing station to which she had been assigned was out of service. No alternatives were offered to her. Christine spent hours searching for spots online and ultimately found an opening for herself at a testing center several hours away in a different state. She continued to search online for a spot in town and finally found one but was charged a $250.00 rescheduling fee. No one from the local center reached out to help. In fact, they had known about the malfunctioning station for more than a week before notifying Christine. Christine ultimately took the test at the local Prometric and passed it after much unnecessary angst.

The PHM ListServ has been littered with posts from those who have been denied the opportunity to become certified via the practice pathway (a tragically common story is the female hospitalist who missed the cut-off by a few months because of maternity time) and with much discussion about whether PHM should be its own subspecialty and, if so, whether the practice pathway should be more accessible. I don’t have the answers to those questions, though I definitely have opinions. What bothers me the most is the callous way that so many physicians have been treated throughout this process. Finding out months after applying that you are deemed ineligible to take the exam, receiving an email a few days before the test saying that your spot has been canceled, or being penalized (as a pediatrician!) for having a child. Please do better in 2024, American Board of Pediatrics.

The author is an anonymous physician.