It is an honor to serve as Chair of the American Academy of Pediatrics (AAP) Section on Hospital Medicine (SOHM). That was not something I had contemplated when I first started reading and making the occasional post on the LISTSERV®, or after meeting many of those other occasional posters at the Pediatric Hospital Medicine (PHM) Conference in San Antonio in 2003. What a long way we have come! My chair position will end shortly after the first cohort of hospitalists take the inaugural PHM certification exam. SOHM will have a large role in preparing hospitalists for subspecialty status, as well as advocating for the large number of hospitalists who will never seek subspecialty status, yet who will provide needed and excellent care throughout our country, especially at smaller community sites where most children are hospitalized. Efforts of the Section will continue to improve the value of care provided to all pediatric inpatients through advocacy, education and service.
Going back to that first meeting in 2003, we heard about the birth of the Pediatric Research in Inpatient Settings (PRIS) network, which has since produced practice changing research in multiple areas including neonatal infections and osteomyelitis. Five years later, hospitalists formed the Value in Inpatient Pediatrics (VIP) network, a grass-roots effort that addresses the value of care in diverse hospital settings, and may even collaborate with PRIS in the future. In 2009, the Section co-sponsored the PHM Strategic Roundtable, creating, among other things, the Joint Council on PHM (JCPHM) that spearheaded subspecialty certification. The PHM Consortium recently replaced JCPHM, and continues the Joint Council's mission of collaboration among the three societies important to pediatric hospitalists: AAP, Academic Pediatric Association, and Society of Hospital Medicine. Clearly hospitalists are natural collaborators, both within and beyond our local institutions. That makes sense given our role as team captain in the center of a complex system. We know that nurses, respiratory therapists, pharmacists, social workers, subspecialists, patient technicians, family members, and countless other people are required to provide the best care for our patients, and we coordinate and direct this care. Furthermore, we have integrated ourselves into the broader system by leading or taking part in quality improvement, patient safety, information technology, medical education, administration and multiple other roles in our hospitals and sometimes beyond.
But in addition to our natural penchant for collaboration, hospitalists are often also at the forefront of promoting evidenced based medicine (EBM), and challenging the status quo. We clamor for transparency in our guidelines and post links to articles when voicing our opinions on the LISTSERV®. We are wary of expert opinion, demanding higher levels of evidence, and ask for absolute, rather than relative risk reductions. While pediatric hospitalists don't have any special claim on the practice of EBM, we share a strong EBM culture. I'm not sure why hospitalists tend to challenge dogma more than other physicians. Is it because our members are generally younger, or because we see a broad range of common conditions, and get to follow patients through the acute stage of their illness more closely than most outpatient physicians do? Whatever the reason, we should be proud of this culture and should leverage our predilection for collaboration to spread this culture to produce better research, better guidelines, better implementation, better clinical decisions, and ultimately better patient outcomes.
I'm excited to be Chair of the Section during this critical time leading up to subspecialty certification. The Section will be busier than ever and the need for volunteers will be greater than ever. Please consider joining one or more of our subcommittees which lead many Section activities, or create a new subcommittee if you see the need. We are constantly looking for ways to better support our members so feel free to contact us with any ideas you have.
Matthew Garber, MD, FAAP, FHM
Chair, Section on Hospital Medicine