How Pediatric Residency Changes May Reshape the Hospital Medicine Workforce

Concerns among pediatric hospital medicine (PHM) leaders are growing in response to recent Accreditation Council for Graduate Medical Education (ACGME) pediatric residency training requirements. PHM leaders worry that the changes could reshape staffing models, educational responsibilities and long-term workforce sustainability.

Cleveland Clinic pediatric hospitalist Anika Kumar, MD, FAAP, SFHM, has been outspoken about understanding the impact of the changes and identifying strategies to allow the field to evolve accordingly. Dr. Kumar and colleagues recently published survey findings and reported focus group data capturing specific concerns among PHM leaders.

Charting the future of a relatively young field

PHM is a relatively young field, emerging only three decades ago in response to demand for dedicated physicians in hospital settings. The steps that followed its inception, including its recognition as an American Board of Pediatrics subspecialty, have been highly intentional.

Now, as the field faces what may be its greatest challenge yet, the next steps could prove critical to its long-term sustainability as a subspecialty.

“We have a history of adaptation and resilience, and what we need to build our future is advocacy at the local, regional and national levels so that we can communicate our value across both the clinical and nonclinical aspects of medicine,” Dr. Kumar says.

The impact of residency changes on PHM

The changes to the 2025 ACGME pediatric residency requirements were designed to modernize training and offer greater customization of the residency experience.

Pediatric residency discretionary time on general inpatient and subspecialty services decreased. As a result, at some institutions pediatric hospitalists are assuming the responsibility for additional inpatient services previously staffed by residents, for example gastroenterology, pulmonology, nephrology, endocrinology and neurology. ICU time also decreased, raising concerns about residents’ readiness to recognize critically ill children and care for newborns needing escalation of care.

“We were hearing that leaders within PHM had concerns about how they were going to care for all these patients that they previously weren't caring for,” explains Dr. Kumar, who was chairing the Academic Pediatric Association's Pediatric Hospital Medicine Leadership Special Interest Group.

Dr. Kumar and her colleagues conducted a national survey to better understand these concerns. They distributed surveys to 165 PHM programs to assess how leaders anticipated the changes would impact staffing, clinical operations and career satisfaction. Responses from 101 program leaders revealed the following:

• 31% anticipated a decrease in residents on PHM services
• 23% were unsure about the status of resident time on PHM services
• 70% reported contemplating, exploring or implementing hiring more hospitalists in preparation for the ACGME changes

“These responses highlight uncertainty and concern among many program leaders,” Dr. Kumar explains, noting that they were collected less than one year before many centers were expected to adopt the new requirements. The team plans to conduct another survey in one year to capture responses from centers that will not fully implement the changes until 2028.

The study findings were published in Hospital Pediatrics.

Focus groups identify key themes

PHM leaders who completed the survey were invited to participate in a focus group to provide a deeper qualitative perspective about the anticipated workforce shift.

The research team organized seven focus groups with 18 participants and used a semi-structured interview guide. Through these discussions, Dr. Kumar and her colleagues identified themes, subthemes and illustrative quotes. The four guiding themes were:

• Impact on hospitalist physicians as educators
• Preparation of future hospitalist physicians
• Incorporation and preparation of advanced practice providers (APPs) into the PHM workforce
• The future of PHM

An abstract was published in the Journal of Hospital Medicine, and Dr. Kumar recently presented this work at the 2026 PHM Conference.

Addressing changes at the center level

Dr. Kumar stresses that every center is different, and how and when changes are implemented, as well as how they ultimately affect PHM teams, will vary.

At Cleveland Clinic Children’s, APPs have long been part of the hospitalist team, which may offer an advantage when the ACGME requirements are fully implemented. However, this is not the case at every center.

Continued investment in the PHM field and workforce

More than anything, Dr. Kumar says, the focus groups revealed the need for continued investment in the field.

“That means advancing the science of pediatric hospital medicine, whether it’s quality improvement work, scholarship or research,” she emphasizes. “We need to create communities and carve out time and incentive structures that value those aspects of our work in addition to the clinical work that we do.”

Studying the hospital medicine workforce, for both pediatric and adult providers, is more important than ever in an era of profound clinical burnout.

“We need to be making sure that we're addressing career satisfaction and looking at providers’ health, whether it be physical or mental, to ensure we can continue to provide great care for patients.”