October 7-8, 2009

Chicago, Illinois

Council of Pediatric Subspecialties

Executive Summary

Happy 3rd Birthday!!

Introductions

Commitment

Subspecialty representative expectations

• Term is 3 years. The two representatives from each subspecialty should have staggered terms with a new representative identified one year in advance. It is strongly preferred that one representative be a current fellowship program director.

• Serve as a timely and thorough communication vector to and from your subspecialty member associations and societies and the Council.

• Collaborate strongly with the other representative of your subspecialty regarding issues of importance to CoPS and your subspecialty.

• Be available for conference calls and meetings as called by CoPS and its working groups.

Subspecialty representative expectations

• Provide links to expertise and resources within your subspecialty associations and societies for projects spearheaded by the Council.

• Vote as a representative of your subspecialty in a timely fashion by presence, phone, mail or electronic means.

• Communicate effectively with training program directors and existing program director organizations in your specialty.

• Voting will move to on online, transparent recorded process.

Financial Report

• Costs of activities are expected to increase as our activities broaden. We must work to minimize these costs to Council while moving forward with our agenda.

• A philosophy of partnership with organizations of FOPO while maintaining independence to act as needed to represent subspecialty pediatric needs.

ERAS/NRMP update

• Neurology via SF match, endocrine starting ERAS

• ? Adolescent medicine, DBP, ID, Child abuse?

Responses to IOM Report on Duty Hours and ACGME Congress

• As an initial response, CoPS participated with the Organization of Neonatal Training Program Directors (led by Josef Neu), in the development of a position paper, published in May.

• “Resident duty hour restrictions: Is less really more?” J Pediatr 2009;154:631-2 (AMSPDC column)

• Galvanizing issue for the Council.

Responses to IOM Report on Duty Hours and ACGME Congress

• After a request by the executive committee, CoPS submitted a formal position paper to Thomas J. Nasca, MD, CEO of ACGME in April 2009. Letter available at http://www.pedsubs.org/about/pdfs/CoPS_Ltr_to_Nasca_Final.pdf

• This letter resulted in an invitation to present our report atat the ACGME Congress on the Institute of Medicine Report on Resident Duty Hours in June (V Norwood and J Bale).

• While agreeing with the importance of patient safety and the adequate supervision of trainees, advocated the following:– non-patient care, educational activities of fellows should be exempt from

the 80 hour rule.– opposition to the recommendation regarding a mandatory 5 hour rest

period.– opposed limiting the maximum frequency of inpatient shifts to 4 nights in a

row.– agreed with a mandatory 5 days off per month.– agreed with counting both external and internal moonlighting toward the 80

hour rule. However, new mechanisms to reduce trainee educational debt should be identified.

– agreed that patient "handovers" should be studied and improved.

Responses to IOM Report on Duty Hours and ACGME Congress

• The CoPS position statement additionally emphasized: Residents may not be adequately prepared for fellowships

currently, especially in critical care specialties. The IOM duty hour restrictions will have a disproportionate effect

on small programs. The current "one size fits all" approach to training does not fit the

complexities of fellowship training, including the needs for autonomy and scholarship.

A workforce crisis exists in pediatric subspecialties. GME funding for fellowships must increase.

slides at http://www.pedsubs.org/newsletters/articles/2009_Summer.pdf

• A follow-up paper, entitled “The response of the Association of Pediatric Program Directors, Council of Pediatric Specialties and the American Academy of Pediatrics to the Institute of Medicine Report on Resident Duty Hours” has been submitted and revised for publication (Sept. 2009).

OPDA ReportJosef Neu, represented CoPS at the OPDA meeting in May. The OPDA is an umbrella organization that has representatives from most program directors groups and provides a forum for networking and advocacy. Discussion focused predominately on the IOM Duty Hours recommendations and the group concluded the following:

• IOM Total hour allowance: No Change, although there was discussion about allowance of "voluntary research" and other educational activities beyond the 80 hours• 30 hour limit with 5 hour nap: Disagreed with IOM• Maximum hospital days on-call with averaging: Disagreed with IOM• Minimum time off between shifts: Disagreed with IOM• Maximum Frequency of hospital night shift: Disagreed with IOM• Days off per month: Disagreed with IOM• Moonlighting: Agreed with IOM• Emergency Room Limits: Agreed with IOM

The group expressed some concern that the views of the various organizations may not have sufficient influence when the regulations are updated.

Pediatric Educational Excellence Across the Continuum

• Developed by APPD, the first PEEAC Conference was held in September 2009.

• CoPS provided input into programming appropriate to subspecialty educators and encouraged subspecialty involvement in all aspects of the conference.

• The goals were to maximize effective and efficient teaching in inpatient and ambulatory clinical settings including – using technology in teaching– assessment and evaluation of learners– providing feedback to learners– navigating challenging interactions with learners– planning and creating structured learning experiences and curricula– using a scholarly approach in your teaching to create scholarship.

Other Activities

• Accepted invitation from APPD to have a CoPS Executive Committee member join their program committee (Jim Bale).

• Open forum session(s) to begin at PAS and AAP to continue and enhance direct communication with subspecialists.

• Second CoPS newsletter distributed this summer.

Advocacy

• Issues– Health care reform: subspecialty vs. general peds,

pipeline, loan repayment, reimbursement, CHIP, etc.– NIH funding– Medical home

• Process– Rapidly moving and changing at the federal level.– Handicapped by lack of mechanism by which rapid

turnaround of answers/ideas can be handled.

Current process

• An informal coalition of organizations with a specific interest in pediatric subspecialties has coalesced around the issue of pediatric work force concerns. The group includes, among others, the Child Neurology Society, American Society of Pediatric Nephrology, the AAP, the National Association of Children's Hospitals and CoPS and has been very active in the recent federal activities surrounding health care reform.

• Need a formal, but nimble process for involvement.

Independence

• Charter MOUs.• Issues –

– Desire to speak with our own voice– Restrictions of some subspecialty groups– Financial independence (past/current support =

$175,000 from AMSPDC and APPD) – Letters to AMSPDC and APPD requesting release

from our MOUs• If approved by all parties, will begin

incorporation proceedings.• Bylaws/leadership to be adjusted accordingly.

Independence Discussion and Vote

Subspecialty and Liaison Updates

Task Force Reports

LUNCH!!

Dues Structure

• Issues– Framework

• AMSPDC model (departments only; academic + non-academic, tiered)• ASP model (departments, divisions, individuals, societies)• Degnon Associates, Inc. can provide infrastructure support for all options

– Membership provides• Representation via subspecialty reps

– Need for understanding and dedication• Access to other subspecialty issues, approaches, activities• Subspecialty voice for GME, health care reform, pipeline, and other

advocacy issues.• Assistance/networking for program directors.

– Roles of liaisons• Desire to avoid ‘Double dipping’• Voting• Past funding

Exec Committee Proposal

• “AMSPDC plus” to include non-academic programs and societies.

• Potential for divisions, individuals, but not a primary goal.

• Liaison organizations to be discussed with their leadership.

• To begin July 1, 2010.

Dues/Budget discussion and vote

Strategic Planning

• Shift from organizing an organization and finding our place

• Updating issues and future goals

• Line up with budgeting and income

• Awareness of constituent needs.

Executive Committee Elections

• Coming soon to a theater near you!