VOLUME 28, ISSUE 2

In addition to fellowship training, the American Board of Anesthesiology (ABA) offers a pediatric anesthesia board certification. In 2010, after listening to constituent groups from within and outside anesthesiology, the ABA voted to support a board certification process for pediatric anesthesiology. The American Board of Medical Specialties approved the proposal in 2011, and the first exam was administered in October 2013. In order to register for the pediatric anesthesiology board examination, a physician must (1) be certified by the ABA, (2) have an unexpired, unrestricted state medical license, (3) be capable of performing independently the entire scope of pediatric anesthesiology practice without accommodation or with reasonable accommodation, (4) participate in MOCA, and (5) have satisfactorily completed an ACGME-accredited fellowship training program in pediatric anesthesiology with verification from the program director. The ABA initially allowed Diplomates to register for the exam under grandfathering criteria if they had completed anesthesiology residency training before July 1, 2012 and if their clinical practice had been devoted primarily to pediatric anesthesiology for the last 2 years, or at least 30% of an anesthesiologist’s clinical practice, averaged over the last 5 years. Clinical practice of the physician must also have included neonates and children under the age of 2 years and procedures considered high-risk. However, Diplomates can no longer register for the pediatric board examination under the grandfathering criteria, but those who have already registered have until January 1, 2019 to take and pass the certification exam. Additional information as well as an exam content outline can be found on the ABA website (www.theaba.org).

Traditionally, discussion related to decreasing the anesthetic risk for children has centered on suggestions that only fellowship-trained pediatric anesthesiologists be required to provide anesthesia for children under a specific age and mandating that all infants and critically ill children who require anesthesia be cared for in a hospital with special neonatal and pediatric care units. Additional consideration must by given to the facility based components needed for the pediatric perioperative anesthesia environment as well including the following: training and experience of the health care team; resources committed to the medical and psychosocial care of infants and children in the perioperative environment; and pediatric-specific techniques for airway management, fluid administration, temperature regulation, catheter insertion, cardiorespiratory monitoring, and pain management¹. Further complicating matters is the proposal by the American College of Surgeons (ACS) Task Force on Children’s Surgical Care to create standards for an “optimal environment” for an infant or child with a specific level of surgical need. Their proposal is a survey and verification process to stratify facilities that provide pediatric surgical care into Levels 1 through 3 modeled after ACS trauma centers². This endeavor is still in the testing stage with site visits ongoing in its pilot program. In Texas, TCH is one of 6 hospitals nationally to serve as a test site and was reviewed in early May 2015.

Ultimately, the decision to pursue advanced fellowship training in pediatric anesthesiology is a personal choice. General anesthesiologists can, and do, provide quality care to pediatric patients every day. However, if your desire is to be proficient in the care of the youngest and most complex pediatric patients, then pursuing subspecialty training has value. Another consideration is that the ABA is no longer allowing Diplomates under the grandfathering criteria to register for the Pediatric Anesthesiology Board Certification exam. The potential cons to a pediatric anesthesiology fellowship are having to maintain MOCA certification for both general and pediatric anesthesiology, possibly being “pigeon holed” to doing only pediatric cases, a possible financial disincentive in a potentially large Medicaid population, and positions focused exclusively (i.e.100% clinical practice) on providing pediatric anesthesiology are often academic with lower salaries when compared to private anesthesiology practices in the same geographic region. The pros and cons must be balanced individually, not only in choosing to pursue fellowship training, but also in how to use your knowledge once you are out in the job market. Those concerned about the potential downsides of pursuing further subspecialty training in pediatric anesthesiology should be reassured that the vast majority of pediatric anesthesiologists believe that providing anesthesia to our youngest patients is extraordinarily rewarding – so who wouldn’t love going to work in Candyland?

REFERENCES:

1. American Academy of Pediatrics – Section on Anesthesiology. Critical Elements for the Pediatric Perioperative
   Anesthesia Environment. Pediatrics Dec 2015; 136(6): 1200.
2. Task Force for Children’s Surgical Care. Optimal resources for children’s surgical care in the United States. J Am Coll
   Surg 2014; 218:479-487.