Recognition of paediatric subspecialties

A stack of books

In recent decades, a subspecialty paediatrics has developed alongside general paediatrics with special skills acquired after additional training or fellowship in university paediatrics departments.

For several of these subspecialties there are both European and Belgian recognition standards.
Although recognition was approved twice by the Supreme Court, previous Ministers of Health have always disregarded this approval

The consequences of not recognising these special competences are far-reaching and are a risk to the child’s health:

  • When parents consult a paediatrician with a special competence, they have no guarantee that the paediatrician does in fact have that special competence.
  • Some conventions (cystic fibrosis, renal dialysis, diabetes) require the multidisciplinary team to include a paediatric pulmonologist, a paediatric nephrologist, or a paediatric endocrinologist, but these do not legally exist in Belgium.
  • Due to the fact that a consultation for a referred patient with a sub-specialty problem is as much honoured as a consultation of general paediatrics, but takes at least twice as long as our 2019 survey shows, the pressure on paediatricians with special competence is high in university centres and large regional hospitals to work faster and thus sub-optimally with possible risks for the children. Stress and frustration is also high in these subspecialty paediatric services.
  • Since the subspecialty paediatric services in Belgium have no official recognition, it is also difficult to get international fellowships recognised and offered.
  • Due to the lack of recognition of paediatric subspecialties, children are still referred to adult internists who have no paediatric training and who perform technical services without having had the necessary training.
  • The lack of recognition means that there is no control over the activities of some paediatricians who claim to have special skills, which is reflected in large differences in the number of specialist examinations in Belgium (cardiac ultrasound, bronchoscopy, gastroscopy) as demonstrated by the RIZIV/INAMI
  • Within a paediatrics department, there is no possibility of honouring a requested opinion of a sub-specialist for an admitted child, which is possible for adults.

Article 8 of the Law of 28 March 2019 on the quality practice in health care stipulates that the health care professional may only provide healthcare for which he has the necessary demonstrable competence and experience. This must be recorded in his portfolio. It is highly questionable whether this new Law, in the absence of recognition of these special paediatrics subspecialty skills, offers any guarantee of quality to the child.

Objectives

To achieve official recognition of Paediatric subspecialties in Belgium in order to assure:

  • a specific, qualitative approach (“child is not a little adult”)
  • new techniques and medications become accessible for children
  • legal texts referring to special competences in paediatricians can be executed
  • paediatric subdisciplines being recognised in surrounding countries

Current applications for recognition are :

  • paediatric endocrinology
  • paediatric gastroenterology, hepatology and nutrition
  • paediatric cardiology
  • paediatric pulmonary diseases
  • paediatric nephrology

A child being examined by a doctor

Members

Stijn Verhulst

Board Member, Head of Paediatric Department, Universiteit Antwerpen (UA)

info@baop.be

Anna Bael

Board Member, President of the Vlaamse Vereniging voor Kindergeneeskunde (VVK)

info@baop.be

Ann Covents

Head of pediatric department at AZ Nikolaas

Philippe Alliet

Boardmember of the VVK

G. de Bielderling

Achievements

  • Some paediatric subdisciplines have been trying for 15-20 years to get recognition, but only paediatric neurology, neonatology and paediatric haemato-oncology succeeded
  • (2008) positive advice from the Supreme Court regarding recognition of paediatric endocrinology
  • (2008) joint application by the academy, the college, the recognition committee and the scientific associations of paediatric sub-disciplines for recognition of 5 sub-disciplines
  • (2008) an (2011) approval of the need to recognise paediatric endocrinology, paediatric gastroenterology, hepatology and nutrition, paediatric cardiology, paediatric pulmonary diseases, paediatric nephrology in the working group and in the plenary meeting of the Hoge Raad
  • (oct-nov 2014) reviewing previous files for publication of transversal criteria for recognition and approval by the Academy, College, scientific associations, recognition committee
  • (14/12/2014) presentation in working group ‘Titles’ high council (14/12/14) with subsequent approval in working group/plenary meeting
  • 2022: – Recognition of subspecialties. We had a breakthrough this year, given that the Supreme Court has set up a joint committee to consider the question for recognition in grade 3 ( special professional title) of paediatric pneumology, -gastro- enterology, -endocrinology, -cardiology and paediatric nephrology. In this ‘mixed working group’ we are represented as a Professional Association and as Belgian Academy of Paediatrics