The transition from eager-to-learn-everything MS3 to self-assured MS4 with a clear residency goal comes much easier for some than others. I had planned on going into Family Medicine throughout the better part of medical school, but late in third year discovered the combined specialty Internal Medicine and Pediatrics (Med-Peds). How was I supposed to explain my interest in this four year program to my friends, mentors and, toughest yet, medicine department chair when I was just beginning to understand it myself? And then the inevitable follow-up question, why not just complete the three year Family Medicine (FM) residency program? FM training remains the perfect choice for many students looking to get broad-based, comprehensive training on how to care for people of all ages. The purpose of this article is to point out the subtle differences between these residency paths and give my top five reasons for why Med-Peds (MP) is a unique, exciting and attractive residency option for about 400 budding young doctors every year.
1) Learn to care for the most complex patients of any age.
Med-Peds residents receive extensive inpatient and critical care training as well as more subspecialty training on both the adult and pediatric sides than Family Medicine counterparts. This substantial breadth and depth of training makes for the perfect “double major,” giving MP residents the experience needed to care for even the sickest of pediatric and adult patients. You will see MP residents rotating through nearly every ICU in the hospital from neonatal to adult cardiac. FM training provides a comprehensive overview of all aspects of medical care including Obstetrics, Surgery and Psychiatry, but only gives significant depth of training in caring for adults. One of the biggest differences comes in comparing pediatric training: MP residents complete a full two years of pediatric rotations whereas FM programs only require four months. This does seem to have an impact on future practice as MP providers have the ability to go into a pediatric subspecialty and those who enter primary care see more children. A study of primary care practices revealed MP practices include about 43% children whereas the average FM practice is only about 15% children (1).
2) Remain eligible for any medicine or pediatric fellowship program.
Med-Peds residents can apply for any pediatric or adult fellowship (some even do combined MP fellowships). There are a few fellowship options open to FM graduates, but the majority do not subspecialize. MP residency training provides the opportunity to work with subspecialists in every pediatric and adult medicine discipline. This gives the MP trainee insight into what it’s really like to become a medicine or pediatric sub-specialist and the chance to acquire specialty-specific mentors. Compare this to a FM resident who works largely with FM-trained generalists and colleagues in OB or surgery. For the indecisive medical student with broad interests, MP training offers more time and real experience in a variety of medical and pediatric subspecialties which are helpful for choosing a final career path.
3) Have a highly flexible and customizable career.
You will find MP-trained physicians in every type of medical position out there, from the outpatient office to hospital floors and ICUs to global health and administration. There are almost no limits to what you can do with your training (outside of the OR). The typical break-down is that roughly half of MP grads go into primary care, 25% complete subspecialty training and 25% become hospitalists. What’s more, most (77-93%) MP primary care providers care for both adults and kids and even half of the MP subspecialists continue to see pediatric and adult patients (2, 3). These numbers give a rough snapshot of what MP providers are doing, but as you meet more MP grads, you will see that very few fit into a typical “box.” Many MP physicians combine their diverse interests into unique job appointments that change throughout their careers. Examples include transitional care of youth with special healthcare needs, hospitalists and subspecialists covering both medicine and pediatric patients and those with hybrid subspecialty/generalist duties. MP clinicians are often ideal choices for teaching and leadership positions and are well-equipped to provide care globally due to their extensive training in complex pediatric and adult medicine.
4) Reap the benefits of being both an internist and a pediatrician.
During residency training, MP residents are treated as both an internist and a pediatrician. Dual-trained residents are held to the same high expectations as their categorical counterparts and are prepared to take both the Internal Medicine and Pediatric boards (which statistically MP residents pass at the same rate as categorical IM or Peds residents) (4, 5). Most MP trainees rise to this challenge, gaining valuable knowledge and practice tips from both sides that make them very effective clinicians. MP residents have access to educational programming such as conferences, skills sessions, special-interest training “tracks” and mentors on both the pediatric and adult sides. Perhaps my favorite part is the ability to work alongside a large network of residents, fellows and attendings – making great friends and partnerships in the process.
5) Maintain a unique identity.
Med-Peds physicians are a special group in more ways than one. Our field attracts some of the most intellectually-curious, motivated, and compassionate doctors out there. With the evidence-based brain of an internist and the fun-loving heart of a pediatrician, MP doctors are often favorites amongst their patients and colleagues alike. If nothing else, the personalities in this field are what sells many medical students on joining. Countless residents have told me that going on their Med-Peds interview trail felt like “coming home,” as they met so many interesting, genuine and personable people at every program. Trust me when I say that this feeling only grows if you are lucky enough to join one of the 80 Med-Peds programs nationally. And this network expands exponentially when you consider the close relationships garnered throughout our national residency (NMPRA) and program director (MPPDA) associations.
In summary, Med-Peds residencies provide a unique blend of training opportunities that give trainees the flexibility to pursue almost any type of medical practice in a vast array of settings. Though some ultimately subspecialize on one side or the other, the majority of graduates find that this dual training makes them very strong, capable clinicians and leaders (6). If you want to care for adults and kids, enjoy working with a large variety of people and want to keep your options for future practice flexible throughout your career, Med-Peds may be the choice for you!
Citations:
1. Fortuna, Ting, Kaelber and Simon. Characteristics of Medicine-Pediatrics Practices. Academic Medicine (84) 3; March 2009: 396-401
2. Freed GL, Fant KE, Nahra TA, Wheeler JR. Internal medicine-pediatrics physicians: their care of children versus care of adults. Academic Medicine 2005;80:858-64.
3. Frohna J, Melgar T, Mueller C and Borden S. Internal medicine-pediatrics Residency Training: Current Trends and Outcomes. Academic Medicine. 2004
4. MPPDA Annual Meeting with American Board of Internal Medicine and American Board of Pediatrics. 2015
5. Falcone JL. Residencies with Dual Internal Medicine and Pediatrics Programs Outperforms Others on the American Board of Pediatrics Certifying Exam. Clinical Pediatrics. 2014 May 6;53(9):854-857
6. Friedland A, Melgar T, Kaelber D, Cull W, Chamberlain J, Kan B. Impact of combined pediatric residency training programs on the educational experience of the categorical pediatric residents. Association Pediatric Program Directors Annual Meeting, Poster Presentation. 2009
Michael Cafarchio is a Med-Peds PGY3 at the University of Maryland Medical Center and is the acting Director of Recruitment and Medical Student Interest Groups for the National Med-Peds Residents’ Association (NMPRA).