Getting a good peds experience as a family practitioner is essential. It's impossible to say that you always get a better peds experience at a university program, and it's impossible to say that community programs always offer a better peds experience.
When it comes to university programs, the ones with separate pediatric hospitals (those that allow FP residents to rotate thru) offer far better training than university programs where there may just be a pediatric floor at one of the hospitals.
Regarding community programs, it's really easy (without knowing it) to pick a program that has inferior pediatric training to university programs, especially university programs with stand-alone major peds hospitals. However, as I'll argue below, I truly believe that great community programs rival the peds experience at university programs with separate peds hospitals, and some of those community programs actually offer superior pediatric training.
1) Regarding inpatient pediatric training...
At the vast majority of university programs, when you rotate on pediatrics, you rotate with pediatric residents. Because you rotate with peds residents, FP residents really get all the crappy admits and scut work while the peds residents get all the great cases... ie. the FP resident may get all the easy, boring RSV admits while the peds resident takes the interesting admits. It was my experience as a student at a university program that the peds residents really looked down on family med residents, and that the peds chiefs even gave preferential treatment to 3rd year students interested in peds. Plus, the attendings were peds attendings who had the attitude that they were there to teach peds residents and that the FP residents were sort-of "in the way". While these FP residents were at a top-10 peds hospital, they got horrible training.
While many community programs see very very little peds (especially in-patient), programs that serve a very large population or act as regional medical centers afford residents the ability to see a high volume of pediatrics without having to compete with peds residents for the good cases; instead, FP residents are the peds chiefs! For example, my program (
McLeod Family Medicine) is one of 4 regional medical centers in SC, serving as the major referral hospital for 12 counties and over a million people. While there is no exclusively pediatric hospital, we do have a women & children?s hospital complete with a NICU and PICU. So, when we are on peds, we see all the referrals that come in (as well as all the sick kids in the community). While we may not see as much pathology as a major peds hospital in a huge city, the fact that I'm at a hospital that has a strong peds unit (rather than 8 usually empty beds on part of a floor of the hospital) and that I don't have to compete with peds residents gives me a huge advantage and really contributes to my learning.
Also, I recommend community programs where you're taught inpatient peds by pediatricians versus being taught by FP faculty. It's nice to learn from someone with a bit of a different perspective so that you can broaden yours.
The mistake many students applying to family medicine make regarding peds is that they feel that they have to be at a program with a stand-alone peds hospital that has a level 1 peds NICU and PICU with peds trauma surgeons and every pediatric specialists under the sun. Why is this a mistake?? Well, aside from what I mentioned above, we are being trained to be family doctors who, more than likely, will never manage kids in the NICU and PICU after residency. We may see the kids, but we'll let a specialist direct their care. So what if some university program has a 20-bed, super-advanced, state-of-the-art PICU... what are the chances you'll ever see it? If that's what you want, seriously think about med-peds.
2. Regarding out-patient peds...
Too many students forget to ask about the quality of out-patient peds experiences. As a family doc though, most of the kids you see will be in your office, so being proficient at out-patient peds is essential. Often at university programs, FP residents struggle to see peds patients because they're all referred to the peds residents' clinics. Again, at a community program, you don't have to worry about that competition. Some community programs really struggle with having a strong peds population in the clinic though, so be sure to ask about that on interviews!! One of the main reasons I chose McLeod Family Medicine is because of the diverse patient base. Since I'm a new intern, I haven?t been in the clinic a ton yet, but so far about 40% of my patients have been kids. While I doubt 40% of all my patients will be kids, it's very nice to know that a large enough number of them will be so that I can actively learn good out-patient peds.
So, I really think that the right community program can give you the best all-around education. While I am not saying that my program has the best peds training of any program, I'm very happy with McLeod's residency in-general as well as their quality of pediatric training. I'd recommend this program to anyone, especially if you want a strong peds experience.
You're asking great questions and thinking about the right things. And if any 4th years about to apply to residency are reading this, here are links to a few of my posts that you may find helpful:
About taking Step 2:
http://forums.studentdoctor.net/showthread.php?t=134812
About the whole application process:
http://forums.studentdoctor.net/showthread.php?t=136528
I hope this helps answer your question. Good luck!
