I am one of those ingrates who searches SDN periodically for information, but rarely posts. There's not a ton of Med-Peds information to be had on SDN, and of course what there is is not collected in one forum, so you spend a bit of time fishing for it. I have no ambitions of remedying that situation, but I thought I'd squander some time by recording why I chose it, what programs I looked at and what I found important in assessing programs. N=1, and the person talking is an incoming Med-Peds intern, so take it for what it's worth.
Background: I'm a career-changer, I spent maybe 6 years working in computer science before I realized that I was not accomplishing much I considered meaningful in life, went for a post-bacc program, and trundled off to med school. I spent a bit of time shadowing while I was trying to figure out what I wanted to do, mostly in family practice, and that's where most of my opinions on FP vs Med/Peds come from.
Why I chose it:
I want to work with adults and kids in a Northeastern inner-city setting. I think the only rotation that I actively detested was OB-Gyn, so I was not keen on going through family practice, learning all that OB stuff, and not doing it anyway. (I know a few FPs in my Northeastern urban area who started off doing OB, but gave it up because of its time demands and liability issues. I can't, offhand, think of any of the 6 I know who have done it for more than 2 years.)
I'm going to assert (and get hazed by all the northeastern FP people, I know) that it's hard to learn and practice FP in the Northeast. Here, where the density of IM and Peds programs is pretty high, you're competing with numerous programs for the same patient pool to learn from - especially an issue with Peds on the inpatient side. And even if you're planning to practice outpatient medicine, I'm told by Pediatricians (and it makes intuitive sense) that it's very important to have that inpatient experience, so that you can
recognize "really sick patients". In the northeast due to density of programs and specialities, you're just not getting the breadth of experience that you might get training in the midwest, for example. In terms of practice, the availability of specialists is considerably higher here than in, say, South Dakota, so there's greater pressure to refer. I'm not saying you CAN'T get good FP training in this area, I just think it's harder. And I'm not saying you CAN'T practice FP without referring left and right, I'm just saying I think it's a lot harder. One of the six FPs I've spent time with in the area is extremely well-organized and a phenomenal clinician; this person ably manages some very sick patients in the office. With the others, well, there's an awful lot of referring going on that I suspect wouldn't have happened in the outpatient Medicine or Peds offices I've rotated through. I know myself, and I'm not sure I'm as smart or diligent as my genius FP.
I want to work with an inner-city population which has a higher burden of illness than the general US population, and Med-Peds gives you plenty of experience with higher-acuity patients. I love caring for kids and adults (in fact, where I'm at, you sucker adults into the office by having them bring their kids in, so doing both is kind of a no-brainer for me). I am a generalist by nature (specialized within comp sci; being "down in the weeds" did not suit me), and I think Med/Peds is the right combination of depth/breadth for me. For the burden of illness among the kids I'll be working with, FP programs did not offer enough time working with kids. There are numerous other rationales for choosing Med-Peds, but since they are not MY rationale, I'll refer you to
www.medpeds.org, which lists various reasons why you might want to do it.
Because we have no Med/Peds program (or even anyone working in Med/Peds) at my med school (Temple), I arranged to work with a local outpatient Med/Peds practitioner for a few days in her office. I would recommend this to anyone considering Med/Peds and coming from a school that does not offer it. I got fantastic advising from a kind local Med/Peds program director, since my Medicine and Pediatrics advisors could only offer limited help.
My considerations in choosing a program (in rough order of importance) were:
1. strength of categorical Peds & Med. Strength of categorical Peds was more important to me, because Peds is less evidence-based (for the simple reason that less research is done with child subjects) and I think there are a lot of weak Peds programs out there.
2. location, location, location. strongly preferred not to move, due to family reasons & husband's career.
3. gut feeling on whether I'd be happy there. This includes comraderie among the residents, level of support by program directors, atmosphere in clinic and hospital. Call structure falls in here, but in practice with the 80-hour workweek I hardly thought about it, as it's moderately painful everywhere, but no longer insane. cafeteria - I like to (try to) eat healthy.
4. demographics/community connections - falls in with location, but I really wanted a place that serves a demographic SOMEWHAT similar to the demographic I plan to work with, and with strong connections to the community (even better if this is the community I plan to work with in the future).
5. specifically strength of outpatient (clinic) experience
I was fortunate that there were about 4 programs I loved for different reasons and would have been very happy at. Where I ended up came down to location (and the Match!)
Programs I interviewed at, & strengths (not commenting on weaknesses for the most part)
1. HUP/CHOP - this is where I matched, so I'd best put it first. Loved the categorical Peds; less familiar with categorical Med. Residents from both sides seem extremely strong, and people I can learn a great deal from. Medicine morning report is mind-boggling. Did a Peds ID elective here, and was very impressed with the "can-do" atmosphere on the Peds side, including the micro & virology lab directors who bend over backwards to help you figure out what's going on with patients. Medicine has extremely strong primary care track, and some great connections with the surrounding community. Really clicked with the Med-Peds residents. Caveat is that this program is only 4 years old, doesn't yet have a Med-Peds clinic, and coordination between Med & Peds side is likely to be imperfect. In all, I'm delighted to be there.
2. Christiana - my 2nd choice. Program director is one of the main strengths here - their program leadership has really got a cohesive, resident-supportive program going. Great Peds at duPont, and I was impressed with the Medicine residents I met & their morning report. Very well-run clinic with plenty of attention given to precepting. I would have really, really enjoyed being there. It's an excellent program that multiple program directors have told me is underrated ONLY because it's a "community program". It's the only "community program" I ranked, but I think the days of that mattering are on their way out. Residents get to determine which attendings are "teaching attendings", if I recall correctly. Has a good number of Med-Peds attendings (who actually teach Med-Peds residents).
3. Cincinnati - In some respects, my favorite program. Med/Peds interns rotate together, so you get to know each other well. Again, very supportive program leadership. Phenomenal Peds, and a very solid (if not "name-brand" ) Medicine program. They are the "only shop in town" for Peds, so no one competes with them for Peds patients, which in my book is a great advantage. Also a very nice, apparently well-run clinic. Tons of Med-Peds attendings (who teach Med-Peds residents)
4. Yale - Another favorite. Stellar med, stellar peds. Absolutely loved the residents here, and the fact that they are unusually supportive of international experiences. Didn't see the clinic (missed the pre-interview day), but was deeply impressed by the clinic director (who is also a minister - you know, so he's into that holistic stuff that I love). Fabulous.
After this, in no particular order...
UMD - Their medicine was really standout; excellent Med program director. They don't have a freestanding children's hospital, but my Peds advisor highly recommended them anyway in part due to the Peds program leadership.
UMDNJ-Newark - I liked the program directors here and thought them to be quite supportive. Seemed to have excellent community connections, and a strong (if slightly cramped) clinic. Has a good number of Med-Peds attendings (who actually teach Med-Peds residents).
UMass - Medicine seemed pretty strong, and the PDs were quite nice. It's been awhile since I interviewed at this one, so it's a little fuzzy for me honestly.
Baystate - standout clinic; sets the standard for Med-Peds clinics. nice residents, only shop in town. Has a good number of Med-Peds attendings (who actually teach Med-Peds residents).
Mt. Sinai - interesting patient mix (Upper East Side, south Bronx - or is it Harlem? I don't know new York obviously), strong Med, pretty strong Peds. Lots of community connections. Probably your best choice by far if your goal is to live in NYC.
Einstein - their Medicine program presented itself well - Peds seemed small, though.
Brown - didn't have an impressive experience here, but from talking to other people, I suspect that was a fluke. So talk to other people.
Places that didn't give me interviews = Harvard (phooey!); Places that didn't even send me a response = Beth Israel Newark (weird). I applied to a bunch of others and got interviews, but cut them out due to location. Applied to 17, interviewed at 11, ranked 7 (or 8? now I don't recall).
Things to keep in mind:
- # of Med-Peds trained faculty != # of Med-Peds faculty who teach Med-Peds residents!
- don't spend all your time fussing about call structure. It's just not going to make that much of a difference compared to your gut feeling on how responsive the program is to resident concerns, the general atmosphere among residents, etc.
- if you meet no interns during your interview dinner & day, you should wonder why.
- Medicine people, and Pediatrics people, will probably tell you it's "too much to learn". You have to try to spend time with clinicians, in Med/Peds, Medicine, Pediatrics, and Family, know yourself, and make your own call.
That's all folks, all hour-and-a-half of it. Thank heavens for the end of 4th year. I hope it's helpful to anyone considering Med-Peds. There's plenty there that one could argue with if so inclined - I won't be around much to argue back, so have at it if you feel so motivated.
Daria
Temple Med '07 + incoming HUP/CHOP Med/Peds intern
ediatric subI-> Hospital choice 3
