Med/Peds vs Family Practice?

[CrimsonMirage]

Hello!

There has been an overwhelming craze over Med/Peds amongst my classmates. I realize that the Med/Peds residency is more rigorous and involves double board certification, but other than that...what's the real difference from Family Practice? Why choose one over the other?

Thanks

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[GoSpursGo]

The way I've had it explained to me by a few of my friends thinking about it is that it makes sense if you're going in with a fellowship in mind that will allow you to do a job that a meds-peds residency will make you uniquely qualified for. A couple of examples I've heard of include Med/Peds endocrine to see type 1 diabetics all the way from childhood through adulthood, or Med/Peds Cards to see congenital heart patients who are now living into adulthood. I'm sure there are plenty of other possibilities, but the over-arching message was that you should have a reason for doing Med/Peds in mind before you jump in.

 

[officedepot]

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[GoodmanBrown]

The way I've had it explained to me by a few of my friends thinking about it is that it makes sense if you're going in with a fellowship in mind that will allow you to do a job that a meds-peds residency will make you uniquely qualified for. A couple of examples I've heard of include Med/Peds endocrine to see type 1 diabetics all the way from childhood through adulthood, or Med/Peds Cards to see congenital heart patients who are now living into adulthood. I'm sure there are plenty of other possibilities, but the over-arching message was that you should have a reason for doing Med/Peds in mind before you jump in.

+1 I agree with Spurs and def. disagree with Office. If you're interested in a specialized area that has crossover from child to adult, med-peds is the way to go. I have met actual doctors who followed the route Spurs refers to.

Probably a good number of med-peds docs end up doing one or the other in private practice, but if you're interested in academics, med-peds can give you a unique niche. Family medicine just isn't the same (not that it's any better or worse). And FM is not eligible for the majority of fellowships that IM or peds are eligible for. So, if you're even half interested in a fellowship, go with med-peds.

 

[officedepot]

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[rad0nc]

Family medicine is more for primary care but in certain areas (i.e. more rural) lots of them do hospital work as well. Thus there really is no difference between FM and med/peds with regards to hospital work except in larger cities. FM also has a variety of fellowship options as well. Thus I still do not understand the fascination with med/peds. It's useless.

The only advantage I see is for people who still aren't sure if they want to do medicine or pediatrics. I hear the med/peds fellowship argument all the time and I don't buy it either.

 

[SteinUmStein]

The only advantage I see is for people who still aren't sure if they want to do medicine or pediatrics. I hear the med/peds fellowship argument all the time and I don't buy it either.

I always just assumed the underlying (maybe even unconscious if you buy that) reason people go for med/peds over FM is because med/peds is more competitive, so maybe they're proving to themselves and those around them that they're "better" than just FM...

It's a stretch, but there's no real logical reason to do med/peds.

 

[tima]

Doesn't FM have long term relationships? Still don't see the difference.

 

[tima]

They have swag because of double board certification.

I always just assumed the underlying (maybe even unconscious if you buy that) reason people go for med/peds over FM is because med/peds is more competitive, so maybe they're proving to themselves and those around them that they're "better" than just FM...

It's a stretch, but there's no real logical reason to do med/peds.

 

[SteinUmStein]

They have swag because of double board certification.

Exactly... mo tests mo money, fool. Except, not. Pretty sure they're either paid as an internist or a pediatrician at any given time, but I could be wrong.

 

[tima]

It's a good article.

Where do med-peds fit?
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=154649

 

[tima]

You're right. They are paid more of an internist's salary. So, not too much mula here.

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=154649

Exactly... mo tests mo money, fool. Except, not. Pretty sure they're either paid as an internist or a pediatrician at any given time, but I could be wrong.

 

[drizzt3117]

A lot of people doing med-peds are focusing on adolescents and young patients in the 15-25 age group; med-peds is basically medicine with board certification in peds with an extra year, so it's actually not a bad deal for those interested. Med-peds grads are far more capable of managing hospital patients than family practioners, and obviously people doing it don't want ob/gyn. Most people will choose the adult fellowship unless they're going to practice primarily pediatrics.

I honestly think you have no idea what you are talking about. Fellowships do not train you do be fully competent in both peds and adults (3 years each). You choose one and do that. There is no "med/peds endocrine fellowship"... And again adult endocrinologists can do type 1 DM. How is it an advantage to see a med/peds trained person? OP, if you want to do a fellowship you must pick either adult or kids. You would be eligible for both since you are board certified in both adult medicine and pediatrics. However there is no 3 year fellowship that fully trains you in both adult and peds subspecialty.

Pretty much everyone I know who wants to do med/peds wants to be a hospitalist and thinks it sells themselves more. Some want to do primary care but really hate obgyn. Whatever. They'll probably get a job but end up practicing one more than the other in the end I bet.

Family medicine is more for primary care but in certain areas (i.e. more rural) lots of them do hospital work as well. Thus there really is no difference between FM and med/peds with regards to hospital work except in larger cities. FM also has a variety of fellowship options as well. Thus I still do not understand the fascination with med/peds. It's useless.

 

[Bacchus]

A lot of people doing med-peds are focusing on adolescents and young patients in the 15-25 age group; med-peds is basically medicine with board certification in peds with an extra year, so it's actually not a bad deal for those interested. Med-peds grads are far more capable of managing hospital patients than family practioners, and obviously people doing it don't want ob/gyn. Most people will choose the adult fellowship unless they're going to practice primarily pediatrics.

I've seen several FPs as hospitalists. They do exist. A current resident at my rotation I'm on has already signed her hospitalist contract for when she graduates her program this year. With this said, I do agree with what you say simply for the fact is more floor medicine = better comfort on the floor and more clinic medicine = better comfort at the clinic. Not to say either field can't work in the clinic or as a hospitalist.

 

[Stixman28]

There is no "med/peds endocrine fellowship"

There are special med/peds fellowships, specifically endocrine? idk, but i know there is a 4 or 5 year ID fellowship (f that btw). crappy part is that just like med peds adds an extra year, the fellowships usually do too.

Also, it's not that adult docs can't "handle" type 1 dm, it's just for continuity of care. E.g. when ure 18/19, if you have congenital HIV, or sickle cell, you're going to have to start working with a new doc, rather than the one you've been with your whole life!

 

[Acoustic]

There are special med/peds fellowships, specifically endocrine? idk, but i know there is a 4 or 5 year ID fellowship (f that btw). crappy part is that just like med peds adds an extra year, the fellowships usually do too.

Also, it's not that adult docs can't "handle" type 1 dm, it's just for continuity of care. E.g. when ure 18/19, if you have congenital HIV, or sickle cell, you're going to have to start working with a new doc, rather than the one you've been with your whole life!

You know what I don't get? That whole continuity of care selling point that FM likes to flaunt. Obviously it makes sense for a single hospital stay or any acute care, but for chronic care does it really matter? I've shadowed pediatricians who had absolutely no idea who her patients were because she had so many of them and spent so little time with each. Her knowledge came from the chart. How is that different than any other chronic care situation? Not sold on that being a real thing with significant benefits.

 

[GoodmanBrown]

There is no "med/peds endocrine fellowship"... And again adult endocrinologists can do type 1 DM. How is it an advantage to see a med/peds trained person? OP, if you want to do a fellowship you must pick either adult or kids. You would be eligible for both since you are board certified in both adult medicine and pediatrics. However there is no 3 year fellowship that fully trains you in both adult and peds subspecialty.

Family medicine is more for primary care but in certain areas (i.e. more rural) lots of them do hospital work as well. Thus there really is no difference between FM and med/peds with regards to hospital work except in larger cities. FM also has a variety of fellowship options as well. Thus I still do not understand the fascination with med/peds. It's useless.

Sorry, but you're wrong. There are combined fellowships. That said, I agree with most of what you're saying. If you're interested in primary care or hospitalist work, med-peds is probably not the way to go.

However, if you're interested in a highly specialized academic center, it can give you an advantage for research dollars and higher positions. The guy running our medical system's congenital heart defects adult clinic is med-peds cardiology for instance. Is he that much better qualified than a normal adult cardiologist? It's maybe debatable, but I'm sure he saw a lot more congenital defects in his fellowship than the adult cards fellow who probably mostly saw old people with saggy hearts.

 

[GoodmanBrown]

You know what I don't get? That whole continuity of care selling point that FM likes to flaunt. Obviously it makes sense for a single hospital stay or any acute care, but for chronic care does it really matter? I've shadowed pediatricians who had absolutely no idea who her patients were because she had so many of them and spent so little time with each. Her knowledge came from the chart. How is that different than any other chronic care situation? Not sold on that being a real thing with significant benefits.

I bet it's hard in peds since you see like 40 kids in a day. My wife comes from a very small town with 1 doc for the whole town. He certainly knew everyone he saw. Even here in a bigger city, some of the FM docs talk about patients they routinely see and who they've built relationships with. I'm sure this happens with other specialties though, so I doubt FM has a lock down on relationships.

 

[smq123]

You know what I don't get? That whole continuity of care selling point that FM likes to flaunt. Obviously it makes sense for a single hospital stay or any acute care, but for chronic care does it really matter? I've shadowed pediatricians who had absolutely no idea who her patients were because she had so many of them and spent so little time with each. Her knowledge came from the chart. How is that different than any other chronic care situation? Not sold on that being a real thing with significant benefits.

Yes, absolutely. It does.

For peds, it's not *quite* as important (although still useful). But, really, how much medical history does the average 3 year old accumulate?

Adult medicine is different. For example, I have a patient with MS, which comes with a TON of related problems. By now, though, I know her history in and out. I don't have to refer to a chart; I can just spend that time talking to her and examining her. She likes that...she says it's very tiring and frustrating to have to tell a brand new doctor her entire medical history all over again. If I had to go through her chart each time I saw her...ugh. I mean, that sucker was at least 2 inches thick. And that was just volume 2.

I also have a patient who had been raped in the past. But she knows me well, and I know her, and I think she trusts me. So, when I see her for her GYN care, she trusts me enough to not have a panic attack when I do her pap.

I have another patient who has a long history of domestic abuse, cutting, drug abuse, eating disorders, and anxiety. But now that I know her, and she trusts me, we don't have to delve into that each and every time she comes in. If she has a new doctor, she has to go over it all, again, in painful detail.

And don't get me started on the demented patients...if you're not familiar with their history, you have no idea if their mental status is any worse, or the same.

Continuity of care saves time, but, above all, it builds trust. When patients trust you, you can encourage them to do so much more with their care than you could otherwise. When you trust patients, you can help them a lot faster and more efficiently.

I'm sure this happens with other specialties though, so I doubt FM has a lock down on relationships.

It can happen in other specialties, although not always. It really depends on the specialist.

Some specialists, who aren't very good at outpatient medicine, and are so pushed to see patients that they see 50 patients a day, are not going to have this kind of relationship.

Plus, some specialists are not very good at seeing the bigger picture. Sometimes I get letters back from them saying that they started XYZ medication, and then I have to call them back and explain that the patient's nephrologist specifically nixed that med.

I've met a handful of specialists who WERE very good at developing those kinds of relationships with their chronic patients, but certainly not all. They stick out in my mind specifically because they were the exception.

 

[AtheGre]

The only advantage I see is for people who still aren't sure if they want to do medicine or pediatrics. I hear the med/peds fellowship argument all the time and I don't buy it either.

I agree with sentiment in full. I also agree with officedepot. The only difference between med/peds and family medicine is that people who go into family medicine know what they want out of a career in medicine, while med-peds people are still undecided.

OK maybe I'm just trashing med peds because I think it's silly

AtG

 

[gravitywave]

as was pointed out, there are combined med/peds fellowships out there, but they tend to be informal arrangements between the fellows and the programs involved. med/peds as i understand it has loads more inpatient training than FM, and obviously less OB. you'll be far more knowledgeable about the ICU in med/peds, for example. but that only really scratches the surface of the difference, because there are also fundamental differences in the culture of the training you'd receive in med/peds vs. FM. they tend to attract different people. or at least they ought to.

that said, the number of med/peds slots has been declining in recent years, and i think that's a function of how many people view the specialty as a bit redundant. it's true that the majority of grads will eventually find themselves practicing predominantly with either one patient population or the other. i do think it's considered to have certain advantages in caring for kids with chronic diseases (CF and endocrine disorders come to mind) as they transition to adulthood. but the truth is that if you are doing med/peds with the intent of having an outpatient-based practice, you're probably wasting your time.

 

[smq123]

as was pointed out, there are combined med/peds fellowships out there, but they tend to be informal arrangements between the fellows and the programs involved. med/peds as i understand it has loads more inpatient training than FM, and obviously less OB.

Not just less OB, no OB at all.

Whether or not med-peds has "loads" more inpatient training depends on the individual FM program. By and large, I would agree that FM is more outpatient heavy, but not universally.

 

[gravitywave]

Not just less OB, no OB at all.

Whether or not med-peds has "loads" more inpatient training depends on the individual FM program. By and large, I would agree that FM is more outpatient heavy, but not universally.

ok, sure. although i think you're quibbling a bit here. that's why i threw up the part about there being cultural differences in the training. whether some FM programs have as much inpatient as most med/peds programs isn't nearly as important as the separate objectives for each specialty and how those are reflected by differences in training, which i thought was germane to this discussion.

the OB was a turn of phase, clearly there is no OB in med/peds

 

[oldbearprofessor]

For peds, it's not *quite* as important (although still useful). But, really, how much medical history does the average 3 year old accumulate?

If they had been one of my complex patients, a lot. That's what the pediatric medical home is about. Continuity of care is critically important in pediatrics, IMO. Sure, the "average" 3 year old doesn't have a complex history, but as many as about 10% of them do, so it's not a small group.

med/peds has no advantages... It is a made up field.

In my opinion the field has no real use and is not different enough from family medicine. Just pick either IM or peds and if you really do like both do FM.

Thanks for sharing. Is it okay if I disagree? Or is this an absolute. I have a lot of respect for the family medicine physicians I have worked with, but, there are unique skills and opportunities provided by a med/peds residency and med students interested in these areas should talk extensively with med/peds residents and attendings about the many career opportunities for graduates of the field.

 

[smq123]

If they had been one of my complex patients, a lot. That's what the pediatric medical home is about. Continuity of care is critically important in pediatrics, IMO. Sure, the "average" 3 year old doesn't have a complex history, but as many as about 10% of them do, so it's not a small group.

Fair enough. I stand corrected.

I don't discount continuity of care in peds, either. I'm on an outpatient peds rotation, and I see the relationship that the pediatrician has with her patients (some of whom are children of former patients!) She can get more done in a 5 minute visit, by virtue of that relationship, than I can in 15.