Rigor, and call schedule?

[mercaptovizadeh]

What is the rigor of med/peds programs at some of the top places like MGH, BWH-Childrens, HUP/CHOP, etc.? It seems that in 4 years you couldn't get the same expertise in IM and peds as someone who did 3 years in one of them. Are the single-boarded people doing more esoteric rotations, or seeing more patients, or is time allotted for research that med/peds people don't do?

Also, what is the call schedule like? Are you in both departments once you're an attending and fully required to meet each call requirement just like a single-boarded person? Can you be an IM/peds hospitalist?

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[medimission]

Hospital reputation does not equal good residency. I've interviewed at several medpeds programs this fall that are at "renowned" hospitals where the residents worked first and were educated if time allowed. When looking for a strong MP program I would recommend the following:

1. Strong categorical programs: MP cannot stand on its own
2. Good communication between MP and the categorical depts (personally, I feel like a medpeds program director and program coordinator are an absolute must (I think the new accreditation rules agrees) and I strongly prefer programs with designated MP chiefs)
3. Complete integration with the categorical departments. On peds you are a full fledged pediatrician, on medicine a full fledged internist.
4. Intra-resident support: if there are never other MP residents around, it is hard to overcome difficult times that all of us face.

These are just my thoughts and I hope they help.

 

[mercaptovizadeh]

Hospital reputation does not equal good residency. I've interviewed at several medpeds programs this fall that are at "renowned" hospitals where the residents worked first and were educated if time allowed. When looking for a strong MP program I would recommend the following:

1. Strong categorical programs: MP cannot stand on its own
2. Good communication between MP and the categorical depts (personally, I feel like a medpeds program director and program coordinator are an absolute must (I think the new accreditation rules agrees) and I strongly prefer programs with designated MP chiefs)
3. Complete integration with the categorical departments. On peds you are a full fledged pediatrician, on medicine a full fledged internist.
4. Intra-resident support: if there are never other MP residents around, it is hard to overcome difficult times that all of us face.

These are just my thoughts and I hope they help.

Do you feel that if the IM and the peds components are independently considered to be excellent for training, and assuming a good overarching MP structure that integrates the two, that that would assure excellent med/peds training? In other words, as a med/peds, are you being trained by the same internists and pediatricians as the IM only or peds only folks?

Also, perhaps I haven't done enough of my own research, but what sort of stuff is cut from the IM or the peds program when you have it fused into one? Is it just less elective/research time or do you somehow lose out on core rotations as well?

Also, are the rotations integrated in such a way that your primary focus is childhood disease that can be followed into adulthood (e.g. congenital heart disease), or does it treat them independently, just as a peds only or IM only resident (or fellow) might see it?

Thanks for the help.

 

[zola]

In terms of what is cut out, I can't be overly specific because I would have to go back and look at the requirements for each and compare it to those for med-peds, but in general, what is cut out is elective and research time. You still have the core rotations that everyone else has. Some m-p programs extend intern "year" to 16 or 18 months so that it is even more similar to the traditional tracks.

For the second question about adjusting rotations to cover topics like congenital heart disease, etc - because you have to fulfill all the requirements of medicine and pediatrics, there is not a lot of extra time, and as far as I know, most programs do not have required rotations in such integrated topics. But, there is elective time (varies, but at least a few months a year), and that is certainly something you could do. Also, if you start to look at med-peds more seriously, this is something I would suggest looking for in a program - most will have some sort of structure to integrate medicine and pediatrics, whether it be a monthly seminar, weekly lectures prior to clinic, or some other avenue. How well this is done and how seriously it is taken is one measure of a good med-peds program.

 

[Doconthego]

What is the rigor of med/peds programs at some of the top places like MGH, BWH-Childrens, HUP/CHOP, etc.? It seems that in 4 years you couldn't get the same expertise in IM and peds as someone who did 3 years in one of them. Are the single-boarded people doing more esoteric rotations, or seeing more patients, or is time allotted for research that med/peds people don't do?

Also, what is the call schedule like? Are you in both departments once you're an attending and fully required to meet each call requirement just like a single-boarded person? Can you be an IM/peds hospitalist?

Actually your basic assumptions are a little off track.

Med-Peds residents are not doing less training, they are doing more. What you learn in pediatrics has great relevence to internal medicine and what you learn in medicine has great relevence to pediatrics. The program requirements reflect this because they know that PICU and ICU have so much overlap that med-peds residents should not do more than 4 of these. There have been some publications that showed that med-peds residents did as well as or better than the categorical residents on the boards. My personal experience was that at times in the residency I was behind where my friends were who started with me in the categorical residency and they should be ahead. They have to finish in three years. By about 42 months I was at the level of a IM and Peds resident when they graduate. The next 6 months was just icing on the cake.

I agree with the other person who responded. Don't confuse a hospital with a great reputation with a good teaching program. Great reputation has to do with research more than anything and nods from people in good old boys clubs who sit on ranking committees. If you look at patient outcomes the lists look a lot different. There are no list that use real measures for teaching so you just have to figure that out for yourself. You might like to use board pass rates but that may have more to do with recruiting than teaching. Put a class of 99ers in any program and they will all pass the certification exams. Guess which programs get the 99ers. I was a student "top place" research institution and my IM attending who was an endocrinologist rounding on the general medicine service wanted to do some off the wall bromocriptine levels from CSF on my patient with right sided endocarditis from IV drug use because bromocriptine is what he worked with all day, everyday, his whole life.

To answer the last question: Call depends on what kind of job you take. If you are in a med-peds practice you take med-peds call for your med-peds group. If you are part time in IM and part time in Peds than you take some peds call and some IM call at about half the frequency of the internists and pediatricians. Yes you can be a med-peds hospitalist. Lots of my classmates did this (and are making disgusting salaries working one week on and one week off) They found jobs pretty easily and some moved up the administrative ladder pretty quickly.

 

[mercaptovizadeh]

Actually your basic assumptions are a little off track.

Med-Peds residents are not doing less training, they are doing more. What you learn in pediatrics has great relevence to internal medicine and what you learn in medicine has great relevence to pediatrics. The program requirements reflect this because they know that PICU and ICU have so much overlap that med-peds residents should not do more than 4 of these. There have been some publications that showed that med-peds residents did as well as or better than the categorical residents on the boards. My personal experience was that at times in the residency I was behind where my friends were who started with me in the categorical residency and they should be ahead. They have to finish in three years. By about 42 months I was at the level of a IM and Peds resident when they graduate. The next 6 months was just icing on the cake.

I agree with the other person who responded. Don't confuse a hospital with a great reputation with a good teaching program. Great reputation has to do with research more than anything and nods from people in good old boys clubs who sit on ranking committees. If you look at patient outcomes the lists look a lot different. There are no list that use real measures for teaching so you just have to figure that out for yourself. You might like to use board pass rates but that may have more to do with recruiting than teaching. Put a class of 99ers in any program and they will all pass the certification exams. Guess which programs get the 99ers. I was a student "top place" research institution and my IM attending who was an endocrinologist rounding on the general medicine service wanted to do some off the wall bromocriptine levels from CSF on my patient with right sided endocarditis from IV drug use because bromocriptine is what he worked with all day, everyday, his whole life.

To answer the last question: Call depends on what kind of job you take. If you are in a med-peds practice you take med-peds call for your med-peds group. If you are part time in IM and part time in Peds than you take some peds call and some IM call at about half the frequency of the internists and pediatricians. Yes you can be a med-peds hospitalist. Lots of my classmates did this (and are making disgusting salaries working one week on and one week off) They found jobs pretty easily and some moved up the administrative ladder pretty quickly.

Thanks for the comprehensive reply. I really have no mentoring on MP. I was interviewed three years ago by a medical student (at a school that I'm not attending) who said she was going into MP. I hadn't even known that was a possibility. I was thinking about it last year and mentioned it at an IM interest group meeting and the pulm/CC guy was dismissive of it's utility for someone interested in a research career. Then I was more interested in basic science research. Now my interests have shifted towards translational/clinical research or in fact full time clinical, so I'm once again looking into MP. Coming from the research perspective, that's why I've heard about CHOPS/MGH/etc. as being great places. From what you're saying, it sounds like they may be great places for research and perhaps for new treatments/interventions, but maybe not the best places for being trained superbly as a clinician. Where can I find a compiled list of patient outcomes at various hospitals?

Btw, what sort of "disgusting" pay are these hospitalists making? Hospitalist sounds like a career that could potentially lead to burnout, with the shifts and all.

 

[medimission]

There aren't too many lists of patient outcomes out there, but a few programs that really impressed me with good solid teaching, balanced strong IM and Peds depts and excellent research opportunities and strong patient care were:

Midwest/Midsouth
U of Cincinnati, UT Memphis, U of Minnesota, Indiana U, OSU (especially if you want to go into a fellowship for this one), Med Coll of Wisconsin, Vanderbilt

New England
Best two programs hands down are Rochester and Baystate, I heard good things about Pitt although I didn't interview there, Christiana wasn't bad either

West: USC has gotten a great reputation as an up and coming program and I've heard good things about Utah

South: USF seems to be a popular one this year and UAB has tons of research going on.

NOTE: I didn't apply/interview in the south so what I'm saying is hearsay from the interview trail

 

[nevercold]

Might be worth re-thinking the questions you need to ask. I would guess that these are important questions for you:

Q: Where can I find out more about Med-Peds?
A: http://www.medpeds.org . After that site, I suggest talking to the dean(s) of your medical school or leaders in either medicine or pediatrics and asking who in the school/hospital is Med-Peds trained and might be willing to talk to you.

Q: How does Med-Peds training compare to categorical training?
A: Partially answered by the first question, but essentially, Med-Peds attracts a slightly stronger overall group of residents than the individual categorical programs and as a result has very high board pass rates in both specialties. Because of the way Medicine and Pediatrics share overlaps (critcal care, pathophysiology of certain diseases, infectious diseases, etc), Med-Peds doctors are generally well-respected for the diversity of their insight into clinical problems.

Q: How do programs differ in terms of their rigor in Med-Peds?
A: Because Med-Peds has to fit so much into 4 years, the overall curriculum is generally pretty scripted and the only significant variations come down to a month or two of inpatient versus outpatient and the duration of the nominal intern role and the timing that one begins the supervisory role.

Q: How do I find out which programs are strongest?
A: Even more so than in medical school, residency programs in the "top 50" tend to be overwhelmingly difficult to divide based on quality. Frequently, residents choose programs based on location and family rather than just prestige, so you end up with good residents everywhere. The only exception is the occasional program with a particularly weak pediatrics or medicine program in which you may get a different level of educational experience in each. Otherwise most of your learning comes from fellow residents and patient care. What is more important is knowing what your "red flags" are and using that to cut down on the list of programs you'd consider.

Q: What career potential is there in Med-Peds?
A: Greater than 75% of Med-Peds physicians continue to do a combination of the two once out of residency. A similar number do primary care with about 25-33% doing a fellowship, some combined fellowships. Your salary is highly dependent on the details of your job and the location. If you're willing to practice in Nowheresville, Idaho, you could probably get a nicely structured job and pull in $200-250k/year. If you want to practice in paradise, you'll likely be closer to the $150k/year. A typical salary is $150-200k/year. Job details can vary even more widely and are based on hours worked and cross-coverage demanded, which is generally nowhere as intense as residency.