UCSF's take on highly thought of programs in IM/Peds

[JTBright]

Congratulations to all who just matched!
I'm applying IM/Peds next year, and already thinking about where I'd like to apply (have to start early to give my wife time to apply to masters programs so we have those lined up before the match). Found this info on UCSF's webpage about "top" IM/Peds programs... sound about right to you guys (generally speaking...). it is dated 2012, so pretty recent...

http://meded.ucsf.edu/ume/career-information-medicine-pediatrics

1. What programs have been popular among UCSF applicants, or how should applicants go about considering programs?
   Programs are really clustered on the East Coast and in the Mid-West. Well-known and highly thought of programs (in both categorical and med/peds) include the two Harvard programs (MGH, BWH), Hopkins (5-year program), UNC-CH, Penn, Duke, Michigan, Yale, Brown, Baylor and UCLA. Lesser-known from a categorical perspective, but highly thought of from a med/peds perspective include: Rochester, Baystate, Case-Western, U Chicago and UCSD.
   

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[chargersfan]

Several thoughts on this. Although MGH and BWH are probably both top tiered and highly competitive I think that BWH >> MGH because BW has Boston Childrens and MGH doesn't.

Johns Hopkins is focused SOLELY on urban/underserved populations. If this isn't you don't even bother applying they will weed it out of you.

Other top tier programs in my opinion: Penn, Michigan, UNC, Duke, U of Chicago, Yale (maybe). I also do not put UCLA here because although their medicine is amazing, their peds does leave a little to be desired
Below that tier: UCLA, UCSD, Baylor, UAB, Ohio st, Cincinnati, Case western (the rainbow babies one not the other)
The highly thought of med/peds programs (although without super strong categoricals) are: Rochester, Baystate, Christiana,

Despite all these rankings I still go back to my mantra of finding the right medpeds fit for you. Med/peds isn't like categorical medicine or peds. The curriculum is so tightly standardized, you'll get a solid medpeds training at any program you go to. Each program has something unique to offer: large tertiary children's hospital, excellent med/peds combined clinic, solid med-peds presence, etc. Keep that in mind as you look at each program. Good luck!

 

[JTBright]

Thank you -- I somehow thought that both Harvard programs got Boston Children's... also had no idea about JH being a niche program.

What is the dividing line, in your mind, between the top tier (Harvards/Penn/...Yale) and the next tier (UCLA/UCSD..Case Western)? Is it that their categorical are more out of balance?

I haven't done much research yet, but I am definitely getting the feeling that IM-Peds is its own animal...

 

[chargersfan]

It really is a grey line and I'm sure a lot of people will disagree with me on certain programs. I tend to use competitiveness as well as med/peds balance. However, this doesn't always work. For example, based on competitiveness most people would put UCLA on the top tier. I keep it lower because of the balance. On the other hand, UCSD is a very solidly balanced program but it's not as competitive as the others.

And yes you're right, I personally think med-peds is completely different than categorical medicine and peds when it comes to applying and ranking programs. Take a look at the other threads to see stuff people have written about choosing the right program.

 

[mercaptovizadeh]

The question is really what is it that you want in a med-peds program? If you want a primary care centered program with strong research, then you may want a place like UNC. If you want a very academic heavy hitter, then Penn may be more up your line. If you want global health, then maybe it's Duke. For rural care, think about Greenville in SC. And if you want urban health (and nothing but) or an MPH (in fact, may be forced to), then there's JHU.

As someone interested in academic medicine, I think it's important to look at programs as both med-peds programs AND for their categorical strengths (in the academic, fellowship-placement, faculty-growth potential sense). It's part of what makes med-peds so competitive, and arguably the top 7 or 8 programs extremely competitive (along with extremely small class sizes). There aren't too many med-peds programs at institutions where either categorical medicine (e.g. BWH, MGH, JHU, Duke, Penn, etc.) or pediatrics (CHOP, BCH, Cincinnati, Texas Children's, etc.) are top 10 or even top 20. There's no Mayo, WashU, UWash, UCSF, Stanford, Columbia, Cornell, NYU, Northwestern, UTSW, Emory, or a slew of other programs considered strong in either medicine or pediatrics or both. To try to harmonize the two for top 10 academic reputation in both categoricals is practically impossible, and I believe is the case only for 2 or 3 programs in all. Having one of the categoricals as a top 10 program and the other as a 10-20 alone will make it extremely competitive.

That's why, for med-peds you need to determine whether the hospital will see a broad array of pathology (more important for pediatrics than for medicine, because there are fewer kids, there's less infrastructure and rigor in general than in medicine, and parents are willing to travel far and wide (if need be from California to Philadelphia) to get the best care for their sick child), what the catchment area is like, whether there's competition in town (MGHfC will lose out on BCH, Chicago will compete with Northwestern, etc.), whether the educational infrastructure is good, what the fellowship placement is like, what the research opportunities are, and - most importantly - whether you like the people.

 

[x1052]

I was asking the same question when I first came to this board... just trying to get a general sense of the consensus on what top programs were so I could narrow down my list before I got into the nitty-gritty. As other have explained, it's so hard to do for med-peds because some are great at meds, some are great at peds, some have great med-peds identity, etc. Mercaptovizadeh was really spot on by mentioning a lot of elite institutions don't offer a med-peds residency, so our pool of options is really quite limited.

I came across that UCSF list as well. I don't know if you looked it up, but it's authored by two UCSF hospitalists who did med-peds residency at Harvard.

I think it is pretty accurate in a very general sense, in that I think they'd be (generally) "impressive" (read: competitive, great education, name recognition, a certain level of prestige) places to do your residency. The only entry that surprised me a bit was Case Western. I'm also surprised Vanderbilt and Pittsburgh aren't on the list.

Personally, I'd probably sub-classify the top programs as follows (this, from the perspective of someone who wants to open up the doors for fellowship training after residency)... [I had to edit this...]

MGH / BWH / Penn / Hopkins [but only for urban health]

UNC / Duke / Michigan / Baylor / UCLA / UCSD / U Chicago / Yale / Brown / Vanderbilt / Pittsburgh

I know that's a lot to all consider relatively equal... but I think I do. Brown/Yale might not be as strong of an educational experience, but they make up for it with name recognition, research, and connections.

...and then everything else in an order that's too nuanced for me to think about.

This is based on my interviews, hearing about my classmates' experiences, talking to med-peds faculty and advisors, and perusing SDN/the internet. I obviously didn't interview at a lot of the places listed above.

just my two cents.

 

[DWB]

Quick question on JHU's urban health program -
I was just looking over their website and it seems to be a primary care track. Does this mean JHU might not be for those wanting to do fellowship?
I don't really know if I want to pursue a fellowship or not at this point, but 4 years is enough to discover new interest in sub-specialties.

 

[x1052]

Quick question on JHU's urban health program -
I was just looking over their website and it seems to be a primary care track. Does this mean JHU might not be for those wanting to do fellowship?
I don't really know if I want to pursue a fellowship or not at this point, but 4 years is enough to discover new interest in sub-specialties.

I would think that your PS and CV would have to show a pretty strong commitment to primary care/urban health to match there. They obviously couldn't stop you from pursuing a fellowship, but I would say it's not the program for you if you aren't pretty committed to primary care. it's def. a program for a special breed of applicants.

 

[chargersfan]

I also don't think it's just primary care. It has to be primary care in an urban/underserve population. If they don't sense that in your app they probably won't even offer an interview no matter your stats. So if you are unsure if this is your future I would say save your money.

 

[mercaptovizadeh]

I would think that your PS and CV would have to show a pretty strong commitment to primary care/urban health to match there. They obviously couldn't stop you from pursuing a fellowship, but I would say it's not the program for you if you aren't pretty committed to primary care. it's def. a program for a special breed of applicants.

I also don't think it's just primary care. It has to be primary care in an urban/underserve population. If they don't sense that in your app they probably won't even offer an interview no matter your stats. So if you are unsure if this is your future I would say save your money.

I've thought about this, and I've concluded that they can make it very hard for you to pursue fellowship. You need letters from PDs and faculty, and they are not going to be inclined to write a letter if they feel you did not at least give primary care a try. I would definitely not expect them to provide a letter during year 3 or 4 of residency. Maybe after several years of "being in the trenches" you could get away with applying for fellowship.

They also apply heavy pressure to do an MPH after residency. And would they foster you doing basic or translational research? How would your elective time look? Is cardio a no-no but geriatrics OK?

It's for a very particular kind of applicant. For most of us, it's much too restrictive to choose to go there.

 

[mercaptovizadeh]

I was asking the same question when I first came to this board... just trying to get a general sense of the consensus on what top programs were so I could narrow down my list before I got into the nitty-gritty. As other have explained, it's so hard to do for med-peds because some are great at meds, some are great at peds, some have great med-peds identity, etc. Mercaptovizadeh was really spot on by mentioning a lot of elite institutions don't offer a med-peds residency, so our pool of options is really quite limited.

I came across that UCSF list as well. I don't know if you looked it up, but it's authored by two UCSF hospitalists who did med-peds residency at Harvard.

I think it is pretty accurate in a very general sense, in that I think they'd be (generally) "impressive" (read: competitive, great education, name recognition, a certain level of prestige) places to do your residency. The only entry that surprised me a bit was Case Western. I'm also surprised Vanderbilt and Pittsburgh aren't on the list.

Personally, I'd probably sub-classify the top programs as follows (this, from the perspective of someone who wants to open up the doors for fellowship training after residency)...

MGH / BWH / Penn / Hopkins [but only for urban health]

UNC / Duke / Michigan / Baylor / UCLA / UCSD / U Chicago / Yale / Brown / Vanderbilt / Pittsburgh maybe [I know that's a lot to all consider relatively equal...]

A tier under that, I'd put: Minnesota / Cincinnati / Baystate / Christiana / UAB / Ohio State / Indiana / Wisconsin

...and then everything else.

This is based on my interviews, hearing about my classmates' experiences, talking to med-peds faculty and advisors, and perusing SDN/the internet. I obviously didn't interview at a lot of the places listed above.

just my two cents.

Never understood why Yale (or Brown) is placed so high. From my perspective, it's equal or weaker than Vandy or Pitt in medicine and certainly pediatrics. But it has brand name recognition and fantastic research opportunities (and New England/New York region, so well connected to other institutions in the area), so I think it places well into fellowships.

 

[x1052]

Never understood why Yale (or Brown) is placed so high. From my perspective, it's equal or weaker than Vandy or Pitt in medicine and certainly pediatrics. But it has brand name recognition and fantastic research opportunities (and New England/New York region, so well connected to other institutions in the area), so I think it places well into fellowships.

Yes, very true (I had to edit my post a little...)

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As an aside, a friend at a top-tier med school that doesn't have a med-peds program forwarded me their internal list of what they considered top programs... their top 10 for this cycle were BWH, MGH, Penn, Chicago, Michigan, UNC, Duke, Baylor, UCLA, UCSD.

No Hopkins [just b/c it's such an oddball program/specialized, I'm sure], Vandy, Yale, or Brown. Just thought it was interesting, especially to compare to UCSF's list, as another top spot w/o its own program.

 

[chargersfan]

In regards to the top programs not having med/peds programs. I've talked to several PDs about this and it seems like the general consensus is that there is a lot of personal bias towards med/peds. Many of the medicine and peds department chairs in these programs are of the "old-school" mindset. They just don't see the point of a med-peds trained physician. That's one of the main reason it hasn't made much headway into these larger, well-known programs.

Times could be changing though. A medpeds chief resident told me that the old medicine chair at WashU was replaced by a new chair who is much more open to starting a med/peds program there. To me it seems like there's going to be a changing of the guard in the near future in regards to these department heads. Who knows, maybe by the time we graduate residency, there will be a demand to start new programs at these excellent places. One can only hope.

 

[mercaptovizadeh]

In regards to the top programs not having med/peds programs. I've talked to several PDs about this and it seems like the general consensus is that there is a lot of personal bias towards med/peds. Many of the medicine and peds department chairs in these programs are of the "old-school" mindset. They just don't see the point of a med-peds trained physician. That's one of the main reason it hasn't made much headway into these larger, well-known programs.

Times could be changing though. A medpeds chief resident told me that the old medicine chair at WashU was replaced by a new chair who is much more open to starting a med/peds program there. To me it seems like there's going to be a changing of the guard in the near future in regards to these department heads. Who knows, maybe by the time we graduate residency, there will be a demand to start new programs at these excellent places. One can only hope.

In all honesty, I think med peds is much more meaningful for the practitioner than the patient. It's like we all have this psychological fascination with cradle to grave and 1.6x the pathology of either categorical specialty alone. Or, we just can't "let go" of either population.

It's real "need" is truly only in extremely resource scarce settings, which is why it's hardly surprising that so many med peds people are interested in international health.