What do you do after Med-peds residency?

I agree with KentW in that from what I have seen/heard it really does vary with the practice.

I chose med-peds over family practice, because I believe that med-peds training offers more career options and produces a very different physician from the family practice programs. For me family practice trains you to be a "jack of all trades, master of none" because you are learning IM, Peds, OB/GYN, a little general surgery in 3 years. We're talking what would be 10 years of categorical training condensed into 3 years. Also, when you look at how many months of peds training that you get overall, I'm not sure that I could honestly consider myself on the same level as a pediatrician, i.e, although I could see kids I wouldn't feel as comfortable as my peds counterparts because they have trained more/seen more than I would have. With med-peds you aren't a family doctor you are a board certified internist AND a board certified pediatrician, which opens the door for doing Med-peds primary care, or a medicine or peds fellowship, or a combined med-peds fellowship (which allows for subspecialty care with a primary care feel, since you can follow patients from childhood through adulthood), or you could be a hospitalist on either or both sides. I think that you have to decide what kind of training you need based on what you ultimately want to do.

AFAIK, med-peds mostly do primary care (and very successfully compete with FPs because patients often prefer a board-certified adult specialist and kid specialist). I also know a guy who did cardiology after med-peds and who now specializes in adult congenital heart disease.

KentW said:

Oh, please...

I don't even think you believe that.

You manage cardiovascular disease as an internist, right? And renal disease, and neurological disease, etc.? These are all specialty fields, with their own lengthy training programs. As a general internist/pediatrician, does that mean you've "condensed 100 years (or whatever) of specialist training into 4 years?" Of course not.

Generalists are generalists, and specialists are specialists. You don't have to know or do everything that the specialist does in order to be a competent generalist.

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Actually I DO believe that...which is why I wrote it. You're entitled to your opinion and I respect your opinion, but I don't think that a FP can honestly say that they are on the same level as an OB/GYN, or internist, or pediatrician. (How could you be...the training is different!) You know a little about each, whereas an OB/GYN, for example, has spent 4 years learning about nothing but that field. And yes, all generalists are generalists and will find themselves in a situation where they have to refer a patient, it's silly to think that they wouldn't, but a person who has dedicated 3-4 years focusing on ONE field will likely find themselves comfortable handling more cases on their own, because they have likely seen most of what comes through their door at some point in residency. Of course as a general internist you haven't condensed all of the potential years of fellowship training into a residency, but you also aren't TRYING to. If you believe that FP residents are the same as a categorical IM, Peds, or OB/GYN residents when they finish, then sorry! We'll just have to agree to disagree.

I'm not attacking family practice or saying that they aren't competent at what they do (where did THAT come from anyway?!) I have worked with family practioners and very much respect them and what they do, but you asked the difference between FP and Med-Peds, so I offered my opinion. Opinions are worth what you pay for them, so if you don't like it that's okay.

Indeed you didn't. Sorry about that!

Yes, we technically see the same patients. But you learn from equally broad-but-shallow trained FPs, while I learn from specialists because, unlike you, much of my training is spent in subspecialty rotations. You learn diabetes care from FPs. I do from endocrinologists. You learn MI care from FPs. I do from cardiologists. You learn antibiotics from the levofloxacin brochure. I do from infectious disease docs. In my training, I spend more time working with subspecialists than you spend in IM altogether, plus I get much more ICU time. This is why in my neck of the woods, med-peds trained docs are able to open new practices and totally suck patients away from FPs. Families want a specialist for mom and dad and a specialist for the kids. Med-peds fits the bill (and has the board certifications on the wall to prove it), an FP doc does not. Sorry.

Hey, I'm just sayin' Never seen an FP resident rotating through any of the medical specialties.

Mumpu said:

Families want a specialist for mom and dad and a specialist for the kids. Med-peds fits the bill (and has the board certifications on the wall to prove it), an FP doc does not. Sorry.

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So you think mom and dad want a specialist huh-so they go to a general internist and general pediatrian? I would hardly call those specialists. And for the record med-peds residents are more incompetent at knowing one field compared to someone who just did that field. All med-peds attendings I have worked with simply are not great internists or pediatricians-they are compentent but not at all great and I have worked with lots.

Second-back to speciality-what is one thing in an outpatient scenario would a med-peds guy be able to do that an FP guy can do. You could learn 95 percent of the things you see in private outpatient practice in about 6 months-

Adults-diabetes, HTN, lipids, colds/coughs/flus,depression
Peds-colds/flus/coughs/snotty noses

Now you are saying it takes a med-peds dude to treat this crap-I did this daily as a medical student after 1month in medicine-come on now. And beyond these common things the general internist refers out anyway-anyone can recognize that if a guy has some penis/urine complaint you refer to urologist. Chest pain and a murmor-refer to cards-All you have to know is the definition of the speciality and a lay-person could likely refer out properly half the time.

There are two studies that are interesting in comparing the perception of preparedness after training among categorical peds, categorical internists, and med-peds. The last article can be found in the Sept. 2006 issue of Pediatrics, page 1104 and there are some references to other studies that have been done. It showed that compared to categorical peds, a greater percentage of med-peds docs felt very well prepared in taking care of kids at all age levels except 0-1 yo and a greater % felt very well prepared at taking care of adults of all ages than categorical internists.

Now, this clearly doesn't say that med-peds physicians know better than categorically trained counterparts, but it does suggest that med-peds people feel more prepared to handle patients greater than 1yo.

To make a sweeping statement that med-peds physicians are incompetent compared to their categorical counterparts really weakens any point you are trying to make since you don't have much else to support it and doesn't seem to be suggested anywhere in the literature I have read. I'm doing just as much ICU training as my counterparts. (I do 4 ICU months on each side, while the categoricals do 5 months total)

megacolon said:

There are two studies that are interesting in comparing the perception of preparedness after training among categorical peds, categorical internists, and med-peds. The last article can be found in the Sept. 2006 issue of Pediatrics, page 1104 and there are some references to other studies that have been done. It showed that compared to categorical peds, a greater percentage of med-peds docs felt very well prepared in taking care of kids at all age levels except 0-1 yo and a greater % felt very well prepared at taking care of adults of all ages than categorical internists.

Now, this clearly doesn't say that med-peds physicians know better than categorically trained counterparts, but it does suggest that med-peds people feel more prepared to handle patients greater than 1yo.

To make a sweeping statement that med-peds physicians are incompetent compared to their categorical counterparts really weakens any point you are trying to make since you don't have much else to support it and doesn't seem to be suggested anywhere in the literature I have read. I'm doing just as much ICU training as my counterparts. (I do 4 ICU months on each side, while the categoricals do 5 months total)

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Thanks for posting this! I plan to check that article out when I get a chance.