Can Someone Explain the Pros/Cons of Med/Peds?

[Putkernerinthehall]

Better job prospects ? Chance to follow meds patients with lifelong conditions ?

Do most Med/Peds choose to practice with one or the other (adults or children) ?

Help me understand why Med/Peds exists and why one would want to pursue it.

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[VA Hopeful Dr]

Pros:
- You have access to all peds and IM fellowships
- You can easily be peds or adult hospitalist
- You can do outpatient peds or adult primary care or both
- Ideally suited for adult congenital heart disease or adolescent medicine fellowships

Cons:
- You have to maintain 2 board certifications
- Many med/peds people end up practicing just one of the 2 specialties so the extra year of training/board certification didn't end up doing much

 

[GoSpursGo]

Pros:
- You have access to all peds and IM fellowships
- You can easily be peds or adult hospitalist
- You can do outpatient peds or adult primary care or both
- Ideally suited for adult congenital heart disease or adolescent medicine fellowships

Cons:
- You have to maintain 2 board certifications
- Many med/peds people end up practicing just one of the 2 specialties so the extra year of training/board certification didn't end up doing much

Bolded for emphasis.

Med/peds is a great idea if you actually have an idea of what you're going to do with the combined training (ie continuity/transition congenital heart disease, AYA oncology, sickle cell, diabetes... basically any chronic medical problem that you can get in childhood/adolescence and then age out of pediatric care). If you're able to articulate what you want from combined fellowship training (or somehow otherwise managing to care for both), places will generally be happy to accommodate that plan since there is such a dire need for pretty much anyone to fill that void of what happens to complex patients as they transition from peds to adults. But if you don't know what you want, you'll likely get pushed in one direction or the other since that what all of the "defined" pathways do.

 

[TelemarketingEnigma]

Med Peds now PGY-2 here:

Agree with most of what is above, though I will note that it is really important to talk to people within the med peds field if you’re considering it, because I hear a lot of not totally accurate stuff from many people in categorical IM or Peds who don’t understand the combined mindset.

About many people “choosing” one or the other: NMPRA data shows that a majority of med peds grads continue to practice with both adults and kids in some fashion (even if they don’t do a combined fellowship), but it can look very different person to person and as mentioned above tends to require a vision for what you want to do and some negotiation with your future fellowship/employer. There isn’t anything “wrong” with eventually picking a side though - plenty of FM trained folks never do a drop of pediatrics or ob/Gyn in their ultimate career, etc. That’s the nice thing about med peds, you have lots of options to make a path that works for you.

There’s a chance that my interests may lead me to an IM only fellowship, but part of my reason for choosing this specialty is that I wanted at least 4 more years working with kids, and I think the knowledge and mindset that comes from experiencing both sides makes me a more rounded clinician. For me, it is worth an extra year. It won’t be for everyone.

Some other things to think about if you’re considering this field:
- very very inpatient heavy at most programs. 10/13 blocks of my intern year were some kind of inpatient primary service (wards, or specialty services that manage their own patients). The other 3 were ER, inpatient specialty consults, and a single block of clinic. It gets better going forward, and I’m still getting great continuity clinic experience, but if you for sure want to do primary care I’d strongly consider if FM is right for you. this can of course be a perk if you are someone like me who prefers inpatient medicine.
- along those lines, more limited elective time. I don’t feel too limited so far but there’s lots of requirements that need completing.
- if you want to do anything with complex pediatric patients/young adult survivors, MP is definitely a better pick. You’ll get a much more robust peds experience than most FM programs. As mentioned above, ACHD is one of the best examples of this. Of course peds will have the most robust training for the complex kids, but my peds colleagues tend to start getting scared of them around age 18-21 lol
- MP programs (and the field at large) tend to be small and tight knit. This is absolutely a bonus for me (I love having a close residency family within two very large programs) but important to consider if it’s right for you.
- for the most part I think MP grads can do whatever they want, but there are a few areas I would not recommend it for, like NICU. Maybe this is just my program but I think this is one of the spots where we get the least exposure and there is the least crossover in knowledge. But I also don’t think too many neonatology minded folks are drawn to Med Peds

Anyway that’s a lot of rambling thoughts but as you can tell I’m always happy to talk about med peds and answer questions. So far I am 100% happy with my specialty decision despite some of the cons above

 

[Putkernerinthehall]

Some other things to think about if you’re considering this field:
- very very inpatient heavy at most programs. 10/13 blocks of my intern year were some kind of inpatient primary service (wards, or specialty services that manage their own patients). The other 3 were ER, inpatient specialty consults, and a single block of clinic. It gets better going forward, and I’m still getting great continuity clinic experience, but if you for sure want to do primary care I’d strongly consider if FM is right for you. this can of course be a perk if you are someone like me who prefers inpatient medicine.
- along those lines, more limited elective time. I don’t feel too limited so far but there’s lots of requirements that need completing.
- if you want to do anything with complex pediatric patients/young adult survivors, MP is definitely a better pick. You’ll get a much more robust peds experience than most FM programs. As mentioned above, ACHD is one of the best examples of this. Of course peds will have the most robust training for the complex kids, but my peds colleagues tend to start getting scared of them around age 18-21 lol

Great insight. Are most Med-Peds positions at large, academic medical centers ? Do many/most Med-Peds attendings also have an academic appointment ?

 

[TelemarketingEnigma]

Great insight. Are most Med-Peds positions at large, academic medical centers ? Do many/most Med-Peds attendings also have an academic appointment ?

depends what you mean by a "Med-Peds" position. a med peds trained physician can work any medicine or pediatrics position, or a combination of both. a job with "Med Peds" explicitly in the title might be more likely in an academic system with a med peds program, but I know of "Med Peds" private primary care practices (sometimes in collaboration with FM trained physicians), or people who have negotiated combined positions in non-academic systems. combined careers can be totally varied, some examples including:

- combined hospitalist: exact set up will vary, but typically I have seen it be separate weeks of service on adult and pediatric services. could be at same or different hospitals. much less commonly you might have both adult and pediatric patients during the same day (likely at a smaller hospital). I will note that there is a lot of consternation right now about the peds academic hospitalist fellowship which will make this career path more annoying (but not impossible).
- mix of outpatient + hospitalist work: lots of the attendings in my program spend most of their time in our combined Med Peds clinic, with a few weeks of inpatient service each year (could be on IM or peds or both)
- combined specialist: do a combined fellowship -> see adults + kids within that specialty. exact mix out outpatient/inpatient service would be specialty and institution/practice dependent. some might focus particularly on transition care, survivorship, etc for young adults within their field
- you could also do fellowship on just one side, and focus on transitions or young adults or whatever
- combined primary care: see adults and kids within in the same day at the same clinic
- adult congenital heart disease: peds and/or adult cardiology -> ACHD fellowship. would likely work in a large academic/tertiary medical center. my institution also has hospitalists who work on the ACHD unit which MP training is perfect for

and lots of other niche options

 

[TelemarketingEnigma]

highly recommend the NMPRA website which has lots of good info! Guide to Med-Peds | NMPRA - The National Med-Peds Residents Association