Confused.

[DoctorMom78]

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Someone please explain to me what the difference between an FM residency and a combined IM/Peds residency. I know that FM is three years and IM/Peds is four, but what else is different about it.😕

 

[Taus]

I'm pretty sure that you would be board certified in both and have many more options for fellowships (through peds)...but I'm no expert...maybe better to post in the general residency forum

 

[dr.kicia]

http://forums.studentdoctor.net/showthread.php?t=199542
could be a good start.
Also try to ask in the residency forum. i am sure you will get much in depth advice on this.

 

[Jamers]

Someone please explain to me what the difference between an FM residency and a combined IM/Peds residency. I know that FM is three years and IM/Peds is four, but what else is different about it.😕

That is a weird residency, from what I know, IM's typically don't want to deal with children. However, if I can guess, IM is the seat into a lot of specialization, thus, with the IM and PEDS you might be able to specialize into something dealing with children. Better yet, ask someone who knows more than I do ahah.

 

[spicedmanna]

I'm generalizing here, so take everything I say with a grain of salt:

IM/Peds, in my opinion, provides more rigorous training in in-patient care and more opportunities for fellowships. It's much more difficult, has more call time, and you have to maintain two board certs. You probably miss out on the OB training you do in an FP residency, but then again, many FP's don't do OB that much anymore, either. I've heard that it's a fairly tough residency.

An FP residency is more focused on out-patient care and provides broad-spectrum training/exposure. Your opportunities for fellowship are fewer.

On a personal note, I want to split my time between an out-patient clinic (as an FP might do) and a hospital (as a hospitalist might do), and treat both adults and children. Also, I want the flexibility of all the subspecialities available to IM and Peds, should I want to do a fellowship to become more focused. Furthermore, I tend to think of in-patient care and ward care training involved in the dual residency to be more rigorous; this is the kind of training I want to bring with me in my care of patients in any setting.

I'm clearly seeing things here with limited knowledge though and might be biased through my discussions with an IM doc I shadowed.

 

[scpod]

I know that FM is three years and IM/Peds is four, but what else is different about it.😕

It almost seems a little silly because IM is for adults and Peds is for kids. FM is where you do a little of both. The main difference is that you are eligible to be board certified in both specialties...but in addition, you are also able to pursue any of the fellowships that either IM or Peds offer. FM wouldn't give you the fellowship opportunities. Just keep in mind that you are combining all the info from two separate three-year programs together into four years. It can be tough.

 

[NickRiviera]

It almost seems a little silly because IM is for adults and Peds is for kids.

Not too silly to me; sounds like another route to areas like pediatric cardiology.

 

[kealaq]

In family medicine, I read that the only three fellowship tracks after the three-year FM residency are: Geriatrics, Adolescent Medicine, & Sports Medicine.

In IM or Peds, your sub-specialty fellowship tracks are numerous. At the end of your four years, you'd be eligible to sit for both specialty boards & apply to various fellowships in either field.

 

[group_theory]

More extensive training in both Internal Medicine and Pediatrics when compare to Family Medicine

Look at the curriculum for Med-Peds at the University of Tennessee Memphis - you spend 2 years doing Internal Medicine and 2 years in Pediatrics (and 6 required months of various types of critical care)
http://www.utmem.edu/medpeds/Curriculum.html

Now look at the curriculum for Family Med at the University of Tennessee Chattanooga - only 2 months of dedicated inpatient pediatrics (and that includes nursery/NICU), and only 1 required month of critical care
http://www.utcomchatt.org/Dept/FM/fm.asp?dpage=curr

Also notice that you spend more time in outpatient settings in Family Medicine than Med-Peds.

When done with the training, Med-Peds residents are eligible to sit for the American Board of Internal Medicine and the American Board of Pediatrics. As such, the residents are able to pursue fellowships in either internal medicine, pediatrics, or in some cases both (ie cardiology, infectious disease, rheum, GI, endocrine, etc)

An old survey have shown 15-30% of Med-Peds graduate go on to fellowship training
(source: Lannon CM, Oliver TK, Guerin RO, Day SC, and Tunnessen WW. Internal Medicine - Pediatrics Combined Residency Graduates. What are they doing now? Results of a 1995 Survey. Arch Ped Adol Med 1999;153:823-828.

Lately, most med-peds program are seeing a 50/50 split between going into fellowship or going into practice directly following completion of residency.

 

[lrobin15]

Dr. Mom, that was a fantastic question! I also found the answers to be very helpful. I have been looking at the same kinds of things. Thanks everyone!

 

[tkim]

In family medicine, I read that the only three fellowship tracks after the three-year FM residency are: Geriatrics, Adolescent Medicine, & Sports Medicine.

In IM or Peds, your sub-specialty fellowship tracks are numerous. At the end of your four years, you'd be eligible to sit for both specialty boards & apply to various fellowships in either field.

Starting soon, FP can do pain management fellowships.

 

[lrobin15]

Starting soon, FP can do pain management fellowships.

Really? Do you have any idea of that time frame?

 

[DoctorMom78]

Thanks everyone! I appreciate all the fabulous responses! 😍 You can also do an OB fellowship with FM. I actually had looked at UT Memphis which is where I first heard about the IM/peds thing. I didn't honestly even know that it existed. My thought with doing IM/peds instead of FM was to do a rheumatology fellowship. Of course, I guess it probably is true that you must miss the OB part. You are boarded in both IM and Peds. So, I guess the difference for me would be what type of fellowship I want. Do I want OB or do I want rheumatology?😕

 

[JonnyG]

MED-PEDS as its refered to is relatively new and as such is still trying to find its nitch. The idea is that you can provide continuity of care as either a specialist or as a hospitalist. A cardiologist can follow the same congenitial heart condition from birth to adulthood. A hospital with only a few pediatric patients could hire a med-peds doctors instead of a seperate pediatrician (cost savings). There are several problems with this new option:

1) Hospitals do not really know how to utilize the doctors skills. They tend to get more peds or more imed responsabilities. Not a 50-50 balance.

2) Fellowships to take advantage of both areas of training are only starting to become available

3) It is confusing to go back and forth between the different requirements for patients. This does get easier with time.

I looked at the specialty but am leaning against doing it because the advantages of the dual board certification haven't developed yet and are probably a few years off.

 

[Doctor Bagel]

Unfortunately, this is another topic that can turn into a flame war. IM/Peds is 4 years instead of 3, and you don't do any ob training. People who do IM/Peds can be board certified in both pediatrics and internal medicine (can be sort of a drag because you have to take two board exams) and have a lot more fellowships options than FM.

My brother does rural medicine and did his residency in IM/Peds. He just liked the style more than FM, and he does feel like he's a little better trained, especially in peds. Now I've got to put on my flame suit for saying that before the FM people get angry. 🙂 There's another poster here with a name like "Rural Medicine" who also did IM/Peds. You might want to check out both the FM and IM board here because this has been discussed a lot. Basically, the FM board is generally negative about the IM/Peds thing, and the IM board is more positive. It's sort of a turf war thing, I guess.

 

[Critical Mass]

I'm pretty sure that you would be board certified in both and have many more options for fellowships (through peds)...but I'm no expert...maybe better to post in the general residency forum

Not disagreeing with you, but traffic is pretty low on any forums around here that seem to be for M3+ people. My take is that you can get 20 mediocre opinions here or possibly 1 or 2 good ones over there. Since I'm a typical American, I prefer quantity and speed to quality.

Just throwing this out there...

Are there any family docs out there who still deliver babies? (If so, give me a relative percentage.) All of the ones who I've talked to say that they don't do it anymore. Malpractice is too high.

 

[Doctor Bagel]

Not disagreeing with you, but traffic is pretty low on any forums around here that seem to be for M3+ people. My take is that you can get 20 mediocre opinions here or possibly 1 or 2 good ones over there. Since I'm a typical American, I prefer quantity and speed to quality.

Just throwing this out there...

Are there any family docs out there who still deliver babies? (If so, give me a relative percentage.) All of the ones who I've talked to say that they don't do it anymore. Malpractice is too high.

The FM board is actually pretty active, but they're one of the few. 🙂 According to the FM forum, lots of FM docs still do OB, but I don't know. From what I've observed just looking around, it appears like most of the docs delivering babies are ob/gyn. In the small town where my brother practices, they have one ob/gyn and a maybe 2 FM docs who do OB. I'm sure they're some facts somewhere, but I'm too lazy to look 'em up.

 

[mshheaddoc]

I know a FP who does OB only (and follow up peds with the kids he delivers). He does say that not many of them do that route anymore due to malpractice.

IM/Peds vs FM is a funny debate. If you talk to the IM people, they will claim you will get more inpatient "hospital" experience/procedures and less clinic. FM's then go on to argue that isn't true. I really think it depends on the residency though because some FM residencies I don't see how they could learn all the things that a 4 year residency does in 3 years. Just my perspective, but with that said, there are some great FM residencies out there and I'm see more people turn to FM who set out on another track in med school (specifically due to family issues).

With that said, Med/Peds has been actually more of an academic role which someone mentioned previously that is now "breaking" out of that role. I'm hoping that the dual boards for med/peds finds a way to break out because as someone mentioned, hospitals have no idea how to utilize doctors properly to be cost effective, so moving in this direction will end up helping hospitals rather than hurting them.

 

[DoctorMom78]

Unfortunately, this is another topic that can turn into a flame war. IM/Peds is 4 years instead of 3, and you don't do any ob training. People who do IM/Peds can be board certified in both pediatrics and internal medicine (can be sort of a drag because you have to take two board exams) and have a lot more fellowships options than FM.

My brother does rural medicine and did his residency in IM/Peds. He just liked the style more than FM, and he does feel like he's a little better trained, especially in peds. Now I've got to put on my flame suit for saying that before the FM people get angry. 🙂 There's another poster here with a name like "Rural Medicine" who also did IM/Peds. You might want to check out both the FM and IM board here because this has been discussed a lot. Basically, the FM board is generally negative about the IM/Peds thing, and the IM board is more positive. It's sort of a turf war thing, I guess.

Thank you. I want to do rural medicine in a small town, so that is some very useful information. I have a few years to decide and I guess I will have to think about what I want to do as a fellowship in the meantime.

As for OB and malpractice, I was worried about that too. But, I guess you can always work for a group or health care system that would pay it for you. I would love to deliver babies, but I don't know about the whole c-section thing. I am really not into surgery. I think the only place you could do OB/FM is in a small rural town. I doubt there would be much use for it elsewhere.

Thank you all for the great information.🙂

 

[Notmyrealname]

MED-PEDS as its refered to is relatively new and as such is still trying to find its nitch. The idea is that you can provide continuity of care as either a specialist or as a hospitalist. A cardiologist can follow the same congenitial heart condition from birth to adulthood. A hospital with only a few pediatric patients could hire a med-peds doctors instead of a seperate pediatrician (cost savings). There are several problems with this new option:

1) Hospitals do not really know how to utilize the doctors skills. They tend to get more peds or more imed responsabilities. Not a 50-50 balance.

2) Fellowships to take advantage of both areas of training are only starting to become available

3) It is confusing to go back and forth between the different requirements for patients. This does get easier with time.

I looked at the specialty but am leaning against doing it because the advantages of the dual board certification haven't developed yet and are probably a few years off.

Med-Peds started 2 years before Family Medicine. The advantages of a dual board certification has to do w/ flexibility in fellowships (there are even combined med-peds fellowships, I'd say the advantages are developed) as well as flexibility in practice locations. It is a blatant misinterpretation that med-peds is somehow less "developed" than other primary care fields.