disadvantage for doing combined residency for fellowships?

[49erfan]

will doing a combined IM/PED residency make me less competitive for fellowships (fellowship opportunities for IM graduates and fellowship opportunities for Peds graduates) as compared to an applicant applying for fellowship having solely done Internal Medicine or an Applicant applying for fellowship having solely done pediatrics?

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[gutonc]

Good question. I'm not sure it will make you less competitive per se, but it does raise the question of "why do both?" if you're going to go on and do advanced training in only one area (and presumably practice only that specialty), then what was the point of the extra year of training to do both IM and Peds.

With very few exceptions (I'm personally only aware of one exception), people who specialize after Med/Peds do either an adult or a peds subspecialty. You won't be unique in that regard, but the question will come up (and you should have a good answer) as to why you chose Med/Peds and then went into whatever specialty you wanted.

All that said, I think the caliber of M/P applicants is, on average, slightly higher than that of IM or Peds applicants so if you're competitive for Med/Peds, you'll probably be OK for a subspecialty.

 

[49erfan]

as of right now I am interested in adult cardiology and completing an im/peds residency would allow me to apply for it.... but adult Cardiology is the most competitive fellowship in my opinion, pediatric cardiology would be my next choice, which i heard is also competitive, but nowhere as competitive as an adult cardiology fellowship... and if that doesn't work out I am very interested in doing pediatric em or neonatology which I heard is fairly ez to get.....

so as you can see, it keeps all fellowship options open doing an IM/PED residency

but yes, the biggest concern is "why do both", and I can't say that I am interested in keeping zillions of options open after residency, since I am not sure I can get adult cardiology fellowship....

and I just get the impression (no factual data to back this up), that fellowship directors are not big fans of combined residents...

that is my biggest concern with the issue

Good question. I'm not sure it will make you less competitive per se, but it does raise the question of "why do both?" if you're going to go on and do advanced training in only one area (and presumably practice only that specialty), then what was the point of the extra year of training to do both IM and Peds.

With very few exceptions (I'm personally only aware of one exception), people who specialize after Med/Peds do either an adult or a peds subspecialty. You won't be unique in that regard, but the question will come up (and you should have a good answer) as to why you chose Med/Peds and then went into whatever specialty you wanted.

All that said, I think the caliber of M/P applicants is, on average, slightly higher than that of IM or Peds applicants so if you're competitive for Med/Peds, you'll probably be OK for a subspecialty.

 

[Frugal Traveler]

One of the adult cardiology fellows at my school did a med/peds residency... so it's possible.

 

[mercaptovizadeh]

Do combined fellowships exist? I have heard they do... I'd imagine that for some subspecialties (maybe not cards, heme/onc, etc.) the issues that show up are not that different.

 

[Pilot Doc]

Lots of things are possible.

My tough love answer is that you need to pick adults or kids. The idea of doing med/peds because you don't know what you want to do with your life is kind of absurd. One of the great challenges/tragedies of adulthood is that you can't do everything. You have to make choices that will forever close off certain experiences. You should put your energy into making the best of what you have chosen, not delaying the choice.

 

[mercaptovizadeh]

Lots of things are possible.

My tough love answer is that you need to pick adults or kids. The idea of doing med/peds because you don't know what you want to do with your life is kind of absurd. One of the great challenges/tragedies of adulthood is that you can't do everything. You have to make choices that will forever close off certain experiences. You should put your energy into making the best of what you have chosen, not delaying the choice.

So what are MD/PhDs?

Yeah, there's so many interesting things out there. I could really imagine myself doing so many fields of medicine (and outside of medicine, too). Sometimes it's hard to choose just one.

However, is it hard to find IM/peds jobs because there's no need for it? Do people have to negotiate separately with an IM group/department and a peds group/department?

 

[michaelrack]

A combined background can be helpful for certain specialties- I used to know a rheumatologist who treated both adults and kids. And a combined background would definitely be helpful in sleep medicine. Many of the sleep docs who are boarded through the ABIM do treat the occasional child. I do.

 

[smq123]

Do combined fellowships exist? I have heard they do... I'd imagine that for some subspecialties (maybe not cards, heme/onc, etc.) the issues that show up are not that different.

They do exist. There are some combined fellowships for many of the specialties, such as GI, cards, pulm, and ID.

If you're interested in subspecializing after med peds, this guide might be helpful:

http://www.medpeds.org/archive/PDF/FellowshipGuide.pdf

 

[oldbearprofessor]

will doing a combined IM/PED residency make me less competitive for fellowships (fellowship opportunities for IM graduates and fellowship opportunities for Peds graduates) as compared to an applicant applying for fellowship having solely done Internal Medicine or an Applicant applying for fellowship having solely done pediatrics?

With the caveats that 1)I can only address pediatric fellowships and 2) I'm not a fellowship director....

We have lots of folks in pedi fellowships who were med/peds. Sometimes it's because they want to work "at the interface" - this is especially common in endocrinology (lots of kids with Type II DM), but increasingly so in cards and some other areas. Sometimes they just decided they wanted to do a pedi fellowship. I've never heard of a pedi fellowship director who didn't want a med/peds person.

As far as pedi EM and neo, there are plenty of med/peds folks in these too. Yup, we have had multiple neo fellows who were med/peds. We just remind them that we don't run our IVs wide open or give an amp of bicarb.😛

So, although ambivalence may not be good, if you want to do med/peds, I do not believe it will limit you on the pedi specialty side. I can't comment about adult medicine specialties.

 

[dragonfly99]

I doubt that it would hurt you for cardiology.
In fact, it could be helpful if you want to specialize in congenital heart disease...it could be quite helpful.
There was a cards fellow @my residency program who had done med/peds at our institution...and one guy who did part of a med/peds residency and then switched to straight IM.

My question for you is do you really want to slog through an extra year of residency if you are going to subspecialize anyway? Cards is a long road as it is.

If your question is whether cards PD's will dislike you as an applicant due to having done med/peds and not straight up IM, I would doubt that...I'd say it would be neutral to positive as a factor in their decision. I worry more about you getting burnout via 4 years of residency prior to fellowship.

I haven't really heard of anyone doing a combined peds and adult cardiology fellowship...that doesn't mean it doesn't exist...I just haven't personally heard of it. The two are quite different, as adult cards deals with a lot of coronary dz and HTN and dyslipidemia, while pediatric cards mostly deals with congenital hrt dz, from what I know. There isn't as much overlap as you'd think between what we do and what pediatric cardiologists do.

 

[mercaptovizadeh]

I doubt that it would hurt you for cardiology.
In fact, it could be helpful if you want to specialize in congenital heart disease...it could be quite helpful.
There was a cards fellow @my residency program who had done med/peds at our institution...and one guy who did part of a med/peds residency and then switched to straight IM.

My question for you is do you really want to slog through an extra year of residency if you are going to subspecialize anyway? Cards is a long road as it is.

If your question is whether cards PD's will dislike you as an applicant due to having done med/peds and not straight up IM, I would doubt that...I'd say it would be neutral to positive as a factor in their decision. I worry more about you getting burnout via 4 years of residency prior to fellowship.

I haven't really heard of anyone doing a combined peds and adult cardiology fellowship...that doesn't mean it doesn't exist...I just haven't personally heard of it. The two are quite different, as adult cards deals with a lot of coronary dz and HTN and dyslipidemia, while pediatric cards mostly deals with congenital hrt dz, from what I know. There isn't as much overlap as you'd think between what we do and what pediatric cardiologists do.

I actually interviewed for med school with a lady who said she was going into IM/peds (first time I'd heard of it) and then wanted to do cards. She explained that because the pediatric treatment was a lot better, these congenital heart disease were surviving into adulthood and many adult cardiologists had barely seen these patients in their training.

But I agree that for some subspecialties it seems the types of pathologies are very different, cards being perhaps the best example. Rheum I've heard is very similar across the two, though. Perhaps endo and renal are not that different either.

Btw, does the 1 extra year of training really hurt that much? This career track is so long anyway that 1 extra year seems like not so horrible.

 

[49erfan]

I doubt that it would hurt you for cardiology.
In fact, it could be helpful if you want to specialize in congenital heart disease...it could be quite helpful.
There was a cards fellow @my residency program who had done med/peds at our institution...and one guy who did part of a med/peds residency and then switched to straight IM.

My question for you is do you really want to slog through an extra year of residency if you are going to subspecialize anyway? Cards is a long road as it is.

If your question is whether cards PD's will dislike you as an applicant due to having done med/peds and not straight up IM, I would doubt that...I'd say it would be neutral to positive as a factor in their decision. I worry more about you getting burnout via 4 years of residency prior to fellowship.

I haven't really heard of anyone doing a combined peds and adult cardiology fellowship...that doesn't mean it doesn't exist...I just haven't personally heard of it. The two are quite different, as adult cards deals with a lot of coronary dz and HTN and dyslipidemia, while pediatric cards mostly deals with congenital hrt dz, from what I know. There isn't as much overlap as you'd think between what we do and what pediatric cardiologists do.

I am interested in IM only, but am not sure whether I will be able to get a cards fellowship afterward, as I heard it is very difficult to get into this fellowship. Thus, my next choice is pediatric cardiology or neonatology which both appeal to me.

BUT adult cardiology is my clear first preference far far far far more than ped cardiology or neonatology... but it is the x factor about the uncertainty that I may not get into cards fellowship. The other IM fellowships dont really appeal to me and I rather prefer doing ped cardiology or neonatology over these other IM fellowships... this fear is what is leading me to possibly aim for IM/PED residency which would still allow me to apply for adult cardiology fellowship as well....

however, do you think this fear of not getting a adult cardiology fellowship is unreasonable? should i just take the chance and aim for a good IM program, expecting that I will get a cards fellowship?....

I have just heard all these horror stories about IM residents trying for years to get cards fellowship, and they simply cant (AMG's)..... and while ped's cardio or neonatology are not my top choices, I could see myself enjoying these specialities too and that's why I am looking into IM/Peds programs....

 

[gutonc]

I am interested in IM only, but am not sure whether I will be able to get a cards fellowship afterward, as I heard it is very difficult to get into this fellowship. Thus, my next choice is pediatric cardiology or neonatology which both appeal to me.

BUT adult cardiology is my clear first preference far far far far more than ped cardiology or neonatology... but it is the x factor about the uncertainty that I may not get into cards fellowship. The other IM fellowships dont really appeal to me and I rather prefer doing ped cardiology or neonatology over these other IM fellowships... this fear is what is leading me to possibly aim for IM/PED residency which would still allow me to apply for adult cardiology fellowship as well....

however, do you think this fear of not getting a adult cardiology fellowship is unreasonable? should i just take the chance and aim for a good IM program, expecting that I will get a cards fellowship?....

I have just heard all these horror stories about IM residents trying for years to get cards fellowship, and they simply cant (AMG's)..... and while ped's cardio or neonatology are not my top choices, I could see myself enjoying these specialities too and that's why I am looking into IM/Peds programs....

Your fear is not unreasonable but this is probably the worst reason I can think of to do Med/Peds. If you want to do this, you'll need to come up with a much better answer to this question.

 

[group_theory]

With very few exceptions (I'm personally only aware of one exception), people who specialize after Med/Peds do either an adult or a peds subspecialty. You won't be unique in that regard ...

I wouldn't say "with very few exceptions" based purely on anecdotal evidence.

Roughly half of Med-Peds graduates go into primary care practice, and of this group, between 77-93% provide care for both adults and children.

About 18-25% of Med-Peds graduates go into fellowship training, and of those who do fellowships, at least 50% of them take care of both adults and kids.

Source: Freed et al. Internal medicine-pediatrics physicians: their care of children versus care of adults. Academic Medicine. 2005;80:858-64


As for combined fellowships - there are combined programs available. But if a formal combined fellowship isn't available, a graduate can always negotiate with fellowship directors to create their own combined program.

Combined cardiology fellowships are available at:
Baylor College of Medicine
Columbia-Presbyterian
Duke
Ohio State
University Hospitals of Cleveland/Rainbows Babies and Children
University of Pittsburgh
University of Rochester (Preventive Cardiology fellowship)
University of Texas Houston
Vanderbilt


For more information about Med-Peds, you can visit the National Med-Peds Residents' Association's website at www.medpeds.org

 

[Pilot Doc]

If you do med peds you burn a year regardless compared to either alone. IM match is at the end of 2nd year. If you don't match cards, at that point you should either a) transfer to peds outright or b) parlay your med experience to date into med/peds.

Best case (and most likely) in that situation - you finish IM and get a cards fellowship
Mid case - you transfer into med/peds and take the same time (or close to) compared to current plan
Worst case - you do 2 IM + 3 peds and take a year longer than your current plan.

 

[NotAProgDirector]

If you do med peds you burn a year regardless compared to either alone. IM match is at the end of 2nd year. If you don't match cards, at that point you should either a) transfer to peds outright or b) parlay your med experience to date into med/peds.

Best case (and most likely) in that situation - you finish IM and get a cards fellowship
Mid case - you transfer into med/peds and take the same time (or close to) compared to current plan
Worst case - you do 2 IM + 3 peds and take a year longer than your current plan.

I'm not sure I follow.

If the OP starts in Medicine and then doesn't match in Cards, it's way too late to "transfer" into Med/Peds. To do med/peds you need start in PGY-1 with both continuity clinics. Plus, Cards match is the last week of June -- the PGY-3 IM schedule will already be made and contract signed.

If the OP starts in Med/Peds, and then tries to match in Cards in their PGY-2, that won't work either. if they decide to go straight med all of their peds time will no longer count towards ABIM certification. They will need to make it all up, and hence would not be able to start in Cards at the beginning of the PGY-4.

 

[Pilot Doc]

APD exposes my (bllssful) ignorance of continuity clinics. Apparently the sidestep into med peds plan isn't practical.

I wasn't suggesting a PGY2 application into cards from med/peds, though. My suggestion was that after a failed cards match you transfer to pediatrics alone. As APD has recently pointed out in another thread, signing a contract does not obligate you to complete the whole year.

Overall, I still think your plan for med/peds is entirely misplaced. If you can't accept the uncertainty inherent in adult cards, and peds cards is your 2nd choice, you should match into peds.