NRAI2001

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If you re interested in possibly just doing a general practice after IM would you still believe IM is the best route to go? Would FP or a combined Med/Peds possibly be better options? I originally thought I would definitely specialize but sometimes I wonder if primary care maybe an option I may enjoy?

So if someone is interested in doing a general practice what are the benefits and disadvantages of the three options:

1)Med/Peds
2)FP
3)Primary care IM

Obviously IM can only see adults but even for FP and Med/Peds i think the majority of your patients will be adults?

Please help I must rank next week. I m ranking Med/Peds programs and general IM programs... didnt apply to FP, mainly because I was interested in the fellowship options but lately I think I would just like to be a general physician (but who knows about the future)..

Thanks :thumbup::thumbup:
 

Instatewaiter

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If you re interested in possibly just doing a general practice after IM would you still believe IM is the best route to go? Would FP or a combined Med/Peds possibly be better options? I originally thought I would definitely specialize but sometimes I wonder if primary care maybe an option I may enjoy?

So if someone is interested in doing a general practice what are the benefits and disadvantages of the three options:

1)Med/Peds
2)FP
3)Primary care IM

Obviously IM can only see adults but even for FP and Med/Peds i think the majority of your patients will be adults?

Please help I must rank next week. I m ranking Med/Peds programs and general IM programs... didnt apply to FP, mainly because I was interested in the fellowship options but lately I think I would just like to be a general physician (but who knows about the future)..

Thanks :thumbup::thumbup:
FM-
Pros/cons- see a wide variety of stuff (OB, peds, mediciney stuff) but it is mainly outpatient. You can't really specialize much if you choose to specialize. For instance, one of the posters on here did FM residency and then decided he wanted to do Pulm/Critical Care and had to start an IM residency. You are a master of none.

IM- much more training in hospital medicine than FM. You learn to take care of more complex and sicker patients. The outpatient training is very variable though. For instance, at my program it is incredibly lacking... of course very few people actually do general med at my program. A pro is that you have a wide variety of specialty options.

Med/Peds- like the hospital version of FM. Good because it gets you broadish training but bad because very few people actually do both, so realistically either the medicine or peds training was a waste of your time. In my experience, these people are almost universally weird.

So in the end, if you want to be a generalist outpatient doctor- I'd say FM

If you want to be an IM hospitalist or specialize- IM

Realistically I don't think Meds/peds is a good option for basically anything. Others of course will differ with me.
 
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well bro I'm not going to tell you anything you likely already don't know, but imo for someone in your situation it's pretty easy... if you want to deal with children rank med/peds higher and if not then IM. Med/peds is 5 years and if you don't even want to treat children then don't bother.

Now if your goal is to work in more under-served/rural areas med/peds would be an advantage both for outpatient and hospitalist type general work. The other advantage to general med/peds is that you literally could follow your patients their entire lives which is pretty cool. IMO if your goal is to specialize then it is best to either go straight IM or peds because as a specialist you can essentially only do adults or kids and not both so those extra 2 years are not helpful. Also as you know in well-served areas most "med/peds" trained physicians choose to mainly practice one or the other, again making those extra 2 years pretty useless.
 
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I agree with the above. I am also in a similar boat...you can also apply for IM-Primary Care Tracks.

Also...disagree about Med-Peds being usless. If you eventually want to do an outpatient specialty that sees kids and adults, such as Allergy, you will benefit greatly by doing Med-Peds.
 
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NRAI2001

NRAI2001

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well bro I'm not going to tell you anything you likely already don't know, but imo for someone in your situation it's pretty easy... if you want to deal with children rank med/peds higher and if not then IM. Med/peds is 5 years and if you don't even want to treat children then don't bother.

Now if your goal is to work in more under-served/rural areas med/peds would be an advantage both for outpatient and hospitalist type general work. The other advantage to general med/peds is that you literally could follow your patients their entire lives which is pretty cool. IMO if your goal is to specialize then it is best to either go straight IM or peds because as a specialist you can essentially only do adults or kids and not both so those extra 2 years are not helpful. Also as you know in well-served areas most "med/peds" trained physicians choose to mainly practice one or the other, again making those extra 2 years pretty useless.
Thanks for the reply, you have good points and its a tuff decision. I think I m leaning towards the med/peds programs. The residents at the programs I interviewed at were just so nice and seemed very very happy with the programs... I just dont know I guess because it seems like even if you do med/peds you end up seeing like 80% adults in your practice.. even the med/peds attending said that...

Med/peds is a 4 year program.. not 5.:thumbup:
 

group_theory

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You also posted in the Combined Residency Forum so I'll try to answer your general question in that forum. I just wanted to correct a few inaccuracies in this thread

FM-
Med/Peds- like the hospital version of FM. Good because it gets you broadish training but bad because very few people actually do both, so realistically either the medicine or peds training was a waste of your time. In my experience, these people are almost universally weird.

...

Realistically I don't think Meds/peds is a good option for basically anything. Others of course will differ with me.
Med-Peds - you're treated like a categorical resident when you're on Medicine, and a categorical resident when you're on Pediatrics. I took both the ABIM and ABP - there is no special board certification for Med-Peds. I'm boarded by the same boards that medicine residents have to take and the pediatric residents have to take. (A study in 1999 shows that 81.6% of Med-Peds graduates are double boarded). When I ran the MICU as a senior resident, I'm treated no differently and expectation was the same as a medicine resident. Same for PICU. Same for medicine wards or pediatrics wards. Only difference was continuity clinic - we had our own clinic (instead of medicine clinic or peds clinic) where we saw both.

Med-Peds has been around for 40+ years, and there are close to a hundred program nationwide.

In regards to your statement that Med-Peds always go into one or another, from an article in 1999, only 4% of the respondents reported that they saw no children younger than 10 years, whereas 6% reported that they saw no adults older than 60 years. Only 1% of physicians reported that 91% to 100% of their practice consisted of children younger than 10 years, and only 1% reported that 71% to 80% of their patients were adults older than 60 years. (1)

Approximately 20-25% of Med-Peds graduates pursue subspecialty training in either pediatrics, internal medicine or both (2). In 2007, 55% of Med-Peds graduates were pursing primary care practice, 18% subspecialty training, 17% hospital medicine, and 10% other careers (3).

Starting in 2000, the National Ambulatory Medical Care Survey began separately identifying Med-Peds physicians within their survey. This data showed that 43% of visits of Med-Peds physicians surveyed were by children 18 years or younger. Compared to family physicians, Med-Peds physicians had a higher proportion of infants and toddlers < 2 years of age (20.5% vs. 3.8%; P < 0.001) and from children < 18 years of age (42.8% vs. 15.6%; P < 0.001). When compared with internists, Med-Peds physicians saw a greater percentage of visits from adults 19-64 years of age (80.2% vs. 60.1%; P<0.01) and proportionately fewer patients age 65 or older (19.8% vs. 39.9%; P<0.01). (4)

1. Lannon CM, Oliver TK, Jr, Guerin RO, Day SC, Tunnessen WW., Jr Internal medicine–pediatrics combined residency graduates: what are they doing now? Results of a survey. Arch Pediatr Adolesc Med. 1999;153(8):823–828

2. Meglar T, Chamberlain JK, Cull WL, Kaelber DC, and Kan BD. Training Experiences of Combined Internal Medicine-Pediatric Residents. Academic Medicine. 2006:81:440-446.

3. Chamberlain J, Cull W, Melgar T, Kaelber D, Kan B. The effect of dual training in internal medicine and pediatrics on the career path and job search experience of pediatric graduates. J Pediatrics. 2007, 151:419-24.

4. Fortuna RJ, Ting DY, Kaelber DC, Simon SR. Characteristics of Medicine-Pediatrics Practices: Results from the National Ambulatory Medical Care Survey. Academic Medicine. 2009 Mar;84(3):396-401

well bro I'm not going to tell you anything you likely already don't know, but imo for someone in your situation it's pretty easy... if you want to deal with children rank med/peds higher and if not then IM. Med/peds is 5 years and if you don't even want to treat children then don't bother.

Now if your goal is to work in more under-served/rural areas med/peds would be an advantage both for outpatient and hospitalist type general work. The other advantage to general med/peds is that you literally could follow your patients their entire lives which is pretty cool. IMO if your goal is to specialize then it is best to either go straight IM or peds because as a specialist you can essentially only do adults or kids and not both so those extra 2 years are not helpful. Also as you know in well-served areas most "med/peds" trained physicians choose to mainly practice one or the other, again making those extra 2 years pretty useless.
First, Med-Peds is 4 years, not 5 years. Second, your assertion that 'most "med/peds" trained physicians choose to mainly practice one or the other, again making those extra 2 years pretty useless' is incorrect, as stated above. Fellowships can get tricky - you can do a medicine fellowship, a pediatrics fellowship, a combined fellowship (adult/peds), or even allergy/immunology. Really depends on what you want to do for the rest of your life, and what type of patients you want to see (adult congenital heart, transition care, adult-pediatric endocrinology, genetics/metabolic specialists, cystic fibrosis, adolescent medicine, etc). For fellowships, Med-Peds definitely offers more opportunities/choices.