Duke1K

5+ Year Member
Mar 2, 2015
43
10
Status
Medical Student
I'm a current med student on rotations right now. From my (limited) experience, the med-peds residents/attendings at my school are some of the best clinicians and teachers around. As a group, they have incredible bedside manner and excellent judgment, and I strive to emulate their practice as much as I can.

Question: how compatible is med-peds with lab research? I know many residency programs prefer med-peds residents to go into primary care, but I have a strong research bent and know 100% that I want to do academic medicine with protected research time. Scientifically, I'm interested in blood-borne cancers and, after a hemonc fellowship, could envision a career around adult/child leukemias. Alternatively, I could stick with basic science and become a med-peds hospitalist.

Clinically, I really just love taking care of very sick people. I'd probably consider pulm/cc if it were more compatible with bench research, and I'd probably do family med if I didn't hate outpatient so much.

My only other real considerations are time (if doing med-peds+fellowship is all that necessary v. just IM+fellowship), and whether or not med-peds is something value-added for society. I don't want to do med-peds just because I'm interested; I'd want to fill a particular unmet need in medicine.

I'd appreciate any thoughts. Thanks in advance!
 

andrek82

7+ Year Member
May 11, 2012
134
91
New York
Status
Resident [Any Field]
I'm a current med student on rotations right now. From my (limited) experience, the med-peds residents/attendings at my school are some of the best clinicians and teachers around. As a group, they have incredible bedside manner and excellent judgment, and I strive to emulate their practice as much as I can.

Question: how compatible is med-peds with lab research? I know many residency programs prefer med-peds residents to go into primary care, but I have a strong research bent and know 100% that I want to do academic medicine with protected research time. Scientifically, I'm interested in blood-borne cancers and, after a hemonc fellowship, could envision a career around adult/child leukemias. Alternatively, I could stick with basic science and become a med-peds hospitalist.

Clinically, I really just love taking care of very sick people. I'd probably consider pulm/cc if it were more compatible with bench research, and I'd probably do family med if I didn't hate outpatient so much.

My only other real considerations are time (if doing med-peds+fellowship is all that necessary v. just IM+fellowship), and whether or not med-peds is something value-added for society. I don't want to do med-peds just because I'm interested; I'd want to fill a particular unmet need in medicine.

I'd appreciate any thoughts. Thanks in advance!
It sounds like you have some great reasons for med-peds. I would disagree about the primary care focus. There certainly are programs who will only take students who want to go into primary care (Hopkins for one), but close to half of residents go on to fellowship as I recall.

One thing you might want to look into is transitional medicine. Christiana has a program, as do others. Some of the more outspoken PDs think it is a particular niche for med-peds. Basically it follows kids with either chronic or acute but devastating childhood disease as they get older. Hiv, leukemias and other childhood cancers, cystic fibrosis, and sickle cell are just a few examples. As you can see, hem onc would be quite useful.

As far as research goes, there are quite a few solid academic programs with extensive basic and clinical research opportunities. The only caveat with med-peds is that you have less elective time for a basic science project, just because you are fitting everything into 4 years. I did ask that question on my own interviews, and most places had examples of residents doing heavy duty basic science research.
 
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NMPRA Director

National Med-Peds Residents' Association
Jul 29, 2015
15
15
Status
Resident [Any Field]
Thanks for your question! I agree with the above in that residency programs don't pressure/encourage you to pursue one specialty over another. If you're interested in primary care, great, if not programs are good about supporting you in whatever it is that you imagine yourself doing. That is the beauty of the Med-Peds residency. There are many people who go into Med-Peds with MD/PhD and a strong basic science background. That being said, there really is limited time during residency to do basic science research unfortunately. However there are many people who then go on to specialize in Hem/onc or other subspecialties and then return to the lab for research. There are many options to pursue what it is that you're interested in. You just have to ask.
 
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URHere

10+ Year Member
Nov 20, 2007
1,783
567
Status
Attending Physician
Most physicians with strong research interests complete the bulk of their research work during fellowship rather than residency. As a Med-Peds trainee, you will have the option to apply to any fellowship you choose in either IM or Peds (or a combined fellowship, if you so desire), and about 1/3 of the graduates from Med-Peds programs take the fellowship route after graduation.

It is true that you will have much less elective time to pursue research during your residency itself. Based on my experience on the interview trail, 4 months is about the max you would have spread over 4 years, and because those months are non-contiguous, it would be very difficult to get any substantial basic science work done. However, some programs are willing to work with you more than others. I applied Med-Peds this year as an MD/PhD who made it very clear that I was interested in continuing to develop my research career. Overall, I had 2 programs bend over backwards to help me find basic science research mentors, 1 program where the PD (who was also an MD/PhD) invited me to continue my PhD research as a free agent in her lab, 2 programs where the PDs explicitly told me that they did not approve of their residents doing research, and the overwhelming majority where the PDs discussed less time-intensive ways to get good research experience (international research electives, chart review projects, clinical trials at nearby vaccine centers, etc). All programs mentioned that it was very rare for students to conduct basic science research during residency, but most could give examples of at least 2-3 past residents who had made it work.

Also, FWIW, many of the successful clinician scientists I know are actually pulm/cc docs. Although you wouldn't expect it, the ability to leave work at very predictable times (e.g. when the night or day attending arrives) coupled with the ability to have long stretches of "off" time actually makes cc quite research friendly.
 
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Duke1K

5+ Year Member
Mar 2, 2015
43
10
Status
Medical Student
Thank you all for taking the time to respond.

I find that it's difficult for me to answer the "why med-peds" question in light of my research interests. The argument against med-peds is often, why would you spend an additional year during residency+fellowship when 1.) you will spend most of your time doing research in the future 2.) med-peds is one less year in which you could be contributing to the field 3.) many med-peds docs eventually do one or the other anyway.

My response is that I do want to be treating both adults and children, on diseases/disease processes I'm interested in clinically and scientifically, but maybe this is a naive way of looking at things...What is the reality of the med-peds practice? Will I be able to carve a career involving both, in addition to having a productive scientific career - or do most doctors end up choosing medicine, or pediatrics, or science only, without much added benefit of the additional training?
 

andrek82

7+ Year Member
May 11, 2012
134
91
New York
Status
Resident [Any Field]
Just a quick response to #3: http://www.amjmed.com/article/S0002-9343(15)00819-0/pdf

Something like 92% of respondents to a survey of Med-Peds physicians reported song some proportion of both adults and peds.

The ID group at my school has a couple of med-peds folks who do clinical research on top of HIV primary care and ID consults on the hospital. They also do global health. Another doc does clinical trials and med-peds endo. There is a balance to be found between research and clinical medicine, but that is going to be an issue in every specialty.
 

mercaptovizadeh

ἐδάκρυσεν ὁ Ἰησοῦς
15+ Year Member
Oct 16, 2004
6,895
2,052
I'm a current med student on rotations right now. From my (limited) experience, the med-peds residents/attendings at my school are some of the best clinicians and teachers around. As a group, they have incredible bedside manner and excellent judgment, and I strive to emulate their practice as much as I can.

Question: how compatible is med-peds with lab research? I know many residency programs prefer med-peds residents to go into primary care, but I have a strong research bent and know 100% that I want to do academic medicine with protected research time. Scientifically, I'm interested in blood-borne cancers and, after a hemonc fellowship, could envision a career around adult/child leukemias. Alternatively, I could stick with basic science and become a med-peds hospitalist.

Clinically, I really just love taking care of very sick people. I'd probably consider pulm/cc if it were more compatible with bench research, and I'd probably do family med if I didn't hate outpatient so much.

My only other real considerations are time (if doing med-peds+fellowship is all that necessary v. just IM+fellowship), and whether or not med-peds is something value-added for society. I don't want to do med-peds just because I'm interested; I'd want to fill a particular unmet need in medicine.

I'd appreciate any thoughts. Thanks in advance!
Med-peds physicians are great clinicians, I agree. It's not exactly a residency that caters to researchers in that you can't fast-track and most programs either want you to do primary care (ie Johns Hopkins) or want you to be the best all around general pediatrician and general internist that you can be (most of the programs, by the way). That said, you can really make of it whatever you want to, and there are plenty who have ended up becoming heavily researchers (basic or clinical). I came from a heavily research background and found that my research background would probably take me further in applying to categorical medicine residencies, while it certainly was not a detraction for med-peds, it was also not as stimulating for conversation with most PDs as are leadership and service projects (which are probably more familiar to most of them). I felt like a PhD was seen as not much more than someone who worked on a health literacy project for 6 months. By all means apply to med-peds, I do enjoy having both sets of training, but work on your clinical application just as much as on the research, because things like AOA and getting honors in medicine and in pediatrics clerkships matters more than your entire PhD.
 

Duke1K

5+ Year Member
Mar 2, 2015
43
10
Status
Medical Student
Med-peds physicians are great clinicians, I agree. It's not exactly a residency that caters to researchers in that you can't fast-track and most programs either want you to do primary care (ie Johns Hopkins) or want you to be the best all around general pediatrician and general internist that you can be (most of the programs, by the way). That said, you can really make of it whatever you want to, and there are plenty who have ended up becoming heavily researchers (basic or clinical). I came from a heavily research background and found that my research background would probably take me further in applying to categorical medicine residencies, while it certainly was not a detraction for med-peds, it was also not as stimulating for conversation with most PDs as are leadership and service projects (which are probably more familiar to most of them). I felt like a PhD was seen as not much more than someone who worked on a health literacy project for 6 months. By all means apply to med-peds, I do enjoy having both sets of training, but work on your clinical application just as much as on the research, because things like AOA and getting honors in medicine and in pediatrics clerkships matters more than your entire PhD.
Thanks for the note - I'd really appreciate your insight on this.

I don't have a PhD; I decided not to do MSTP for a variety of different reasons. I'm fortunate in that leadership, service, and grades won't be an issue for me. If my ultimate aim is to be 80% research, 20% clinical, will the med-peds residency+hemonc hurt me in the long-run in getting K awards/faculty positions relative to fast-tracking hemonc? I'm assuming that for my goals, more research time is always better than more clinical. Was the med-peds route worth it for you?

Maybe I'm just scared of being a poor clinician when I start focusing more of my time on research. Of course, I'm not going to be as good as anyone doing 100% clinical, but I hope doing med-peds will give me the training necessary to stave off my eroding clinical skills.
 

mercaptovizadeh

ἐδάκρυσεν ὁ Ἰησοῦς
15+ Year Member
Oct 16, 2004
6,895
2,052
Thanks for the note - I'd really appreciate your insight on this.

I don't have a PhD; I decided not to do MSTP for a variety of different reasons. I'm fortunate in that leadership, service, and grades won't be an issue for me. If my ultimate aim is to be 80% research, 20% clinical, will the med-peds residency+hemonc hurt me in the long-run in getting K awards/faculty positions relative to fast-tracking hemonc? I'm assuming that for my goals, more research time is always better than more clinical. Was the med-peds route worth it for you?

Maybe I'm just scared of being a poor clinician when I start focusing more of my time on research. Of course, I'm not going to be as good as anyone doing 100% clinical, but I hope doing med-peds will give me the training necessary to stave off my eroding clinical skills.
It will not hurt you at all. That said, if you do heme-onc, it would likely be adult only. It is hard to do a combined fellowship since the diseases are quite different (mechanistically, types, prognostically, etc.). Unlike a field like endocrinology or rheumatology where there are much stronger similarities between adults and children. For K award/faculty positions, they care about your research and publication record, which will be based on fellowship and/or post-doc(s) after residency or fellowship.

Nobody will care whether it's straight internal medicine or straight pediatrics or med-peds because these are clinical training programs that have very little to do with your ability to do cancer genetics research or immunotherapeutic vaccines research. Believe it or not, there is very little you get from having experience with NICU babies, the (adult) CCU, adult renal consults, pediatric autism clinic, etc. that will help or inform your research on sarcomas or leukemias.

In terms of becoming a good clinician, you can do that in internal medicine or in med-peds. I do think most pediatricians come out weaker as clinicians than internists or med-peds because there is a very high degree of anxiety and caution around children within the culture of pediatrics which leads to deferred responsibilities (fellows are doing things in pediatrics that analogously IM residents would be doing; subspecialty attendings are doing things in pediatrics that analogously IM subspecialty fellows would be doing, etc.).

If you spend 80% of your time in lab, your clinical skills will definitely erode. That is why the usual wisdom is to do fellowship and then subspecialize ad nauseum until ideally you only see a handful of diseases in clinic and are a national or international expert. The thought being that only if your scope of practice is so restricted will you be able to maintain top notch skills while 80+% of your time is in lab, whereas trying to do something like general IM hospitalist medicine or even inpatient hematology consults, would be very hard to do really well when you don't have adequate time to be on the wards and read the papers. I disagree, and think it's absurd to train for 6+ years to then only treat GI stromal tumors and nothing else (might as well become a PA or NP and just do that, and after a few years you'd probably know the same about that narrow subject as the overtrained MD), but that's just me.

More personally, for me, med-peds was worth it because I did not want to stop treating children, and couldn't imagine not treating adults either, so it seemed like a good fit. I liked having that knowledge base and comfort around so many different kinds of patients. I also have thought about doing international missions medicine, so having familiarity with both adults and kids (and, moreover, the experience with acute/urgent care, emergencies, intensive care unit and ward medicine that happens in med-peds training but not family medicine) was a plus. Whether I'll work in a missions hospital in the future, I don't know, but certainly there was some contingency in place when I pursued this career path.
 
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