Probably different ways of viewing this. Depends on whether your focus is primary care or academia. Then, you could put first those programs with greatest history and integration (e.g. URMC, UNC). Then, you could just take the separate IM and peds reputations and average them, so that there are some places with really strong medicine and less famous peds (e.g. Duke) or really strong peds and less famous medicine (e.g. Cincinnati), along with places that are really outstanding at both separately (e.g. the Penn-CHOP and BWH-CHB).