Med-Peds

[Dave1980]

Genuine question for those that considered it or went through it but what is the point of med-peds? Presumably at some point your practice has to gravitate to one field or the other and it seems you wouldn't be as well trained as those who chose either IM or peds.

I'm in rads so I'm not super familiar with clinical medicine anymore.

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[Crayola227]

Genuine question for those that considered it or went through it but what is the point of med-peds? Presumably at some point your practice has to gravitate to one field or the other and it seems you wouldn't be as well trained as those who chose either IM or peds.

I'm in rads so I'm not super familiar with clinical medicine anymore.

It's not that your practice has to gravitate to one or the other, it's that the training prepares you for niche populations and setting. It sets you up to be a peds hospitalist dealing with the sickest most complex kids with multiorgan failure, or it sets you up for kids who have aged out of developmental peds, ie all the kids with the extreme and rare conditions that you deal with while they're kids, but nowadays a lot of them are living longer and getting old enough to have "adult" diseases that need management in addition to their core issues.

An example would be older Down's syndrome patients. A lot of IM docs don't feel as comfortable inheriting some of these patients when they age out of peds. A lot of peds have stories of managing these patients until their late 20s and 30s. But if they develop say DM2, that isn't something general peds usually has a lot of in their training (although sadly that has been changing). Atherosclerotic heart disease would be another example where just gen peds might leave you short in managing older patients.

So it is fair to say the "point" of a med peds residency isn't for you to practice run of the mill peds, or run of the mill IM. There are a few patient populations that would allow you to draw on both.

I am not in med peds, but my best friend is a peds combined specialty and was in a program with med peds and we talked about the "point" of med peds in detail. Like a lot of subspecialties or combined programs, it isn't usually isn't a waste if you are seeing a certain type of patient.

Now, not everyone ends up having a practice that maximizes their training, but that's also true for a lot of things.

 

[Apollyon]

It's not that your practice has to gravitate to one or the other, it's that the training prepares you for niche populations and setting. It sets you up to be a peds hospitalist dealing with the sickest most complex kids with multiorgan failure, or it sets you up for kids who have aged out of developmental peds, ie all the kids with the extreme and rare conditions that you deal with while they're kids, but nowadays a lot of them are living longer and getting old enough to have "adult" diseases that need management in addition to their core issues.

An example would be older Down's syndrome patients. A lot of IM docs don't feel as comfortable inheriting some of these patients when they age out of peds. A lot of peds have stories of managing these patients until their late 20s and 30s. But if they develop say DM2, that isn't something general peds usually has a lot of in their training (although sadly that has been changing). Atherosclerotic heart disease would be another example where just gen peds might leave you short in managing older patients.

So it is fair to say the "point" of a med peds residency isn't for you to practice run of the mill peds, or run of the mill IM. There are a few patient populations that would allow you to draw on both.

I am not in med peds, but my best friend is a peds combined specialty and was in a program with med peds and we talked about the "point" of med peds in detail. Like a lot of subspecialties or combined programs, it isn't usually isn't a waste if you are seeing a certain type of patient.

Now, not everyone ends up having a practice that maximizes their training, but that's also true for a lot of things.

I asked one of the med/peds residents, when I was a resident, why he was doing it, and he said that he liked the congenital cardiology cases, and, with med/peds, and then a cards fellowship, he could see them into adulthood because, as you say, these folks are living longer.

On the flip side, especially at a really uber brainy academic place, ask the med/peds folks what is the difference between them and FM (and throw in a "they deliver babies, and, in some places, do appys and gall bags" for xtra lulz). They really like that.

 

[Gaborik10]

I've met a couple of attending's who are hospitalists for both IM and Peds. So I don't think it's true that you have to gravitate towards one or the other.

 

[TelemarketingEnigma]

As a student applying med peds this year, there seem to be a few main reasons I've heard from other med-peds folks:
- want to work with range of ages
- interest in things like transitional care, adult survivors of childhood disease, or adult illness in children (ie obesity, DM 2)
- because we're indecisive as heck, or just like having a very broad knowledge base with the flexibility to pursue a lot of career paths
- want to do something like global health where it helps to have broad skillset
- strong focus on advocacy/activism (I've gotten this vibe from a lot of straight peds folks as well, but it's definitely not as common on the straight IM side IMO)

as far as why not FM:
- don't wanna deliver babies
- more inpatient training
- much much more peds exposure

 

[Redpancreas]

Genuine question for those that considered it or went through it but what is the point of med-peds? Presumably at some point your practice has to gravitate to one field or the other and it seems you wouldn't be as well trained as those who chose either IM or peds.

I'm in rads so I'm not super familiar with clinical medicine anymore.

Great answers here. With the division of labor, everyone's leery of things like Med-Peds but basically the residencies teach medicine and pediatrics to the extent that residents are board certified in both and are able to practice to the top of their certification in both. It allows true versatility and is appealing to hospitals looking to find someone who can manage the pediatrics and adult floors.

 

[BigRedBeta]

Majority of Med/peds folks per their own professional association reporting actually do take care of both children and adults.

As a pediatrician (I'm a PICU attending), if I were put in charge of GME for a day, I'd immediately change all the FM residencies to Med/peds . The training quality IMO is generally significantly better...if nothing else it's certainly better in regards managing the breadth of pediatric disease. Also think it's a bit much to expect one to stay on top of current trends in 3 specialties like FM tries to.

When I was in academics, I told anyone looking at Med/peds that they needed to feel like they were going to have a hole in their professional soul if they never got to take care of another old person or a baby again to really be the right fit for combined training, that if one of the fields were "just nice to have", then they and their future patients would be better served by them going into just a single field.

There absolutely is a growing need for physicians to manage the growing population of patients aging out of children's hospitals. We as pediatricians have gotten significantly better at keeping these kids alive into adulthood that never used to and it's leading to a population with significant healthcare needs that I doubt are being adequately met. Not saying that's the only use for this training pathway, but it is a great landing spot. Trisomy 21, CF, congenital heard disease, and sickle cell are just a couple of pathologies that come to mind.

It allows true versatility and is appealing to hospitals looking to find someone who can manage the pediatrics and adult floors.

While this sounds like a great thing, I think the numbers of places looking to for this sort of thing are probably pretty small. Hospitals small enough to be using FM folks for inpatient management are probably too small to really have any peds beds given the intense regionalization of pediatric medicine. Larger places likely have already divided their patient populations and medical staffs in ways that would probably make the hiring process done in isolation (eg. the adult Hospitalist group needs to hire new staff, they aren't going to inquire if the peds hospital group is in a hiring phase). Maybe after a med/peds person has been hired, they might seek out the opposite group to provide coverage, but I think it's unlikely to be an a priori sort of decision.

 

[VA Hopeful Dr]

Majority of Med/peds folks per their own professional association reporting actually do take care of both children and adults.

As a pediatrician (I'm a PICU attending), if I were put in charge of GME for a day, I'd immediately change all the FM residencies to Med/peds . The training quality IMO is generally significantly better...if nothing else it's certainly better in regards managing the breadth of pediatric disease. Also think it's a bit much to expect one to stay on top of current trends in 3 specialties like FM tries to.

When I was in academics, I told anyone looking at Med/peds that they needed to feel like they were going to have a hole in their professional soul if they never got to take care of another old person or a baby again to really be the right fit for combined training, that if one of the fields were "just nice to have", then they and their future patients would be better served by them going into just a single field.

There absolutely is a growing need for physicians to manage the growing population of patients aging out of children's hospitals. We as pediatricians have gotten significantly better at keeping these kids alive into adulthood that never used to and it's leading to a population with significant healthcare needs that I doubt are being adequately met. Not saying that's the only use for this training pathway, but it is a great landing spot. Trisomy 21, CF, congenital heard disease, and sickle cell are just a couple of pathologies that come to mind.



While this sounds like a great thing, I think the numbers of places looking to for this sort of thing are probably pretty small. Hospitals small enough to be using FM folks for inpatient management are probably too small to really have any peds beds given the intense regionalization of pediatric medicine. Larger places likely have already divided their patient populations and medical staffs in ways that would probably make the hiring process done in isolation (eg. the adult Hospitalist group needs to hire new staff, they aren't going to inquire if the peds hospital group is in a hiring phase). Maybe after a med/peds person has been hired, they might seek out the opposite group to provide coverage, but I think it's unlikely to be an a priori sort of decision.

Hard pass.

One of the selling points of FM is the breadth. Yes, very few of us still do it all (though rurally its still fairly common) but it lets you tailor your practice to a greater extent. Plus, anecdotally at least, there are areas of peds/adult medicine that neither peds nor IM do especially well. Ortho being the obvious one with GYN a close second. Plus, a significant number of IM programs view outpatient as an afterthought at best with outpatient procedures being almost a dirty word.

Beyond that, I know of very few FPs who actually need to keep up on the same things that peds, IM, or OB do. FPs doing inpatient peds are quite rare so we don't really keep up with that (nor need to). My wife's IM boards had a shocking number of questions about specific chemotherapy regimens. Not just side effects of common chemo drugs, but "Which regimen would you use to treat Hodgkin's Lymphoma" type stuff. I've been out of residency 8 years this month and not knowing specific chemo regimens has never caused any problems. We also don't worry about obstetrical surgical techniques even if we do OB most of the time.

 

[BigRedBeta]

Hard pass.

One of the selling points of FM is the breadth. Yes, very few of us still do it all (though rurally its still fairly common) but it lets you tailor your practice to a greater extent. Plus, anecdotally at least, there are areas of peds/adult medicine that neither peds nor IM do especially well. Ortho being the obvious one with GYN a close second. Plus, a significant number of IM programs view outpatient as an afterthought at best with outpatient procedures being almost a dirty word.

Beyond that, I know of very few FPs who actually need to keep up on the same things that peds, IM, or OB do. FPs doing inpatient peds are quite rare so we don't really keep up with that (nor need to). My wife's IM boards had a shocking number of questions about specific chemotherapy regimens. Not just side effects of common chemo drugs, but "Which regimen would you use to treat Hodgkin's Lymphoma" type stuff. I've been out of residency 8 years this month and not knowing specific chemo regimens has never caused any problems. We also don't worry about obstetrical surgical techniques even if we do OB most of the time.

Fair points. It certainly would not be a decision made without some downstream effects.

I've spent a fair amount of time in small town Nebraska and mid-sized cities in Indiana and Arkansas, all of which leads me to the conclusion that while coverage for GYN and Ortho may not be ideal in rural locations, in places where people are used to traveling to regional hubs, (and specialists spend a fair amount of time going to smaller hospitals in the area) there's generally adequate access to clinical expertise. The hard part is that those things that IM and peds do poorly isn't guaranteed to be done well in FM training right now. There are obviously some really wonderful unopposed FM programs that provide absolutely stellar training and then there are programs at major medical centers that never get their residents out into situations where they aren't overrun by residents in other programs - especially OB/GYN. Where I did residency, it was a super common occurrence for FM continuity clinic patients to transfer to the OB resident clinic the minute they got pregnant. Part of that was problems with central scheduling not knowing where to send the patient, part of that was patient preference, but the FM residents complained about it all the time.

Obviously board exams are not a real measuring stick of what constitutes new evidence worth knowing. Believe me, peds boards asks ridiculous questions about genetic diagnoses, what temperature to store certain vaccines, and the infamous developmental milestones questions but instead of the answer choices being 3,6,9, or12 months old like on the Peds shelf exams and instead are 4, 5, 6, or 7 months. None of which represents real world clinical practice (at least in the way the questions get presented - the development questions are always "how old is this baby?" not "is this baby delayed enough to be referred to therapy/specialist")