MedPeds future?

[amherejusttoobserve]

What are the options after medpeds residency?

IM hospitalists? or do we get to do both for the same salary or more?


[edit: thank you guys for replying to this thread, so many useful insight and perspective on the topic]

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[DrMetal]

What are the options after medpeds residency?

Well, you have the entire scope of general internal medicine and general pediatrics as your options, go nuts.

 

[amherejusttoobserve]

Well, you have the entire scope of general internal medicine and general pediatrics as your options, go nuts.

is it worth the extra one year? if i dont plan to do any fellowships

 

[gutonc]

is it worth the extra one year? if i dont plan to do any fellowships

What do you plan to do? If you want a “full spectrum” primary care practice but don’t want to have to do OB, then go for it I guess. If you’re already thinking about being a hospitalist or doing primarily adult or peds outpatient, then just choose now.

 

[DrMetal]

is it worth the extra one year? if i dont plan to do any fellowships

In my opinion? No, not worth it. But I also think that combined residencies are a bad idea, in general. Medicine is a large universe, each specialty it's own planet. To try to simultaneously play in two different planets creates a wide scope for error. Better to pick one specialty, pediatrics or adult medicine, and go with it. I guess you can try to be a great pediatrician and an internist at the same time, if you want, but at some point you may also want to have a life.

 

[xoggyux]

Though at some point in the past I thought it would be neat and "efficient" getting a whole second full board certification for a relatively modest investment now I think that was mostly my "achievement *****" in overdrive. I am sure a handful of people could justify having both specializations at once, but in the real world, I struggle to think of many useful applications of this other than very limited niche options.

 

[wamcp]

Anyone else have noticed the IM/EM trained folks are always the sharpest and most knowledgeable of all the generalists?
At least when it comes to acute care.
I have the most respect for those guys.

 

[eimaise]

What are the options after medpeds residency?

IM hospitalists? or do we get to do both for the same salary or more?

You have lots of options. I am med-peds trained and currently practicing 50% as a med-peds hospitalist (take care of newborn infants, children and adults simultaneously in a community hospital) and 50% as an outpatient primary care doc seeing infants to the elderly in the office. I am in a large institution with a medical school but my job is non-academic. I would say med-peds is a good fit for someone who wants lots of career flexibility. Many of us don't know precisely what we want to do after residency, so med-peds gives us great flexibility during that time. I was planning on doing a critical care fellowship for a lot of residency and then decided later on to do what I am currently doing. Most of us don't want to worry about OB or surgical things in our practice which is why we did not do FM training. We also wanted the ability to specialize further if we wanted which FM doesn't really enable you to do as much. I had residency colleagues go into combined med-peds rheum, combined med-peds ID, combined med-peds critical care, etc. There's lots of niches and it's a great field. You just really need to know what you're getting into. You have to really like both fields otherwise the 4 year training program will just frustrate you. Some people realize part way through they only want to practice one side or the other so they switch to the categorical program or they just don't pursue board certification on that side when they finish. One of my classmates is doing only outpatient pediatrics by her choice. One of my classmates is doing adult pulm-ccm fellowship right now.

Regarding your salary question -- med-peds hospitalist jobs are few and far between outside of academics. They won't likely pay significantly more and I actually know of plenty of adult hospitalist jobs that pay significantly more than combined hospitalist jobs. Personally, I wanted to do both so I accepted a job that paid me 75k/year less in order to enable me to do what I really wanted. If you do outpatient only, you will likely make similar amounts to what family medicine docs or other primary care docs make in general. Of course, this is highly variable depending on practice location, academic vs private, partnership track, etc.

 

[DrSnips]

I am a hospitalist at a major academic center; we do have one med-peds hospitalist among us. She does 50% IM wards and 50% peds wards, so she's employed 0.5 FTE by each division. I think the only reason to do what she does would be if you seriously love all 3 IM, peds and teaching.

 

[Suprep]

Anyone else have noticed the IM/EM trained folks are always the sharpest and most knowledgeable of all the generalists?
At least when it comes to acute care.
I have the most respect for those guys.

is it worth doing EM/IM if the primary work place is almost always EM in most cases? Jus do EM in that case. If interested in acute care, do IM plus two year critical care and work as intensivist.

 

[gutonc]

is it worth doing EM/IM if the primary work place is almost always EM in most cases? Jus do EM in that case. If interested in acute care, do IM plus two year critical care and work as intensivist.

Still 5 years. Have to decide where you want to do your acute care. Downstairs or upstairs.

 

[eimaise]

Anyone else have noticed the IM/EM trained folks are always the sharpest and most knowledgeable of all the generalists?
At least when it comes to acute care.
I have the most respect for those guys.

is it worth doing EM/IM if the primary work place is almost always EM in most cases? Jus do EM in that case. If interested in acute care, do IM plus two year critical care and work as intensivist.

There was an EM/IM program where I did my residency and pretty much all of them (2 residents per year) funneled themselves into the 1 year critical care medicine fellowship at our institution to become triple boarded. Afterwards, the vast majority of them (>95%) practiced either CCM alone or a 50/50 mix of CCM/EM. I don't know a single one that did hospitalist as a part of their job. I think most of them viewed the IM component as key training to learn how to think like an inpatient doc for their future CCM practice. My personal experience was there was a big difference between the EM/IM residents and the EM residents during MICU service months. The EM residents (even those interested in CCM) hated thinking about long-term medical management, dispo, tube feeding regimens, etc whereas it was second nature to the EM/IM residents.

 

[IMreshopeful]

There was an EM/IM program where I did my residency and pretty much all of them (2 residents per year) funneled themselves into the 1 year critical care medicine fellowship at our institution to become triple boarded. Afterwards, the vast majority of them (>95%) practiced either CCM alone or a 50/50 mix of CCM/EM. I don't know a single one that did hospitalist as a part of their job. I think most of them viewed the IM component as key training to learn how to think like an inpatient doc for their future CCM practice. My personal experience was there was a big difference between the EM/IM residents and the EM residents during MICU service months. The EM residents (even those interested in CCM) hated thinking about long-term medical management, dispo, tube feeding regimens, etc whereas it was second nature to the EM/IM residents.

I know two EM IM docs from my residency who ended up as hospitalists. Another one did a more outpatient fellowship and I met another one who did a pulm/crit fellowship (not simply CC).

They do tend to be stronger residents in general. However, it varies, and some are clearly much more comfortable in the EM realm and vice versa. It’s more self selecting than IM perhaps which tends to have a wide diversity of personalities, but still fairly diverse.

With regards to OPs original question - I think Med Peds as a specialty works best for those who either want to practice both in the outpatient or hospital setting OR do a specialty which is heavily favored by having a Med Peds background. Most common one I can think of is Allergy/Immunology. However that being said I know residents who have stayed purely adult and done adult fellowships and vice versa. One person I know did adult cardiology and then adult congenital fellowship; another I know of did Peds heme onc with intention to specialize in seeing adults with childhood malignancies. Etc

You can always find your niche if you’re flexible on where and how you want to practice

 

[IMreshopeful]

is it worth doing EM/IM if the primary work place is almost always EM in most cases? Jus do EM in that case. If interested in acute care, do IM plus two year critical care and work as intensivist.

Might be any number of reasons. Some can’t decide exactly what they want to do between the two specialties. Some like the inpatient or outpatient IM focus

 

[jdh71]

There was an EM/IM program where I did my residency and pretty much all of them (2 residents per year) funneled themselves into the 1 year critical care medicine fellowship at our institution to become triple boarded. Afterwards, the vast majority of them (>95%) practiced either CCM alone or a 50/50 mix of CCM/EM. I don't know a single one that did hospitalist as a part of their job. I think most of them viewed the IM component as key training to learn how to think like an inpatient doc for their future CCM practice. My personal experience was there was a big difference between the EM/IM residents and the EM residents during MICU service months. The EM residents (even those interested in CCM) hated thinking about long-term medical management, dispo, tube feeding regimens, etc whereas it was second nature to the EM/IM residents.

You can’t get “triple boarded” with only a year of critical care from EM/IM. You need two years of fellowship.

 

[jdh71]

is it worth the extra one year? if i dont plan to do any fellowships

Yes. It’s just ONE year. You can practice two hospitalist specialties at a time without being bad at both.

 

[aafisahar]

Yes. It’s just ONE year. You can practice two hospitalist specialties at a time without being bad at both.

1 year is 250k opportunity cost.

 

[jdh71]

1 year is 250k opportunity cost.

So?

If it is what you want to to do, it is worth it.

 

[inspirationmd]

You can’t get “triple boarded” with only a year of critical care from EM/IM. You need two years of fellowship.

Internal, Emergency, & Critical Care Med Training | ABIM.org

Physicians can obtain triple certification in Internal Medicine, Emergency Medicine and Critical Care Medicine by completing a 6 year combined training program.

www.abim.org

Yes you can. 5 institutions currently allow you to do all 3 in six years. The requirements for each specialty are reduced to take advantage of the synergistic components of each specialty.

 

[jdh71]

Internal, Emergency, & Critical Care Med Training | ABIM.org

Physicians can obtain triple certification in Internal Medicine, Emergency Medicine and Critical Care Medicine by completing a 6 year combined training program.

www.abim.org

Yes you can. 5 institutions currently allow you to do all 3 in six years. The requirements for each specialty are reduced to take advantage of the synergistic components of each specialty.

That’s not a fellowship though. It’s a unique residency.

 

[amherejusttoobserve]

1 year is 250k opportunity cost.

whats the typical starting salary though for medpeds? same as im hospitalist?

 

[wamcp]

1 year is 250k opportunity cost.

Technically ~500k opportunity cost for a year, if you work 70h/wk as a fellow vs 70h/wk of hospitalist moonlighting

 

[eimaise]

That’s not a fellowship though. It’s a unique residency.

At my institution the IM/EM/CCM guys in their 6th year were full fledged fellows for that one final year. They had to apply for and match into the 6th year fellowship slot as a seperate CCM fellowship just like all the other fellows and were definitely not considered residents.

You can’t get “triple boarded” with only a year of critical care from EM/IM. You need two years of fellowship.

Sorry, wrong again. I have numerous friends from my residency who are triple boarded after doing 5 year IM/EM and one year of critical care.

 

[eimaise]

whats the typical starting salary though for medpeds? same as im hospitalist?

Again this is going to vary a lot. I paid for the MGMA data after residency through a contract negations company and basically the average for new med Peds attendings in my region of the US is around 200K. The numbers went from 130K (academics) to 230K. Straight IM hospitalists can definitely make more than that. I interviewed for an IM hospitalist job that was offering >300K plus productivity bonus but I think most are going to be closer to 240 or 250 for new grads.

 

[jdh71]

At my institution the IM/EM/CCM guys in their 6th year were full fledged fellows for that one final year. They had to apply for and match into the 6th year fellowship slot as a seperate CCM fellowship just like all the other fellows and were definitely not considered residents.



Sorry, wrong again. I have numerous friends from my residency who are triple boarded after doing 5 year IM/EM and one year of critical care.

Whatever.

I can stand corrected if wrong and the way some places treat the 6th year is like a fellowship and the 6th year gets treated like a “fellow”. I’m not convinced that isn’t anything but a unique residency.

 

[IMreshopeful]

Whatever.

I can stand corrected if wrong and the way some places treat the 6th year is like a fellowship and the 6th year gets treated like a “fellow”. I’m not convinced that isn’t anything but a unique residency.

We had the one year of CCM after EM/IM. It’s a real fellowship. They have the roles of a fellow and the responsibilities of a fellow. It does integrate more CCM into the last year of EM/IM but that 6th year is VERY intense - no elective time, all ICU.

 

[jdh71]

We had the one year of CCM after EM/IM. It’s a real fellowship. They have the roles of a fellow and the responsibilities of a fellow. It does integrate more CCM into the last year of EM/IM but that 6th year is VERY intense - no elective time, all ICU.

I can stand corrected.

 

[CatFactorial]

I can stand corrected.

Just in case you’re unaware, there are programs with one-year fellowships.

 

[jdh71]

Just in case you’re unaware, there are programs with one-year fellowships.

Outside of this unique EM/IM/CC combined situation, not through ABIM unless you first have another non critical care ABIM subspecialty, all critical care fellowships in the ABIM are two years. Most subspecialties are two to three years. So there is no “fast” way to doing critical care in ABIM, 6-7 years before you are done. If you want to be boarded anyway.

Other non ABIM boards in the ABMS do have one year fellowships. You cannot sit for their boards even if you do their fellowship training unless you start in one of their residencies.

 

[CatFactorial]

Outside of this unique EM/IM/CC combined situation, not through ABIM unless you first have another non critical care ABIM subspecialty, all critical care fellowships in the ABIM are two years. Most subspecialties are two to three years. So there is no “fast” way to doing critical care in ABIM, 6-7 years before you are done. If you want to be boarded anyway.

Other non ABIM boards in the ABMS do have one year fellowships. You cannot sit for their boards even if you do their fellowship training unless you start in one of their residencies.

Poorly conveyed humor on my part, I have no idea about anything in this thread.

 

[jdh71]

Poorly conveyed humor on my part, I have no idea about anything in this thread.

Some men just want to watch the world burn. 🙂