Pediatrics Career Path Question

[thatonegrrl]

I am starting medical school this fall and am interested in Med/Peds as well as Gen Peds and Triple Board. I'm particularly interested in primary care for underserved communities. I've started to lean towards Med/Peds over FM because of the more robust Peds training, as I'm fairly certain I want peds patients to be a substantial chunk of my future practice. (I have a background in K-12 education and know I love working with kids and families. I've been working in higher ed more recently and I already really miss seeing kiddos on a daily basis). Also, if I did decide to specialize, I like the fellowship options from Med/Peds better than the options available from FM.
As pediatricians already out in the field: What things should I be doing/considering as far as electives or extracurriculars to be a competitive Med/Peds applicant? Any advice you would give re: Peds in general? Anything I should look for/consider when choosing where to attend school? (I will be finalizing my choice in the near future)

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[GoSpursGo]

First of all, focus on learning your basic science well. There will be plenty of time in clinical rotations to figure out what you want to do when you grow up, but basic science is your one chance to learn that pathophysiology that underlies medicine. It doesn’t come up every day in practice, but the best doctors are the ones who can think critically from a mechanistic point of view when it comes to those tough cases.

So why do you want to take care of adults if you like kids so much? If you want to take care of kids, be a pediatrician. If you want to be a primary care doc, I really can’t think of an advantage of med/peds over FM. If you really want peds as part of your practice in FM, then just do that. You’ll keep learning as a junior attending and there’s little benefit to spending another year in training.

I really think you need a good reason and plan for doing med/peds. Otherwise I’ve seen most med/peds docs differentiate into one or the other.

 

[Stitch]

I disagree with Spurs slightly here. It's true that many med/peds end up eventually picking one or the other, but I definitely feel that your pediatric training will be much more extensive and better in med/peds than FM. This will give you a lot of options moving forward.

That said, focus on getting through first year. No need to plan too much about long term. Bring an open mind to your rotations and see if anything else captures your interest. Maybe try to do an elective in the peds ED or PICU, or some other peds service that consults all around the hospital (ID is a good one too). That will give you quite a bit of exposure. Good luck!

 

[BigRedBeta]

1) Keep an open mind about any specialty. It's great to have an idea of what you want to do, but if you fall in love with something that's not Med/peds, then go for it

2) I absolutely disagree with Spurs here. Med/peds training is undoubtedly more robust than FM training for taking care of the spectrum of pediatric disease. If you absolutely must have OB in your practice, then sure, you need FM, but if it's just wanting to take care of both adults and kids, Med/Peds will make you a more complete physician in each of those areas. The FM people will probably try to say that being focused on outpatient medicine during residency for a career that is 100% outpatient just makes sense, but I think there is undoubtedly utility in having managed complex patients when they are acutely sick. No one heading into residency is staying up nights worried about how they will manage an outpatient clinic appointment...they are worried about how to deal with complex acute illness requiring significant intervention.

3) go to the least expensive school you are accepted to.

 

[WheezyBaby]

I'm med peds now subspecialized. I will strongly agree with the last two posters and say your pediatric training is dramatically stronger in med peds VS FM. You're a boarded pediatrician and should be comfortable caring for children with a variety of significant comorbidities in an outpatient setting I would prefer not be managed by an FM physician. To my knowledge, the majority of med peds physicians also continue to see both populations to some extent (though if your desire is to do this in a setting other than outpatient there are definitely challenges). With that being said, med peds by virtue of what you need for accreditation leans strongly inpatient. That is not to say you can't become a stellar PCP through med peds (a substantial portion of med peds are PCPs), but I would use any flexibility in rotation selection to tailor your experience to primary care / outpatient medicine. FM also gets a substantial amount of training in minor procedures (eg skin biopsy, joint injection, reductions, splinting) for which the education in med peds (in my experience) is quite weak and for more significant procedures (eg c-scope) for which the the education is zero. And obviously FM cares for OB while med peds does not.

 

[GoSpursGo]

It's true that many med/peds end up eventually picking one or the other, but I definitely feel that your pediatric training will be much more extensive and better in med/peds than FM. This will give you a lot of options moving forward.

2) I absolutely disagree with Spurs here. Med/peds training is undoubtedly more robust than FM training for taking care of the spectrum of pediatric disease.

I'm med peds now subspecialized. I will strongly agree with the last two posters and say your pediatric training is dramatically stronger in med peds VS FM.

To be clear--I 100% agree that the peds training that we get in a pediatrics or Med/Peds residency is superior to FM peds training. At no point was the intended message that FM can take care of kids as well as a pediatrician, because that isn't true.

That said, I think it is important to keep in mind the end game. If you're aiming for a subspecialty career like @WheezyBaby , then yeah Med/Peds probably opens a wide variety of fellowship possibilities, maybe more than you would have by doing either peds or IM alone. But if you are really, really sure that you want to be a PCP, then is that increase in expertise for the 0.5% of difficult cases really worth an extra year of training? Maybe, maybe not. All I can say is that I have known many med/peds docs who are very happy with their careers, but most of them are subspecialists who have really managed to create a niche for themselves in managing adolescent/young adult patients. I have also known a few med/peds docs who regret having done an extra year of training, and they are generally in primary care. At the end of the day, having spent an extra year to gain some additional expertise isn't the worst outcome in the world, but it was not ideal for them in retrospect.

So the bottom line I am trying to convey is--spend the next 4 years trying to figure out your career goals, and pick the career path that will help you achieve that. Based on what the OP shared, I think there's a good chance that the right choice could be med/peds, but it could also be peds-only or FM, and at this stage I think it's important to keep an open mind.