Do you like Peds or Internal Medicine more?
I would think that would solve this dilemma. I have worked with both and I am interested in heme/onc. There is no way I could do a peds residency though. So that made the choice quite easy.
I think this is the most crucial question to ask. One way I think you should phrase the question to yourself for both a primary specialty and subspecialty is "can I tolerate the mundane" of X field, because it's what you're going to see the most of. IM: poorly controlled DM, obesity, depression/anxiety, HTN, etc. For every cool workup you're going to see a hundred of the above. Peds: well child exams (umpteen developmental screening), rash, earache, fever, acne, obesity, depression/anxiety (the latter most frequently in the teens), well adolescent exams (umpteen HEADDS screens) and for every cool workup...well you get the story. And you have to be able to tolerate all the training requirements of the primary specialty. Lots of interminable rounding and navel gazing on MICU, PICU, Med & Peds Wards. Shoot-me-in-the-head amounts of formulating TPN and what to do with residuals in the NICU. More multiple co-morbidity patients in Medicine, but still plenty in Peds. More differing physiologies to deal with in Peds esp. in the critical care environments. You'll do most codes on old folk in medicine and on newborns in peds. You get the drift, each one has its challenges and rewards. Peds was my thing. The toleration for the mundane becomes even more important for the subspecialties, because you're narrowing yourself to an even greater degree. Peds pulm? Asthma, asthma, Asthma, asthma, Asthma, asthma, Asthma, asthma, a little CF, maybe some transplant, the mechanically dependent, Asthma, asthma, Asthma, asthma, Asthma, asthma. Hope you like asthma. Adult cards? Probably a whole lot of heart failure, MI, and CHF. For my chosen field (peds cards) I have to tolerate umpteen murmur evals, a fair smattering of syncope, chest pain (not ususally of the same consequence in my age group as the IM cards folk). But I like the mundane stuff and the variety of the field (esp. the superspecialties like imaging, interventional, failure/transplant, EP, critical care) and the crazy physiologies with CHD-love it. I think both adult and peds heme-onc offer a fair amount of variety. Lots of different types of cancers and heme disorders. Both busy as hell. Some pluses of peds: 1) Very few cancerns with causal links to lifestyle choices in PH/O vs. adult. 2) Greater variety of age/physiology-neonate to young adults (the oldest I took care of was a 26yo with ALL), but as stated elsewhere there is more management of multiple comorbidities in adults (count that as a plus for PH/O in my book). Tie for complexity of the critically ill H/O patient-a critically ill kid with cancer and MSOD will offer just about as much diagnostic and therapeutic challeng as a critically ill adult with Ca and MSOD. Plus for adults: you will less frequently encounter the caretaker who is non-compliant because most of the adult patients will be making their own decisions.
If you're contemplating both, then go with adult. I think it's emotionally easier to deal with all the sorrow when they're adults vs. children.
On the other hand, adults often have many more co-morbidities, so the care gets much more complex (when they have CHF, diabetes, etc.) However, if you really like problem solving really tough and complex issues, then go adult.
I'm not sure I buy the whole "emotional" argument, and I state this somewhat in defense of the internist. Remembering my own experiences from medical school I have a hard time believing that internists aren't also often touched by the struggles and loss of a patient that they had a particular connection to. Yes, many will have that "I see my own child there" moment, but doesn't the internist also see their Mother, Father, Sister, or Brother there as well? But for some the illness and death of a child will hit harder. But what is great about the rest of the field will make up for it and you learn to press on. I'd imagine the same for the internists.
If you are truly torn and truly love both patient populations I would suggest looking into Med-Peds. There are programs out there that are now integrating atleast the onc part by offering training in transitional care for adult survivors of childhood cancer.
I'm not sure if there are any true combined fellowships yet but that is something you should check out as well if you are really interested in both.
Best of luck
It's a thought, but I wonder truly what place there is outside of reserch for such a person. An adult H/O doc is likely to be fairly savvy to this scenario. It's not like the stark difference in the knowledge/expertise of adult vs pediatric cardiologists. A dual trained cardiologist would actually fit a niche-most adult cardiologists suck at figuring congenital stuff beyond the simple ASV/VSD and most pediatric cardiologists aren't experts in management if CAD. I don't see much of a niche for the adult and peds H/O person. I also wonder how many places treat adult and childhood cancer patients together. I would think in most cases this individual would be picking one field or another.
