Peds-IM joint program

[curious monkey]

I enjoy both working with children and adults and most importantly love the academics of medicine. For that reason, a peds-IM residency interests me. Anybody know what the average salary for someone who has been trained in a similar joint program assuming they do not do a fellowship and instead acts as a primary care physician? Secondly, does the decision to do a joint peds-IM residency hurt your chances if you desire to apply for a peds or adult fellowship only.

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[deleted87716]

You may find this link helpful: AAP Med-Peds Section

From the section on income:

Mean income for Med-Peds physicians has not been published, but is felt to be similar to categorical pediatricians or internists. Historically, primary care physicians' incomes have been lower than the non-primary care specialists. However, with the emergence of managed care insurance plans, with their emphasis on primary care, there has been some change in this pattern. In 2000 (the most recent year reported for physician income data), the American Medical Association found that pediatricians' mean net income was $137,800. (12) The mean net income for all physicians was $205,700; of general internists $164,100; and of family practitioners $144,700. The range of income for generalists is wide, ranging from $106,000 to $188,000. Median net income for all physicians tends to vary with geographic location within the United States.

 

[traveltheworld]

I too am interested in the field and would like to hear from some residents, graduates, or just anyone who knows a lot about it. What have you all heard of in terms of good med/peds programs out there, not necessarily "elite" names, but strong ones that prepare you well and have a good fellowship match track record? Thanks!

 

[The Med-Peds Dude]

You may find this link helpful: AAP Med-Peds Section

From the section on income:

One other final thought on the subject. There are two common schools of thought on setting salaries. One is that, since you've gone to the trouble of dual training, and truely are capable of multitasking at a high level, you should at least be paid at the rate of the higher earning specialty (usually IM). Others believe the salary should be split somewhere between the two, perhaps, by proportion of adult vs ped svc provided.

Either approach has it's strong and weak points. Our practice gets paid on the IM pay scale. I hope it doesn't change, but if it days, my career will be far from ruined.

 

[RuralMedicine]

I too am interested in the field and would like to hear from some residents, graduates, or just anyone who knows a lot about it. What have you all heard of in terms of good med/peds programs out there, not necessarily "elite" names, but strong ones that prepare you well and have a good fellowship match track record? Thanks!

I'm being lazy and just reposting a list I provided on another thread. Bear with me I'm now post my post call nap (which included a come in from home 2AM central line--Very fun ) and heading back to bed soon. If you have questions I'll try to check this thread some time when I'm feeling more energetic and being more helpful or you can PM me with questions.

Programs that impressed me:
(In Alphabetical Order)
-Albany Medical Center
-Baylor University
-Indiana University
-Maine Medical Center
-Marshfield Clinic
-University of Michigan
-University of Rochester

I ranked them all and matched at my first choice but I really think that any of these programs would have worked for me. In looking over my list I realize it's perhaps a bit eclectic but I can still remember what drew me to each program. I think the challenge is finding out what your "must-haves" in residency are and not compromising on those issues but also recognizing that the perfect residency program probably does not exist and all programs (just like all residents) have strengths and weaknesses. Good Luck!
Go Med-Peds!

 

[polkadocs]

Hi, is anyone considering to apply to both FP and Med/Peds? Is this generally frowned upon or is it common? I can't seem to narrow it down...

 

[traveltheworld]

I'm being lazy and just reposting a list I provided on another thread. Bear with me I'm now post my post call nap (which included a come in from home 2AM central line--Very fun ) and heading back to bed soon. If you have questions I'll try to check this thread some time when I'm feeling more energetic and being more helpful or you can PM me with questions.

Programs that impressed me:
(In Alphabetical Order)
-Albany Medical Center
-Baylor University
-Indiana University
-Maine Medical Center
-Marshfield Clinic
-University of Michigan
-University of Rochester

I ranked them all and matched at my first choice but I really think that any of these programs would have worked for me. In looking over my list I realize it's perhaps a bit eclectic but I can still remember what drew me to each program. I think the challenge is finding out what your "must-haves" in residency are and not compromising on those issues but also recognizing that the perfect residency program probably does not exist and all programs (just like all residents) have strengths and weaknesses. Good Luck!
Go Med-Peds!

Thanks rural! That's a good list to investigate. How important do you think it is to have a combined med-peds continuity clinic? It sounds like it would be a big advantage. What were your "must-haves" by the way? Thanks again!

 

[traveltheworld]

Hi, is anyone considering to apply to both FP and Med/Peds? Is this generally frowned upon or is it common? I can't seem to narrow it down...

I'm just applying this year too, so I'm no expert, but it seems like the two specialities have a lot of similarities. So it's probably pretty common to apply to both. Maybe being on the interview trail and seeing how different programs away from your home institution work will help you decide. Personally, I am planning on applying to both med-peds and peds programs and I know of many others who did so with IM. Good luck with you decision!

 

[RuralMedicine]

Thanks rural! That's a good list to investigate. How important do you think it is to have a combined med-peds continuity clinic? It sounds like it would be a big advantage. What were your "must-haves" by the way? Thanks again!

I trained in a program that did have Med-Peds continuity clinics (and I think it's a definite plus if done well). Although I sort of developed my office practice around taking what I liked and thought worked from my continuity clinic experiences and striving to fix that which I thought was "broken" I do think the case mix estimated a lot of what I see now. Obviously there are significant differences but they more relate to population (urban underserved vs rural underserved) and health care infrastructure differences (strong integrated tertiary network vs rural community (in a state with a rather fragmented tertiary care infrastructure). I still contend that learning how to adapt your practice to the strengths and resources of your community is critical for primary care providers. This doesn't mean you must do your residency in the area you intend to practice what it means is that ideally residency illustrates how to work through the process.

DISCLAIMER: My opinion only---as always your experiences will vary

Strong Med-Peds Programs Have:
*Strong categorical medicine AND strong categorical pediatrics programs. (Unfortunately many Med-Peds programs are strong medicine or strong pediatrics programs. Programs that are strong in both do exist seek them out!)
*A dedicated Med-Peds program director
*A Med-Peds continuity clinic (rather than shuttling to you to medicine clinic and peds clinic on alternate weeks--I did interview at two programs that didn't have their own clinics and I was assured at both that it wasn't a detriment although at both they also admitted that it was something they were considering)
*Adequate opportunities for critical care, and subspecialty months (ideally with at least a few subspecialty months being combined Med-Peds experiences).
*A cadre of Med-Peds faculty who are respected as competent internists and pediatricians by both categorical faculty. But when you talk to them they recognize (and are willing to explain ) that Med-Peds is more than Medicine + Ped but it's own discipline

I'm sure there are more criteria, but these were some of the things I looked at. If you have specific questions about programs feel free to pm me and I'll help if I can. Good luck with the application process.

 

[ekydrd]

I have agree with Rural. A strong med-peds program comes from strong peds and IM programs. I am currently at University of Louisville in med-peds. We are a strong program because of the two strong sister programs. We are working to resolve the alternating peds/adult clinic issue and this year the interns have been paired with med-peds physicians in the community for their clinic experience so they will get a true med-peds clinic exposure. We have a very favorable fellowship matching record - one 4th yr resident created his own combined med-peds GI fellowship! About half of each graduating class does a fellowship and the other primary care. Louisville is an urban area and see typical urban illnesses like COPD, asthma, alcoholism, etc. but we surprisingly enough get pathology usually limited to rural areas... i.e. guy got hand stuck in PTO, Ehrlichiosis, lead poisoning from moonshine distilled in car radiator... You get the picture.

 

[RuralMedicine]

Louisville is an urban area and see typical urban illnesses like COPD, asthma, alcoholism, etc. but we surprisingly enough get pathology usually limited to rural areas... i.e. guy got hand stuck in PTO, Ehrlichiosis, lead poisoning from moonshine distilled in car radiator... You get the picture.

I would guess that your referral base gets pretty rural pretty fast. Training at a tertiary center that serves a rural referral base is not a bad way to train for later practice in a rural area. I think University of Louisville was a much different program when I was applying and training but I've heard things are improving there.

 

[MicroBugs]

Rural- Just curious about where you did your residency.

 

[traveltheworld]

I have agree with Rural. A strong med-peds program comes from strong peds and IM programs. I am currently at University of Louisville in med-peds. We are a strong program because of the two strong sister programs. We are working to resolve the alternating peds/adult clinic issue and this year the interns have been paired with med-peds physicians in the community for their clinic experience so they will get a true med-peds clinic exposure. We have a very favorable fellowship matching record - one 4th yr resident created his own combined med-peds GI fellowship! About half of each graduating class does a fellowship and the other primary care. Louisville is an urban area and see typical urban illnesses like COPD, asthma, alcoholism, etc. but we surprisingly enough get pathology usually limited to rural areas... i.e. guy got hand stuck in PTO, Ehrlichiosis, lead poisoning from moonshine distilled in car radiator... You get the picture.

Wow, that sounds like a good variety of patients...esp. the moonshine business. Do you think the pairing with community med-peds physicians will continue? How're they liking that? The only concern I could think of would be that you might lose a little autonomy in that they aren't your own patients anymore. Is that even an issue? So many questions I know.

 

[RuralMedicine]

Wow, that sounds like a good variety of patients...esp. the moonshine business. Do you think the pairing with community med-peds physicians will continue? How're they liking that? The only concern I could think of would be that you might lose a little autonomy in that they aren't your own patients anymore. Is that even an issue? So many questions I know.

The pediatrics side of the program I trained at offered this as an option for pediatric residents for continuity clinic but from what I hear is considering dropping it effective next academic year because of the concerns you raised. There is definitely the potential for it to become more of shadowing/student type rotation rather than supervised practice. Several friends who opted for that did admit their preceptorships trended in that direction (admittedly their preceptors may not have been representative of the preceptor pool, and they may not have been representative of the resident pool).

Med-Peds has the option of doing an "away" (or not so away) rotation with a Med-Peds preceptor. It used to be required but it was switched to a group of selectives to better accomodate work hours coverage. This is actually a nice option. Continuity clinic for us was (and still is for current residents) a Med-Peds continuity clinic in one of our residency affiliated CHCs precepted by Med Peds attendings.

 

[ekydrd]

The pediatrics side of the program I trained at offered this as an option for pediatric residents for continuity clinic but from what I hear is considering dropping it effective next academic year because of the concerns you raised. There is definitely the potential for it to become more of shadowing/student type rotation rather than supervised practice. Several friends who opted for that did admit their preceptorships trended in that direction (admittedly their preceptors may not have been representative of the preceptor pool, and they may not have been representative of the resident pool).

Med-Peds has the option of doing an "away" (or not so away) rotation with a Med-Peds preceptor. It used to be required but it was switched to a group of selectives to better accomodate work hours coverage. This is actually a nice option. Continuity clinic for us was (and still is for current residents) a Med-Peds continuity clinic in one of our residency affiliated CHCs precepted by Med Peds attendings.

Since this is a brand new thing here we don't yet know how the clinic experience will go. It may be that the time spent is more of a shadowing experience, but I hope it's more of a continuity clinic experience. We do AHEC (away rotations in underserved areas) as a requirement starting in our 3rd year. I'm kinda lookin forward to my month away.