ZAZA67401

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Anyone know anything about these programs? (Yale, UW, WU, Childrens National/NIH, UTHouston, Baylor, Mt Sinai, UCONN, CedarSinai). How many people match to these programs straight out of school?
 

ZAZA67401

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Also do you have to first match to the peds residency before you can them both or do you apply to a separate peds/Medgenetics program?
 

GeneticsGoddess

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So, this post is pretty ancient, but I'm hoping that there will be more responses now. I am very interested in doing a peds/genetics combined program but there is not very much information on these aside from what's available on FREIDA. For instance: are these combined programs very competitive? How does the experience compare to doing a peds residency and then a genetics residency separately (aside from the number of years)?
Any information or advice would be greatly appreciated.
Thanks!
 

Mendelssohn

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So, this post is pretty ancient, but I'm hoping that there will be more responses now. I am very interested in doing a peds/genetics combined program but there is not very much information on these aside from what's available on FREIDA. For instance: are these combined programs very competitive? How does the experience compare to doing a peds residency and then a genetics residency separately (aside from the number of years)?
Any information or advice would be greatly appreciated.
Thanks!
Hi, hope this is of help. Most peds/genetics programs overall are not very competitive because there aren't a lot of applicants. However, there are very few programs, and there are only 1-2 spaces per year. Most programs also aren't aiming to fill those spaces no matter what, so they'd rather not fill than match someone who wasn't a good fit for the program. There's not much difference doing the peds/genetics route versus striaght peds (that's what I did, am currently a PL-3) then fellowship. Most combined peds/genetics programs are 5 years, and peds residency alone is three years. However since most genetics fellowships are 2 years the training either way ends up being 5 years. The exception is Boston Children's/HMS fellowship which requires 3 years. A lot of places though do encourage an extra year for research though so it could extend a year either way.

The reason I liked doing peds only first was that I really got to focus on being a pediatrician and really get a good foundation for congenital/metabolic pathology (plus you have to learn that stuff anyway for the peds boards). I feel much more prepared to be a genetics fellow at this level. If you go through a combined program, you will be flip flopping back and forth (every 3-6 months peds, then genetics, then back, etc. depending on the program), and won't be eligible to take both boards until you're done with th5 years. (versus I will be taking my peds boards this October, then genetics at the end of fellowship, definitely prefer to do 1 board exam at a time). Some of my friends in combined IM-Peds programs say the back and forth can be difficult too. On the flip side, some people would prefer to stay at one program all 5 years and not have to deal with moving, applying for fellowship again, making connections at one place early, etc.

If I had known as a med student that I wanted to do peds/genetics, I probably would've applied for one of those programs. However, I enjoyed getting to see different programs when I was interviewing for fellowship, and I am going to train at my top choice, so I don't think it really made a difference at the end. If you have any other Q, feel free to PM.
 
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I am highly interested in Genetics and going to apply for these programs this year. Anybody else applying too? Lets get together. :thumbup:
 
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BUMP.

I am interested in peds/genetics. It sounds like there is no benefit of applying to the combined programs? Can anyone comment on the current job market?
 

Lawgiver

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Bump, yeah me too. Plan on applying in 2022 :D
 

Mendelssohn

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Hi all - I essentially haven't been on this thread since I made my last post in 2013, but I was PM'd for an update. As I didn't realize others had also posted in recent years also with interest, I figured I would reply here in case it helps someone else out there.

I am now an attending, and I can say beyond a shadow of a doubt I am 100% satisfied with my career choice, and if you're even remotely interested in genetics, absolutely consider this for sure. If you want to be part of an amazing revolution in the way we practice medicine across all specialties in the next 10-20 years and definitive job security on all levels, absolutely consider medical genetics. Forget things like radiology (Seriously: what was once so coveted is one of the worst job markets I've ever seen. Due to things like tele radiology where places and outsource overseas, every single person I know from my class who went into this, unless they were doing interventional rads, has basically not been able to find a job, and had to do additional fellowships because they couldn't find jobs) or ER (no way the pay grades will continue the way they have, who wants to be doing night shifts still when you're mid career?). Medical genetics is an amazing field that has changed so dramatically over the last 5 years, I think most pre-meds, medical students, and residents aren't aware of the scope of what we do now or what capabilities exist. This is actually an interest of mine, to help get the word out there about how great this field is, because the demand for geneticists is skyrocketing. This is not just about sending a karyotype for Down syndrome anymore, believe me.

First, an update about a practical thing. When I last posted, I basically said the time frame for training in med genetics was the same whether you do combined peds-genetics residency versus regular peds (or whatever primary specialty - doesn't have to be peds, can be IM, OB etc.) then dedicated genetics residency. This is no longer true - last year the ACGME changed this so the combined program is now 4 years like med-peds, not 5. Therefore, you could potentially shave off a year by doing a combined program. However, the pros/cons of course still exist as I mentioned previously (e.g. constantly flip flopping versus focusing on one specialty at a time, 2 boards at once or one first then the other etc., getting to train at multiple programs vs. staying put at one place etc.). So that's really personal choice.

Now, for the real info. Why has medical genetics exploded and why is this where medicine is going? Simply this: the fact everyone has DNA whether you like it or not, people will continue to have babies, technology, and this little thing called the Human Genome Project (HGP). Many of you may not have recalled much of this, but the HGP took thousands of scientists, millions of dollars, and THIRTEEN years to complete essentially the basic "map" of the entire human genome. The first draft was completed in 2001, then the final version in 2003.

Now, what if I told you, within the span of the last 5 years or so, the technology has become so advanced, we have the capability of mapping an entire human genome…in less than a month…from just a few drops of blood…from a pregnant mother…on her baby...without ever touching her baby…before the baby is born?!

That's right. You can take a few cc's from a pregnant mother, and with the help of the father's DNA, you can map the fetus's entire genome, because the blood crosses the placenta. Is it possible to know right then and there, before the child's born, whether they carry a variation in a BRCA1 or BRCA2 gene putting them at a huge risk for breast cancer when they're adults? Yes. What about if they're at risk for developing dilated cardiomyopathy? Yes again. What about familial Alzheimers? Absolutely. Does that mean we should? Do people even want to know this information? I can't even tell you how difficult the answer to that is, and how complex these ethical issues have become. Personally, I think no, and as a genetics community we don't recommend this now. Will it happen anyway?…to be determined, but you want to be part of this debate.

And if you haven't heard of the 3 parent babies, you need to stop everything and go read this now, and read about the technology in the links.

http://www.scientificamerican.com/article/when-will-3-parent-babies-come-to-the-u-s/

I am happy with my job for a number of reasons. First, I am a thinker. I like puzzles and solving interesting cases. This is not unlike fields like rheum, neurology, etc. where you have complex patients and have to put the story together. So if you're more into acute procedures all the time like surgery or a very high paced environment like the ED, maybe not for you. However, for me, I love that nearly every case I see is different which keeps me constantly thinking and learning, and I'm never bored. Our "standards" are often children with developmental delay and hypotonia, but really my clinic has run the full gamut of all kinds of things walking through the door. A child with a history of dilated vasculature and concern for connective tissue disease. A family with a family history of XYZ disorder and need for carrier testing. A child with hearing loss, syndromic and non (yes there are different causes). We get referrals from all subspecialties because we are learning more and more about genes that cause human disease, and guess what? They cross all specialties. There are genetic causes of cardiac congenital defects, cardiomyopathy, arrythmias, cancer syndromes, dermatoses, nephrotic syndrome and congenital kidney disease, rheumatologic disease, the list goes on. For this reason, regardless of your specialty, you will start to come across genetic testing more and more. Multiple specialties turn to us to help interpret this testing because it's popping up in their fields, but they don't have the full understanding of what some of the genetic pieces really mean.

Second, the job security is excellent as I've mentioned previously. There has never been such a high demand. Right now there are basically two groups of folks - those who are part of an older generation who trained before there were formal regulated genetics residency program, and those of a more recent generation who came into this during this ridiculous growth period thanks to the sequencing technology that literally turned the field upside down. Many of the older generation are starting to retire, and right now there are still very few graduates per year. The top programs always fill, but the remainders are hit or miss. Most places are not aiming to fill, so they'd rather not have someone than a poor candidate. When I graduated, the jobs probably outnumbered grads 3:1 or more, and the list is growing, and will continue to grow. Due to this (rising demand, decreased candidates available), this has helped boost salaries (definitely comparable to other non-surgical specialties and rising).

Side note: at the end of the day, NEVER choose a specialty for money. Seriously. You must like what you do first and foremost, because otherwise, you will be miserable. Medicine is a very, very very long road. It takes so long to even finish training, when you get to the end, you need to ultimately like what you're doing. I had folks tell me not to do peds due to the decreased salaries, and I am so glad I resisted and stuck to my guns, because you couldn't pay me enough to be a general surgeon and be get paged to operate at 3:15 am. Fine when you're young, but even 10 years out it draining…I can't even imagine repeating residency right now, which was taxing enough.

Third: You can go in any direction with genetics. Want to be a researcher? Sure. Want to be primarily a clinician? Definitely. Want to be both? Definitely possible. Academics is where most of the jobs are, but private, industry and lab opportunities continue to grow. If you have particular interest in biochemical genetics (think of all the rare disorders you learned about in med school but probably haven't seen - galactosemia, PKU, MSUD, lysosomal storage disease like Niemann pick and all the others you probably cursed while trying to memorize for Step 1), even better for you, because there is an unbelievable demand for physicians with this interest due to newborn screening. When you have every single child being born in the US receiving newborn screening, this creates automatic demand for physicians who can take care of them, and there is a critical shortage right now. That's not my primary interest, but you will end up being cross trained in this by necessity as biochemical genetics and general genetics/dysmorphology are typically covered by the same folks (though in larger institutions they function separately).

Fourth: Every major institution, both public and private, is going towards "genomic medicine" and "personalized medicine". This is particularly the case in the cancer realm with targeted therapies, but really there are many conditions for which we are doing enzyme replacement therapy (Gaucher, Fabry, many more), and treatments are being developed for things which everyone once thought wasn't possible. Look up Eteplirsen to help treat muscular dystrophy through a mechanism called "exon skipping". http://www.nature.com/nrd/journal/v14/n4/full/nrd4587.html
And many other things are being developed.

Fifth: It's a great lifestyle in general. There are very few genetic emergencies, unless you're at an institution that's very biochemical heavy. And even so all call you take is essentially home call - your sickest kids are basically in the NICU and PICU, and management can be done over the phone. And if you're at a private practice with just general genetics or working for industry it could definitely be more like an 8-5 kind of job. I have several friends who are in positions like this and love it.

Bottom line is, this is a great field, and where medicine is going. If you're still interested after reading this, then I've done my job.

Side note: if you're still interested in genetics, but are not sure you want to do the whole long medicine route, consider the field of genetic counseling as well. They also have an amazing job outlook and our roles overlap a lot. We work very closely with genetic counselors, and they are essential for helping us provide the best care to patients (I am definitely so grateful to my amazing team, and they are also super high in demand!). Check out their national organization: http://www.nsgc.org.

And this is ours: https://www.acmg.net and the site to our medical board http://www.abmgg.org

Hope this was helpful to someone and best of luck with whatever field you choose!
 

Lawgiver

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wow, thank you!
 

Ibn Alnafis MD

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Thank you @Mendelssohn for this generous write up. It has inspired me to give the field a very serious consideration. However, I can't help but consider the financial aspect of pursuing a career in medical genetics, especially that I'm anticipating to graduate med school with an astronomical debt burden.

I was wondering if you could provide us with a ballpark the type of salaries medical geneticists make. In other words, how likely is it for a medical genetics to make a similar income to that of a primary care doctor?
 
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numbersloth

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What type of research should a medical student do to show interest in Ped/Genetics? Obviously genetics research but does it necessarily have to be the peds department?
 

kb1900

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id like to bump this thread as peds-genetics has been on my radar since i was a lowly freshman premed. i am now matriculating at a school with a combined program available and would love to know more about the field.

i essentially have the same questions as the posters above me.
what kind of research should one pursue?
what can one do to "fit" when you say programs want good-fitting candidates more so than to fill empty spots?
how widespread is the job market? (ie. do most grads of genetics fellowships and combined programs end up in industry positions or big academic centers or elsewhere?)
when you reference "the industry", could you provide a couple specific examples of what a genetics-specialist might do there?

would love to see a response from @Mendelssohn or other people in the field.
 

settingshadow

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I got pinged by @kb1900 (thanks!) I'm an attending who did a combined peds/genetics program. I'm now on faculty and involved with admissions at a combined program

You can do any type of research you want. We want to see research experience, but we don't really care how "genetics-y" it is. Pick a mentor you like who will support you. Do work you're enthusiastic about using techniques that will some-day be applicable to genetics.

Fit means that you're enthusiastic about genetics, you have evidence that you are going to pursue clinical genetics and not dump us for general peds and that you're dependable and a good personality match, since in most programs you'll spend a lot of one-on-one time with each attending and we don't want you to be annoying. Personality depends on the program. At my program, it means not whiny, and able to react quickly to biochemical labs, but it can vary.

Almost everyone ends up in a big academic center, but there are larger private practice groups (e.g. Kaiser) that higher geneticists.

The "industry" mostly means drug development for rare genetics diseases or being the medical director of a commercial genetics laboratory.

Hope that helps!
 
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kb1900

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I got pinged by @kb1900 (thanks!) I'm an attending who did a combined peds/genetics program. I'm now on faculty and involved with admissions at a combined program

You can do any type of research you want. We want to see research experience, but we don't really care how "genetics-y" it is. Pick a mentor you like who will support you. Do work you're enthusiastic about using techniques that will some-day be applicable to genetics.

Fit means that you're enthusiastic about genetics, you have evidence that you are going to pursue clinical genetics and not dump us for general peds and that you're dependable and a good personality match, since in most programs you'll spend a lot of one-on-one time with each attending and we don't want you to be annoying. Personality depends on the program. At my program, it means not whiny, and able to react quickly to biochemical labs, but it can vary.

Almost everyone ends up in a big academic center, but there are larger private practice groups (e.g. Kaiser) that higher geneticists.

The "industry" mostly means drug development for rare genetics diseases or being the medical director of a commercial genetics laboratory.

Hope that helps!
Thank you so much-super helpful!
 

Mendelssohn

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Agreed with Settingshadow on above comments! A few additional thoughts.

Genetics research definitely does not need to be in peds specifically, as you can technically train in any primary residency before doing genetics training (unless you do a combined peds/genetics or IM/genetics program right away). Cancer genetics for example is a big field and many folks, particularly ones with interest in adult medicine end up focusing on that. If you have shown you have sought out some kind of project with at least some type of genetic spin (peds, cancer, prenatal genetics etc.) that should be good enough. You also should like what you're doing (easy to tell if someone just took a project to put something on their CV!) so pick something that genuinely interests you.

In general residency programs also want candidates who are not only strong clinically but are able to adapt. This is especially important in combined programs where you flip flop back and forth between sides. In these programs, you need to be a good fit from both sides as well. For example, if peds does not think you're a good fit, even if the genetics team wants you, you may not match there. When on the genetics side in combined programs, you essentially function more at a fellow level vs. resident in that role (hence the more 1:1 time with attendings), so definitely important to be able to work well with staff members and take more of a leadership role and be proactive about cases. Agreed the personalities and general vibes at institutions vary quite a bit around the country.

Demand for geneticists is incredible right now, even better for folks with biochemical/metabolic training. Most jobs are academic (at least what was posted at our last national meeting) but there are always exceptions. Labs also need folks with clinical expertise to help interpret lab data, so that's another way someone could work in industry.
 
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Thank you a lot for your information Mendelssohn and Settingshadow!

I am a medical student in my last year, and I studied biotechnology before. I have always loved science and genetics is one of the fields with more future.
I do want to do a genetic residency, not so much a combined residency because I like all life stages and I can´t decide by only one. I also would love to work in personalized medicine and gene therapy, so this are my doubts:
-Do you have to match for IM, peds or Ob/gyn and after match again for genetics residency? Or how is the process if I don´t choose a combined residency.
-Is it necessary to complete a residency before doing a fellowship in genetics? because I am not really interested in another specialty than genetics.
 
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Or it is possible to apply for genetic residency by another specialty (not IM, peds or Ob-gyn) like family medicine or preventive medicine?
Do you prefer combined residencies or just genetic residency? or a fellow after your specialty?

Maybe some of these questons sound obvius, but I am studying in Mexico and some things work different.
 

Mendelssohn

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Hi Bioeli, if you want to pursue genetics you must first finish at least 2 years of a primary general residency. That could be any residency (even surgery), although the majority complete Peds, Ob-gyn, or IM. It is not possible to do genetics residency alone right after medical school and then practice. After completing (or at least 2 years) of a primary residency, then yes it is another match process. The cycle is typically 1 year prior to starting (so apply/interview summer/fall of your last year of residency, with the match in November).
 

Naruhodo

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Thank you @Mendelssohn for this generous write up. It has inspired me to give the field a very serious consideration. However, I can't help but consider the financial aspect of pursuing a career in medical genetics, especially that I'm anticipating to graduate med school with an astronomical debt burden.

I was wondering if you could provide us with a ballpark the type of salaries medical geneticists make. In other words, how likely is it for a medical genetics to make a similar income to that of a primary care doctor?
It would probably come across as crass to ask about this (i.e. maybe don't ask program directors), but the good news is that you don't have to. Public universities are required to disclose the salaries of employees, and this includes many major academic medical centers. You can google this for yourself. To answer your question, yes, it is reasonable as a medical geneticist to expect to earn a similar salary to what primary care physicians earn. You will definitely not earn what your orthopedist or ENT colleagues do, and this is not because what you do is less valuable but because our current healthcare system rewards specialties that perform procedures. With the exception of those that are OBGYNs, most geneticists don't do procedures so there's not much you can do about that. Most doctors still manage to pay off their loans though, and ultimately what matters is that you enjoy the career you chose.
 
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So I am curious about the combined Medical Genetics programs. I am a M3 MD/PhD student with a PhD in Bioengineering. My research Computational Cancer Genetics and how it applies to personalized medicine, so obviously these programs are of an enormous interest to me. I can definitely see myself integrating genetics, bioinformatics research, and primary care into a career.

I see my track as entering either one of 2 paths: 1) Doing a combined IM/Genetics or Peds/Genetics 4 year program or 2) Doing a Med/Peds or FM residency and then a Genetics Fellowship after that.

I have a few questions as I haven't been able to find a ton of information on the subject:

1) How competitive are the 4 year programs and does having a PhD matter?
I ask because I did not very well on STEP 1 (202), and there are not a ton of combined programs in the country, but they do sound incredibly interesting to match into.

2) What is the general clinic/research duties of MD/PhD clinical geneticists? My endgame is to hopefully have a computational lab while also doing clinical practice, and if possible doing primary care at least on a semi-regular basis to keep myself fresh
 

Naruhodo

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Hi 2KOTN,

Hopefully someone else will chime in, but I can give my 2 cents. First, I think the paths you lay out are reasonable. *Remainder of my comment redacted as I realized I honestly don't know enough to give good counsel.

1) I would like to think that the PhD should help. I think Mendelssohn did a great job above explaining the constraint of there being a small number of programs. I recently found out my med school has a list of grads willing to be contacted by current med students about the residency match process, so you can always ask if your school has something similar. I definitely plan on emailing the person who matched to peds/genetics last year from my school. I can't give you a number, but I know of a recent clinical genetics fellow (now professor) who said he didn't do well on STEP 1 but nonetheless was successful in residency and had no trouble finding a job once he was done with training.

2) Honestly, I think it can be hard to do both well, but there is probably more natural overlap in genetics than in many other medical fields. Here's a recent interview that might be of interest: Inside AJHG: A Chat with Christian Schaaf
 
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Mendelssohn

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Hi, I just saw this. 2KOTN I don't know if you're still interested in the combined programs but in answer to your questions:

1. The combined programs are competitive (more competitive compared to the classic categorical residency programs. This is primarily due to the small number of spots (at most 2 per year) and programs, and due to the applicant pool being skewed towards candidates who have had a strong interest in genetics from a very early time, hence have done more activities focused on genetics, etc. compared to someone who decided later in residency. Having a PhD is definitely not mandatory by any means, but certainly is a plus in general. If you did well on Step 2, this may help programs overlook the Step 1 score, however really this will overall depend on whatever program you're applying to. There are some honestly who have a hard cutoff for Step 1 and may not look at your application because of this. Keep in mind with the combined programs, both sides need to feel the applicant is a good fit. I have definitely seen candidates who were highly desired by the genetics side, but blocked by the peds side for XYZ reason (and I'm sure the opposite may occur).

2. Md/PhD clinical geneticist duties will depend on the type of job you have. Vast majority who continue with the research route have and 80/20 set up (80% research, and 20% clinical which ends up being about one clinic a week). To have any less research time I would say would definitely potentially impact the time you have to do the actual research, get grants etc. and be really successful from the research side. In reality your time does not get split "exactly" into those percentages no matter how nicely that is written on paper. So any place that says you can do "50/50" or "60/40" cannot truly guarantee this, especially when you're up against deadlines for XYZ grant, and still have clinical duties to complete for your patients.
 
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Hi, I just saw this. 2KOTN I don't know if you're still interested in the combined programs but in answer to your questions:

1. The combined programs are competitive (more competitive compared to the classic categorical residency programs. This is primarily due to the small number of spots (at most 2 per year) and programs, and due to the applicant pool being skewed towards candidates who have had a strong interest in genetics from a very early time, hence have done more activities focused on genetics, etc. compared to someone who decided later in residency. Having a PhD is definitely not mandatory by any means, but certainly is a plus in general. If you did well on Step 2, this may help programs overlook the Step 1 score, however really this will overall depend on whatever program you're applying to. There are some honestly who have a hard cutoff for Step 1 and may not look at your application because of this. Keep in mind with the combined programs, both sides need to feel the applicant is a good fit. I have definitely seen candidates who were highly desired by the genetics side, but blocked by the peds side for XYZ reason (and I'm sure the opposite may occur).

2. Md/PhD clinical geneticist duties will depend on the type of job you have. Vast majority who continue with the research route have and 80/20 set up (80% research, and 20% clinical which ends up being about one clinic a week). To have any less research time I would say would definitely potentially impact the time you have to do the actual research, get grants etc. and be really successful from the research side. In reality your time does not get split "exactly" into those percentages no matter how nicely that is written on paper. So any place that says you can do "50/50" or "60/40" cannot truly guarantee this, especially when you're up against deadlines for XYZ grant, and still have clinical duties to complete for your patients.
Thanks for reaching out to me. I just saw this response so I am a bit late. While I did consider matching to a Peds/Med Genetics, I ultimately ended up matching into a good Med/Peds program actually. I felt that it was too difficult to give up seeing adult patients and understanding their complex pathology. However, that being said, I still am interested in doing Medical Genetics after I finish residency so I would definitely like to keep that door open.