Peds or Med-Peds

[gluteus maximus]

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Hi Everyone,
I was considering the advantages of Med-Peds over Peds as regards future scope, research and demand is concerned. Any ideas? thanx,
GM
🙄

 

[notstudying]

Thinking about this myself...

Med peds is longer (4 years compared to 3 for peds), and harder because you are an intern for 18 months instead of 12 since you are doing 2 internships. There's less elective time, and more inpatient blocks (read: more q3 call). You also take 2 Step 3 exams instead of 1. That said, when you are done, you are board certified in both medicine and pediatrics, and can treat either or both. There are starting to be more fellowships specifically for MedPed folk, so they can treat kids with chronic disease that grow up to be adults with chronic diseases (like CF, etc). Many do do private practice, and some stay in academics. there are some neat areas of research that fit well into the medpeds model. MedPeds residents tend to be on the brainy side, and are often overachievers. Peds residents from what I understand are more variable (depends on the region and school-I'll be peds residents at Children's HO Boston or CHOP are pretty brainy and overachieving themselves!).
Not sure about demand...

Hope this helps!

 

[HiFi]

since I did a peds residency associated with a med-peds residency, I have some experience in how things worked.

there aren't a lot of programs, so there are not too many practices out there yet.
My friends had some unique experiences when looking for jobs, and most felt obligated to join groups of other med-ped specialists BECAUSE, of call coverage.
Most med-peds did very limited OBGYN in residency, so they really couldn't provide coverage for FP patients. Likewise, if they went in with straight Peds or Straight medicine ( and they did med peds ) their patients couldn't get night coverage from their group...(you can't have a pediatrician taking night calls from some 70 year old with angina )

So they did have some trouble / limitations looking for jobs.
I knew several med-peds that switched to straight peds or straight medicine in residency, after deciding that they liked one better than the other.

It looked awfully difficult to me. the knowledge base is so vast in IM ( not to slight pediatricians ) and it looked difficult to go back and forth every 3 months.
When a person came back to peds after 3 months on medicine, they always looked rusty, because the thought processes are so different.

Still, most enjoyed it and did a good job.

I don't know how a fellowship works.
I suppose a fellow trained in say adult and peds GI would be very valuable in many community hospitals where there is no peds GI.
I have a friend from residency that did med peds, followed by adult ID and she is now practicing totally adult ID, so she wasted a year doing peds.

I am unaware of any combined fellowships for both adult AND peds.

I am also unaware of med-ped residents taking USMLE step 3 two times ( as another person posted )
that is false.

you do take both the Peds and the IM boards though and are BC/BE in both

 

[notstudying]

Sorry-I was confusing Step 3 and the peds/im boards. My point was that you have to take two exams in two different areas, rather than one.

 

[gluteus maximus]

Thanx HiFI and Notstudying. Reading into your views I am beginning to feel that staying focused in one field and may be specializing later on in Peds or IM would be the obvious rational path to follow. I dodn't want to end up being more confused that I am right now!!
GM

 

[stephcf]

actually, I'm going into MedPeds this year and want to clear up some misconceptions.

because you are an intern for 18 months instead of 12 since you are doing 2 internships

at most programs you still do internship for just 12 months. there are a few programs where internship is longer, but for the most part you become a resident at the end of one year.

less elective time, and more inpatient blocks (read: more q3 call).

true, less elective time but with the new standards for 80-hr work weeks, most call is now q4. only some places still have q3 call on the ICU months

I am unaware of any combined fellowships for both adult AND peds

A doctor at my school completed a combined fellowship in Infectious Disease and is now staff at both the adult and children's hospital. Other combined fellowships include endocrine, heme/onc, and allergy/imm. I also know a lot of people interested in cardiology and treating congenital heart disease now that patients are living longer. You can really tailor your fellowships to what interests you.

I chose MP because I'm interested in treating both adults and kids, and felt that I would be better trained to do so with a 4 year residency (as opposed to 3 yrs in FP). There's more training in Peds and you don't do OB or surgery, which I wasn't going to practice anyways. There are quite a few med-peds practices especially in the cities where there are residency programs.

It is true that the field is relatively new, so job searches may be limited by geography. Med-Peds is bigger in the Midwest and Northeast, whereas FP is bigger on the West coast. And of course, Medicine and Peds are prevalent everywhere.

If you are leaning more towards just Medicine or Peds, then I would go ahead and chose one. However, if you want the flexibility of treating both adults and kids, I would do Med-Peds

 

[athena21]

Looking at the job market, Med-Peds will put you in a MUCH stronger position. You're more specialized than a family practioner and your employer does not need to hire a separate internist. you are much more marketable and will probably make more if you do the extra year and complete a med-peds residency.

 

[deleted6669]

we have a med-peds doc here but only because we couldn't find an fp willing to take the job( er fast track). they still can't do trauma so their replacement will be fp. most of the time they seem overtrained for the position and launch into huge workups of benign problems-every bronchitis with chest wall pain becomes rule out p.e., etc
the place where a med-peds person would shine would be on an inpatient service for instance adult/peds intensivist or hospitalist, just my opinion.

 

[HiFi]

Originally posted by athena21
Looking at the job market, Med-Peds will put you in a MUCH stronger position. You're more specialized than a family practioner and your employer does not need to hire a separate internist. you are much more marketable and will probably make more if you do the extra year and complete a med-peds residency.

from talking to my friends, that did med-peds residency that was just not the case.
like I stated earlier, if you do not do OB/GYN then you can't cover for the FP patients. Likewise, pediatricians and internists can't cover for you, so you are pigeonholed into joining med-ped practice ( or either doing peds or IM in a group of similar specialists)

I am sure there are exceptions but my best friend from medical school is practricing med-peds and these are the concerns he expressed to me after finishing his residency and looking for a job. He eventually joined a med-ped practice which is where he wanted, but there aren't that many around so there was a great deal of competition. He settled for a job in Grand Rapids, MI because there weren't any jobs in Detroit

 

[RuralMedicine]

As a current Med-Ped resident I thought I'd add my two cents. I originally considered doing family practice as I plan on working in a rural area after completing residency. My concern with that was that even the standalone FP programs really didn't provide me with the critical care training I know I will need in a rural area. I'm not knocking FP one of my medical school mentors is an excellent FP PD and I have good friends from medical school who are FP residents across the country. The good FP doctors I know are excellent at preventive medicine, well child care, etc and they recognize their limitations (Hey we all have limitations and that's ok. During my last call I was consulted by an ortho resident about his patient who had been having episodes of v-tach all night. I suggested he might want to correct the patient's hypokalemia, hypomagnesemia, and hypocalcemia and that probably central access would be helpful in doing this--preferably a femoral line because of the risk of placement arrhythmias with subclavian and IJ approaches. The ortho resident informed me that he couldn't do femoral lines or central lines in general and he was feeling overwhelmed. So I put in his line and fixed his patients electrolytes. When in doubt do what's right for the patient). FP residents really are not trained to take care of acute medical issues of hospitalized patients. FP residents are not trained to stabilize acutely ill patients. Eventually I envision working as a hospitalist/ critical care provider in a rural tertiary care hospital and the Med-Peds training I'm receiving will enable me to do this well.

Now to respond to some comments:

From a job market perspective Med-Peds salaries are typically in line with IM salaries (and higher than Peds or FP) obviously geographic and personal factors influence salaries.

Yes you do spend an extra year in residency but in my opinion that extra year is a much needed year as you are completing two residencies in that time. The extra year gives us time to really feel comfortable being Med-Peds providers. In my program (and most others) the internship is 16 months which provides 8 intern months of each specialty. This is enough time to be comfortable with both specialties. As a resident I've found that every once in awhile my peds training is helpful on the medicine side and vice versa. Perhaps it is for this reason that MedPeds residents are often viewed as some of the stronger residents in both departments.

As far as fellowships you can do a combined Med-Ped fellowship in any subspecialty now. Some programs may require a little negotiating but it is definitely possible. Endocrinology and Rheumatology are two areas that may be particularly suited to MedPeds residents. Our residency program has recently had residents do combined fellowships in Endo and GI.

Finally I am interested in Emedpa's comment:
"we have a med-peds doc here but only because we couldn't find an fp willing to take the job( er fast track). they still can't do trauma so their replacement will be fp. most of the time they seem overtrained for the position and launch into huge workups of benign problems-every bronchitis with chest wall pain becomes rule out p.e., etc
the place where a med-peds person would shine would be on an inpatient service for instance adult/peds intensivist or hospitalist, just my opinion."

I agree with you that MedPeds doctors can be excellent hospitalists. However I'm not sure why an FP would be any better than they were at trauma. Perhaps I am biased by the fact that in my residency program we receive excellent EM and critical care training. Admittedly the FP residency at this institution is extremely weak but even if I look at some of the strong standalone programs I considered I don't think their residents were particularly versed in trauma either.

Just my thoughts of course.

 

[HiFi]

Originally posted by RuralMedicine
During my last call I was consulted by an ortho resident about his patient who had been having episodes of v-tach all night. I suggested he might want to correct the patient's hypokalemia, hypomagnesemia, and hypocalcemia .

"Don't call a surgeon for his opinion. Call him to cut"


--I can't claim this quote. A nephrologist said it first

 

[tBw]

Originally posted by emedpa
we have a med-peds doc here but only because we couldn't find an fp willing to take the job( er fast track).

what is the er fast track? If you are referring to board certification in EM for IM people I thought this no longer existed? Or is this some special part of the ER designed to treat people with certain conditions 'faster'???

 

[ewells]

I am interested in more comments about fellowships and the job opportunities afterwards. I read in another thread (which I cannot find now) that peds endocrine is sort of limiting, but I definitely want to work with kids. How would medpeds followed by an endocrine fellowship put me at an advantage? What is the downside, other than the added postgraduate workload and the fact that I would be in my forties when I finally started to practice?

 

[newbie123]

I'm also interested in doing a med-peds residency followed by a med-peds fellowship if one exists. I have a quote from a packet given to me at a residency fair:

"Training in Med-Peds is a great launching pad for many subspecialties. Many subspecialty fellowship programs offer combined adult and pediatric training."

But what and where are these programs? Someone above mentioned hem/onc (which would be my first choice) and cardio (also another interest of mine) But I've never actually heard or a specific program at a specific location. Does anyone know more about this? (sorry if this question has already been asked, I didn't read all the posts above, just skimmed)

 

[run4fun]

A useful link to those interested in combined fellowships in Medicine and Pediatrics

http://www.medpeds.org/PDF/FellowshipGuide.pdf