Some questions on MD/PhD, residency, and fellowships

[mercaptovizadeh]

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1.) It is possible in practice to do two different specializations, given that they stem from internal medicine. I've heard that sometimes rheum and allergy/immuno are combined. In other words, would it be possible to do heme/onc and ID, for example? How are multiple fellowships looked upon in academic medicine?

2.) The combined IM/Peds residency, how well does it train MD/PhDs interested in research and some clinical work? How is it looked upon by fellowships and beyond? Do top IM/peds programs allow for this (e.g. MGH and Boston Children's, etc.)?

3.) Do fellows almost always stay at the same institution for a tenure track position, or is it reasonably possible to switch institutions for a first faculty position, particularly to the one where med school/residency was done?

 

[greg12345]

1) While theoretically possible to do 2 specialities, almost no one does it. You would have to do 2 fellowships (e.g. one in ID and one in heme/onc) to be clinically trained with each fellowship usually being 3 years...that's a lot of training for someone who already spent 7-8 years in med school and 2-3 years in residency. I know a few faculty who trained in two different fellowships, but they only practice one. In my limited experience it would not be practical to try to pursue multiple fellowships.

2) MED/PEDS residencies will not train you at all for research, that is not their purpose. Their purpose is train you clinically in the basic aspects of internal medicine and pediatrics. Sure, you might have several months during the 4 year training track which you can devote to "research", but how much research can you get accomplished in several months (even if they are contiguous, which they might not be). The real research training you get will be during your fellowship. Some places these days offered combined fellowships for med/peds graduates, e.g. a combined pediatric and adult heme/onc fellowship but traditionally most of the med/peds grads I know either pick an adult or pediatric subspecialty for their fellowship.

3) It is reasonably possible to switch institutions for your first junior faculty position, and many people do this.

 

[Circumflex]

I agree wth everything Greg12345 said. It may sound interesting to be trained in multiple areas so that you can do many things, but to be a successful academician (especially if you want tenure), you have to focus your career, especially the research portion. As an MD/PhD doing research and clinical work, you will have your hands full keeping up with your field of science, much less your clinical area. Clinicians have to recertify every so often and Hem/Onc and ID reccomendations are constantly changing - trying to be good at both + research would be insane - not to mention how old you would be (as Greg12345 mentioned) after MD/PhD, residency, and 2 fellowships.

A few of my friends did Med/Peds residencies and none of them do both - they all did fellowships in either an adult or ped specialty. Plus, they talked about issues of finding people to take call for them (weekends, etc.). When you have adults and kids in the hospital, you have to either find another Med/Peds person to take call or find 2 people - IM and a pediatrician. This is a little off-topic, but I thought I would mention it.

As a physician-scientist, the goal for most is to blend basic research with clinical practice and it is not practical to have a large clinical load.

 

[greg12345]

If you are really dying to do Med/Peds followed by subspecialty training, the one area you could really do it in is Allergy/Immuno. I could see where a combined adult/ped endocrinology fellowship could be feasible as well. Both nice outpatient specialties where the pathophysiology between kids/adults overlaps quite a bit...and almost no emergencies, hence minimal call.

I loved peds and considered doing med/peds pretty heavily, but in the end it just isn't worth it if you are just going to subspecialize in either adult or pediatrics. Med/Peds is really designed for primary care docs (essentially like family med but without the OB/GYN training).