Switching from peds to FM

[Pedstogas]

Maybe a bit unusual, but I'm a current peds resident (PGY-1) looking to switch into FM. Reasons being: I miss adults, I dislike inpatient medicine and would not want to do it for the rest of my career, I miss being able to do procedures in-office, I discovered through my continuity clinic that having my own patient panel to follow up on and who I get to know is pretty awesome. I also like the breadth of FM, and it would still let me have peds as part of my practice. I'm not sure how approach a potential switch, however, and I feel like it might be too late to apply this year.

If it matters, I'm a USMD, Step scores 235/250, I did an inpatient FM sub-i, and two of my letters were from FM faculty. I thought of reaching out to them for letters, but not sure if it would be appropriate to do so since I haven't worked with the for over a year. I also figure I would need a third letter from my current residency program.

Anyone with any advice/thoughts/pusback?

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[deleted87716]

One of my friends completed his peds residency and then switched to FM (my program - nearly 20 years ago). Now, he's a hospitalist/administrator, so...go figure. In the end, it's all about transferable skills and experience.

 

[septoplasty]

I mean, intern year, its "almost" all the same in primary care fields, so certainly that's a benefit.

Just be aware, you'll get significant in patient ADULT experience (divided into ICU/CCU etc.), as well as in patient peds experience. Can't avoid it altogether.

You might not be able to match in the most competitive programs, but you'll have an easier time than an IMG that's for sure seeing it purely from scores/training, no red flags?.

Sometimes, programs also offer advanced level positions outside of the match. You need to contact programs that have PGY2 vacancies and see if they'll look at your app. NRMP doesn't necessarily get too involved w/ PGY2+ positions (I mean, that all in policy afaik doesn't apply).

 

[wysdoc]

Maybe a bit unusual, but I'm a current peds resident (PGY-1) looking to switch into FM. Reasons being: I miss adults, I dislike inpatient medicine and would not want to do it for the rest of my career, I miss being able to do procedures in-office, I discovered through my continuity clinic that having my own patient panel to follow up on and who I get to know is pretty awesome. I also like the breadth of FM, and it would still let me have peds as part of my practice. I'm not sure how approach a potential switch, however, and I feel like it might be too late to apply this year.

If it matters, I'm a USMD, Step scores 235/250, I did an inpatient FM sub-i, and two of my letters were from FM faculty. I thought of reaching out to them for letters, but not sure if it would be appropriate to do so since I haven't worked with the for over a year. I also figure I would need a third letter from my current residency program.

Anyone with any advice/thoughts/pusback?

In my pediatrics residency almost 100% of our training was with hospitalized patients and with some very specialized and very ill patients (bone marrow transplant, liver transplant, etc.). We were "supposed to" go to an outpatient continuity clinic once a week but I never got done with ward duties in time to go. In pediatric practice my first job was about 10% inpatient work and subsequent jobs 0% inpatient work. So, add that to your things to think about as you consider changing your focus.

 

[PTPoeny]

If you miss adults then it makes sense to switch to FM. But most of the rest of your concerns aren't different between Peds and FM. Most of my co-residents are doing outpatient pediatrics with no inpatient work at all, you can do procedures in office, and most outpatient pediatricians have a patient panel they follow and get to know and then see their kids and so on. I had attendings seeing the grandkids of patients they started seeing in residency. Unfortunately most residencies have trouble with the continuity in residency but it isn't impossible if you have motivated patients.

 

[Shambere]

Unless you cant, stick with peds a little longer. you ll see

 

[NurWollen]

In my pediatrics residency almost 100% of our training was with hospitalized patients and with some very specialized and very ill patients (bone marrow transplant, liver transplant, etc.). We were "supposed to" go to an outpatient continuity clinic once a week but I never got done with ward duties in time to go. In pediatric practice my first job was about 10% inpatient work and subsequent jobs 0% inpatient work. So, add that to your things to think about as you consider changing your focus.

What? Really? Who saw all your patients waiting for you in your continuity clinic? This doesn't seem real. A program like that should be shut down.

 

[wysdoc]

What? Really? Who saw all your patients waiting for you in your continuity clinic? This doesn't seem real. A program like that should be shut down.

There were no patients "waiting for me" in the continuity clinic. I did go to some of the days but I never saw the same patient twice because they did not set it up truly as a continuity clinic. It was an outpatient peds clinic only. I think that by now that residency has improved things so that outpatient training time is protected and is separate from ward rotations.

 

[BigRedBeta]

First, don't miss the forest for the trees. Being a peds attending does not mean you have to have any portion of your career being inpatient if you don't want it to be...after you get through residency. Obviously there are plenty of 100% outpatient peds jobs out there, with even some subspecialties having no inpatient requirements (ie Developmental Peds or Adolescent) in case you didn't want to do general peds.

I guess my question is how bad do you miss adults? Like is it just a "well it would be nice to have some patients able to talk to me every now and then" or like "my professional soul is incomplete, and I'll never be fulfilled as a physician because there are no adults to be seen"?

If it's just a "nice to have" sort of thing, stick with peds, it's simply not worth the headaches of transferring to a different field - far better to wait and then set up your practice to focus more on adolescents. I have a couple friends in general pediatrics who are the adolescent "specialists" in their big group practices. They didn't do an adolescent fellowship or anything, just that they set up with their partners an agreement that kids eventually age out to them. Their partners are happy with the arrangement because they can focus on little kids and babies that they like, and my friends get to do different things with how they schedule clinic times and work with the surrounding school districts. Not a bad set up if you can work it out.

On the other hand, if not seeing adults is a gaping hole in your self-perception of your career as a physician, then yes, by all means, you need to move on.

The other thing I'd throw out, not that it would cut down on your inpatient experience during residency, is would you consider doing Med/Peds? Obviously another year and lots of inpatient experience, but the entirety of your peds intern year would count. I think there is something to be said for being board certified in IM and Peds vs FM (sorry, sorry, I know this is the FM forum). Unless you have an interest in doing the OB portion, I think Med/Peds gives you a better knowledge base than FM.

 

[LeroyJenkinsMD]

I agree with the above post. Unless you want to deliver babies, IM/peds > FM. Especially, if you're going to be losing a year by going to FM.

 

[deleted87716]

Unless you have an interest in doing the OB portion, I think Med/Peds gives you a better knowledge base than FM.

Maybe for inpatient, but not for outpatient. Also, having to certify/recertify two different boards sucks.

 

[TableMD]

I don't think anyone rationally disputes that all things being equal, the average Med-Peds training will have several orders of magnitude greater inpatient experience/diversity/volume. Why? You take two reasonably motivated/intelligent twins and you out one of them in the hospital more, they are going to be better in the hospital.

At issue is whether this is in OP's interest, as he/she does not seem to like hospitals all that much. I can relate. Med-Peds may be great for some, but that will not help the OP if they are burnt out/unhappy. The only time I bother with hospitals is to visit patients of mine and check with the admitting service. As a fellow hospitals were useful to learn from the ortho trauma service regarding fracture care, but otherwise, generally glad to be done with it.

As an aside, remember that if you spend a lot of time learning inpatient medicine, you are giving up outpatient opportunities. There is more to obstetrics than deliveries, there is the overall breadth of gyn care that factors into a woman's health, being up on that stuff adds to your clinical experience, as do procedures and comfort with conditions that aren't worked up in a hospital. No one in a hospital floor is going to teach you how to a do a carpal tunnel injection or deal with a dislocation or fracture on the sidelines of a game. For me, being able to do a physical exam to help distinguish hypermobile EDS from classical EDS or a concussion eval and make a return to play decision is more useful than being able to rattle of the various RTA subtypes.

OP, do what you gotta do and good luck. The easiest thing though, may just be to stick out the 2 years and keep an older/adolescent panel?

 

[VA Hopeful Dr]

Maybe for inpatient, but not for outpatient. Also, having to certify/recertify two different boards sucks.

And outside academics, I've seen very few Med/Peds people actually practicing both. They usually end up picking IM or peds.

 

[AFMD]

[...]
The other thing I'd throw out, not that it would cut down on your inpatient experience during residency, is would you consider doing Med/Peds? Obviously another year and lots of inpatient experience, but the entirety of your peds intern year would count. I think there is something to be said for being board certified in IM and Peds vs FM (sorry, sorry, I know this is the FM forum). Unless you have an interest in doing the OB portion, I think Med/Peds gives you a better knowledge base than FM.

Don't forget the ability to specialize. You can gain a nice knowledge base as you work as a family physician, and I don't think that the starting knowledge base is a good reason for the extra year because you'll get that anyway as you work as a physician.

 

[deleted87716]

Don't forget the ability to specialize.

I don’t see the point of doing med-peds if you intend to specialize. You’d have to pick one path or the other, so you’d just end up spending an extra year in residency and waste half of your training.

 

[VA Hopeful Dr]

I don’t see the point of doing med-peds if you intend to specialize. You’d have to pick one path or the other, so you’d just end up spending an extra year in residency and waste half of your training.

The one exception I could see to that is allergy, but as an internist can do that and then treat kids just fine its definitely overkill.

 

[AFMD]

I don’t see the point of doing med-peds if you intend to specialize. You’d have to pick one path or the other, so you’d just end up spending an extra year in residency and waste half of your training.

Just leaving the option open. I wouldn't do it, and I don't think it's worth it for most, but to some it is important.

The one exception I could see to that is allergy, but as an internist can do that and then treat kids just fine its definitely overkill.

This really gets me. Family physicians are uniquely qualified for allergy/immunology fellowships with training in adults and peds, certainly much more than IM or peds on their own. But, we are excluded. It's silly.