Torn between Peds and Med

[Benzo4every1]

Are you in the same situation? Did you have to pick? Did you decide on Med-Peds? What have you? I really cannot tell what I want to do. Any suggestions? Appreciate all comments. Thanks! B-

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[12R34Y]

Go with a combined Med/Peds program. It is only one more year (4 years!) for two board certifications in both medicine and peds.....if you did them seperately that would be six years! i'd say go med/peds and from what I've heard they aren't all that competitive.

later

 

[Man In The Box]

Med/Peds can actually be fairly competitive depending on where you want to go.

 

[Gut Shot]

I don't know, the Med/Peds residents I've known are some of the most miserable and unhappy creatures I have ever encountered. Getting the requisite number of cases/procedures to sit for boards can be hell for them. That's the dark side of having only 4 years to train. From what I've seen, most of them end up practicing essentially medicine or peds, which they could've done anyways without the combined training.

That said, I'm sure there are some Med/Peds folks who utilize both aspects, and for them it was a good move.

 

[Man In The Box]

Seems like Med/Peds would be a good mix for someone wanting to go into pediatric cards, pediatric GI, etc.

 

[kinetic]

Are you in the same situation? Did you have to pick? Did you decide on Med-Peds? What have you? I really cannot tell what I want to do. Any suggestions? Appreciate all comments. Thanks! B-

It would probably be best if you picked one or the other, or at least figured out what your long-term goal was. For example, if you plan to just enter private practice, then realize that if you have a mixed adult/child patient population, you're setting yourself up for difficulty. In essence, you can only partner up with other Med-Peds people (because if a peds patient presents to the person on call and they are not a peds specialist, you're SOL). In addition, the residency is much more difficult, given that you are basically trying to cram in two residencies into four years, which means you spend almost all four years on call and probably will get few elective months. Moreover, you end up having to maintain double certification. Therefore, if your sole motivation is "I like kids" or "I still want to treat adults," I'd think things through more carefully.

 

[novacek88]

Go with a combined Med/Peds program. It is only one more year (4 years!) for two board certifications in both medicine and peds.....if you did them seperately that would be six years! i'd say go med/peds and from what I've heard they aren't all that competitive.

later

I was torn and settled on IM in the end. Most Med/Peds people eventually choose one field over the other. I don't recommend this path unless you are for sure interested in being a generalist. If you are interested in pursuing a fellowship, I highly discourage this path because the extra year is waste and you will work harder during all 4 years because you are combining two residencies in one. I know some people erroneously pursue med/peds to become a more competitive candidate for fellowship. It will make you slightly more competitive but it's not worth wasting another year and sacraficing more of your free time during residency just for this slight edge.

 

[jeffreydsolomon]

I don't know, the Med/Peds residents I've known are some of the most miserable and unhappy creatures I have ever encountered. Getting the requisite number of cases/procedures to sit for boards can be hell for them. That's the dark side of having only 4 years to train. From what I've seen, most of them end up practicing essentially medicine or peds, which they could've done anyways without the combined training.

That said, I'm sure there are some Med/Peds folks who utilize both aspects, and for them it was a good move.

Just to set the record straight:

A literature search by Campos-Outcalt et al. showed that approximately 80% of med-peds graduates achieved certification in both specialties, one third subspecialized to some degree, and 80% provided care to both adults and children (Campos-Outcalt D, Lundy M, and Senf, J. Outcomes of Combined Internal Medicine-Pediatrics Residency Programs. Academic Medicine 2002;77:247-256).

More recently, a Web-based survey of U.S. med–peds residency program directors based on residents completing their programs from 1998 through 2002 (responses were obtained from 92% (83/90) of the programs, reflecting 1,595 residents entering med-peds programs) showed that 82% were seeing both adults and children, 22% went on to subspecialty residencies, 21% began practice in rural or underserved areas, and 25% entered an academic position. Overall, 79% of the 1998 graduates were board certified in both specialties. (Frohna JG, Melgar T, Mueller C, Borden S. Internal Medicine-Pediatrics Training: Current Program Trends and Outcomes. Academic Medicine 2004;79:591-596).

Respectfully yours,

A Most Miserable and Unhappy Creature

 

[12R34Y]

Yeah, I don't think the posters have much experience with med/peds after the residency. The study listed previously lays that to rest. Most med/peds folks see both adults and peds and do quite well.

I know several.....One is a med/peds guy who did a pediatric critical care fellowship and runs the PICU and still has an adult medicine clinic. He's doing quite well and happy to boot.

I say go med/peds. 4 years and double boarded. can't beat that. the guys at my institution are happy and much more well rounded than straight peds or straight medicine. Several also work in family medicine groups. they just don't see OB.

later

 

[Gut Shot]

Just to set the record straight:

Thank you for the data, AMMAUC. A couple of points, however.

1. My post was pure anecdote, and opinion drawn from my experience. I have only worked closely with three med/peds residents, but all of them spent their fair share of time groaning about the demands. Perhaps they will be singing a different tune when they are in practice.

2. Some would say, myself included, that an 80% rate of double certification is actually not that great. That means that one out of every five does not complete both (for whatever reason).

3. I am glad that most med/peds docs see both adults and children, but I would be curious to see a more thorough breakdown of their practices. I bring this up because many specialties can see both adults and children in at least some capacity. Pediatricians can see adult cystic fibrosis patients, FP's can see both adults and children, rads, onc, neuro, OB/GYN, etc. If I end up practicing general private practice pathology I will certainly have peds cases cross my desk.

I guess my point is that it is impossible to infer from the numbers whether the combined training was a good choice for most meds/peds doctors, or whether it is too often swatting a fly with a Buick.