Why would you choose FM over Med-Peds (or vice versa)?

[futureapppsy2]

Other than the presence/absence of OB training?

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[CalmAndCollected]

IMO, because FM is less years and gives you similar job opportunities.

If you are interested in working primarily as IM or Peds, or want to follow into one of the IM or Peds sub-specialties, I don't see the value in doing combined. If you want to have a practice that sees both adults and kids, FM is generally sufficient.

Combined residencies in general can be hard to justify unless you are interested in a very specific niche.

 

[differentiating]

Med-peds, in my experience, is for people who want to either do a subspecialty in both kids/adults or people who want to attend at academic centers as IM and peds attendings (alternating). If you want to do outpatient, FM probably makes more sense.

 

[futureapppsy2]

Med-peds, in my experience, is for people who want to either do a subspecialty in both kids/adults or people who want to attend at academic centers as IM and peds attendings (alternating). If you want to do outpatient, FM probably makes more sense.

Would you then have to do two subspeciality fellowships (e.g., a peds GI fellowship and an adult GI fellowship)?

 

[differentiating]

Would you then have to do two subspeciality fellowships (e.g., a peds GI fellowship and an adult GI fellowship)?

iirc the med/peds nephrologist I worked with did something like one year of each? Idk how long a typical fellowship is in im/peds

 

[GoSpursGo]

Would you then have to do two subspeciality fellowships (e.g., a peds GI fellowship and an adult GI fellowship)?

It depends. Someone in my program is med-peds trained and doing a combined peds/med onc fellowship. This is a good niche to be in, given the emphasis in peds heme/onc on AYA populations, and how there's definitely a spectrum of patients who get similar oncologic diagnoses in their teens and 20/30s.

Basically, you should have a good reason for going into med-peds in the first place, usually with a fellowship endgame where you're going to take care of AYA patients as they transition from peds to adulthood. If you're going to do general outpatient, or a fellowship where you'll really only do adults OR peds, I don't understand the point.

 

[andrek82]

Fair warning, I'm pretty biased here...

If you want outpatient with mostly adults, FM is fine. If you want to be comfortable with peds, most FM residencies will not give you that. I would argue that the OB and surgical portions of FM are outmoded for most grads since they are limited in practice to women's health (and many don't even do that) and minor procedures. Med Peds can prepare you for both. From a purely primary care perspective, FM is better training for workflow and realities of independent practice, while Med Peds is better for peds and comfort with sicker patients and those survivors of congenital or early childhood diseases.

In the hospitalist world, you can work in both community and academic settings. Most agreements I have seen are a little heavier on adult time due to the patient volumes, but it is definitely available around the country. Here Med Peds has a clear advantage over FM due to more inpatient experience. If you went primarily peds after Med Peds, you'd still be more comfortable with sicker inpatients than the average peds resident. On the adult side you would be more comfortable with CF, CP, and other chronic childhood conditions. I know hospitalists who've chosen all three options and feel their background in Med Peds served them well and gave them a good perspective.

For specialties it is a bit tricky. I'm starting a combined fellowship in a couple months that will take 4 years. Realistically I could ride my peds boards and just do adult fellowship as it is nononprocedural while practicing both, but I wouldn't feel comfortable with that. Different specialties have different requirements, but to be boarded in both adults and peds, typically take the number of years for peds and add one.

All this said, Med Peds isn't for everyone, which is why there are only 78 (I think?) programs. You really have to love both, or it will be a long 4 years. It was right for me, and it was the right choice for the ~90% of grads who practice both through their careers.

 

[VA Hopeful Dr]

Fair warning, I'm pretty biased here...

If you want outpatient with mostly adults, FM is fine. If you want to be comfortable with peds, most FM residencies will not give you that. I would argue that the OB and surgical portions of FM are outmoded for most grads since they are limited in practice to women's health (and many don't even do that) and minor procedures. Med Peds can prepare you for both. From a purely primary care perspective, FM is better training for workflow and realities of independent practice, while Med Peds is better for peds and comfort with sicker patients and those survivors of congenital or early childhood diseases.

I'm going to need you to back that up

 

[andrek82]

I'm going to need you to back that up

That's a fair question. I do know some very competent peds focused FM physicians and work with them on inpatient floors, so this is not a blanket statement at all. If the generalization is too broad, I'd love to know. In terms of board requirements, only 3 dedicated peds months are required, and 25% total training time including outpatient care. Anecdotally, of the current residents I have worked with over 4 years, only 2 provide full spectrum peds care. The rest are either adult only or 15 and up. Since many FM clinics take late teen patients, they are technically practicing pediatrics, but I would argue that doesn't paint the full picture. In terms of evidence, I couldn't find a lot of articles that delved into granular peds data but here are a couple general ones:
Changes in Preparation and Practice Patterns Among New Family Physicians - This article more points to narrowing scope of practice over time, not a uniquely FM problem for sure.
Scope of Practice Affected by Residency Program and Physician Characteristics | ABFM | American Board of Family Medicine - this again points out that scope is narrowing with northeast being a bit worse.

Certainly if you have other info I'd love to hear it.

 

[VA Hopeful Dr]

That's a fair question. I do know some very competent peds focused FM physicians and work with them on inpatient floors, so this is not a blanket statement at all. If the generalization is too broad, I'd love to know. In terms of board requirements, only 3 dedicated peds months are required, and 25% total training time including outpatient care. Anecdotally, of the current residents I have worked with over 4 years, only 2 provide full spectrum peds care. The rest are either adult only or 15 and up. Since many FM clinics take late teen patients, they are technically practicing pediatrics, but I would argue that doesn't paint the full picture. In terms of evidence, I couldn't find a lot of articles that delved into granular peds data but here are a couple general ones:
Changes in Preparation and Practice Patterns Among New Family Physicians - This article more points to narrowing scope of practice over time, not a uniquely FM problem for sure.
Scope of Practice Affected by Residency Program and Physician Characteristics | ABFM | American Board of Family Medicine - this again points out that scope is narrowing with northeast being a bit worse.

Certainly if you have other info I'd love to hear it.

In my group of roughly 60 FPs, only 2 refuse care based on age. The rest of us see kids.

The residency requirement, incidentally, is 4 months not 3. Most places do more, at least everywhere I applied 10 years ago.

There's definitely been a narrowing of scope, no argument there but most of us still see kids.

 

[togaedere]

I am nearing the end of my med-peds residency. Contemplated family medicine as I knew I was destined for an outpatient career. I signed on to my residency clinic as an academic attending.

I sometimes feel like family medicine would have been the better choice. I certainly got more inpatient training and thus do feel prepared to manage sick/not sick in both adults and kids. Though through residency I felt like I was doing most of my primary care from afar (we have so few truly outpatient blocks) - managing my outpatient panel while working on the wards or nights etc. It was definitely very challenging.

I was afraid that I wasnt going to feel comfortable taking care of kids fully with 4 months of training and knew I wanted a balanced practice, so that’s why I chose med peds. It’s hard to say I have regrets, because I love my program, leadership, and coresidents, and I can’t be certain I wouldn’t be “grass is greener” if I had chosen FM. I do love the confidence that comes from being trained in both IM and peds.

 

[deleted480308]

I am nearing the end of my med-peds residency. Contemplated family medicine as I knew I was destined for an outpatient career. I signed on to my residency clinic as an academic attending.

I sometimes feel like family medicine would have been the better choice. I certainly got more inpatient training and thus do feel prepared to manage sick/not sick in both adults and kids. Though through residency I felt like I was doing most of my primary care from afar (we have so few truly outpatient blocks) - managing my outpatient panel while working on the wards or nights etc. It was definitely very challenging.

I was afraid that I wasnt going to feel comfortable taking care of kids fully with 4 months of training and knew I wanted a balanced practice, so that’s why I chose med peds. It’s hard to say I have regrets, because I love my program, leadership, and coresidents, and I can’t be certain I wouldn’t be “grass is greener” if I had chosen FM. I do love the confidence that comes from being trained in both IM and peds.

Glad you’re happy, but you do know most fm residencies see peds the entirety of their program right? My med school rotation site they had peds on their clinic panel from day 1

 

[togaedere]

Sure. But what I was looking for was the training that made me comfortable with outpatient medicine (outside of the well checks and anticipatory guidance of a normal outpatient peds encounter).

I mean doesn’t matter now at this point, the calculation I made at the time was one of training (knowing my personality I wanted to have the board certification, even though I knew plenty of FM docs who were comfortable seeing kids). And I went to school where there was a med peds program and it seemed like a better fit at the time.

one of our attendings at our outpatient clinic is family medicine trained and I can’t tell the difference between her and the MP trained attendings honestly.

when advising someone who is interested in an outpatient career — I never tell them that med peds is clearly superior. Not sayin what I did was the right move, and not saying I’m never sad about, say, having to take 2 board exams or being in residency for 4 years, but it’s what happened.

Glad you’re happy, but you do know most fm residencies see peds the entirety of their program right? My med school rotation site they had peds on their clinic panel from day 1

 

[URHere]

Agree with above. As I see it:

Benefits of med-Peds:
-More inpatient time (good if you want to be a Hospitalist)
-More critical care time (more comfort with sick patients)
-Ability to pursue any IM or Peds fellowship, including combined fellowships (good if you want to specialize)
-More Peds training (2 years + continuity clinic vs 4-6 months + clinic for most FM)

Benefits of FM:
-More clinic time, including more training on how to run a clinic
-More education on in-office procedures
-OB training (and often more women’s health, LARC training)
-Shorter (except for the West coast where some programs are also 4 years)

If you know you want primary care from the beginning and you dislike inpatient medicine, FM may be a better choice because you will have SO MUCH inpatient time with med-Peds. However, lots of med-Peds docs do choose primary care and it does give you more Peds training and more exposure to sick/complex patients.

For context, I’m not a clinic person. I’m wrapping up a med-Peds residency then taking an adult Hospitalist job. Considering further training in Peds EM vs PICU vs global health after that.

 

[BorntobeDO?]

Fair warning, I'm pretty biased here...

If you want outpatient with mostly adults, FM is fine. If you want to be comfortable with peds, most FM residencies will not give you that. I would argue that the OB and surgical portions of FM are outmoded for most grads since they are limited in practice to women's health (and many don't even do that) and minor procedures. Med Peds can prepare you for both. From a purely primary care perspective, FM is better training for workflow and realities of independent practice, while Med Peds is better for peds and comfort with sicker patients and those survivors of congenital or early childhood diseases.

In the hospitalist world, you can work in both community and academic settings. Most agreements I have seen are a little heavier on adult time due to the patient volumes, but it is definitely available around the country. Here Med Peds has a clear advantage over FM due to more inpatient experience. If you went primarily peds after Med Peds, you'd still be more comfortable with sicker inpatients than the average peds resident. On the adult side you would be more comfortable with CF, CP, and other chronic childhood conditions. I know hospitalists who've chosen all three options and feel their background in Med Peds served them well and gave them a good perspective.

For specialties it is a bit tricky. I'm starting a combined fellowship in a couple months that will take 4 years. Realistically I could ride my peds boards and just do adult fellowship as it is nononprocedural while practicing both, but I wouldn't feel comfortable with that. Different specialties have different requirements, but to be boarded in both adults and peds, typically take the number of years for peds and add one.

All this said, Med Peds isn't for everyone, which is why there are only 78 (I think?) programs. You really have to love both, or it will be a long 4 years. It was right for me, and it was the right choice for the ~90% of grads who practice both through their careers.

Adding my small contribution, but as someone who interviewed a bunch of FM programs this last season but who only wants to do peds/adults and not OB, I can confirm all the FM programs I interviewed at had significantly more time in OB than peds. Only one was even set up to do more than 2 rotations in peds. I used to think it was OB that got the short end of the stick in Family. Now I think it’s peds. If your interest is kids with adults, I think med-peds is a better route.

 

[VA Hopeful Dr]

Adding my small contribution, but as someone who interviewed a bunch of FM programs this last season but who only wants to do peds/adults and not OB, I can confirm all the FM programs I interviewed at had significantly more time in OB than peds. Only one was even set up to do more than 2 rotations in peds. I used to think it was OB that got the short end of the stick in Family. Now I think it’s peds. If your interest is kids with adults, I think med-peds is a better route.

Where roughly did you interview?

I ask because all 6 of the programs in my area that I interviewed at have more peds than OB so I'm wondering if this is a regional thing.

 

[mvenus929]

Adding my small contribution, but as someone who interviewed a bunch of FM programs this last season but who only wants to do peds/adults and not OB, I can confirm all the FM programs I interviewed at had significantly more time in OB than peds. Only one was even set up to do more than 2 rotations in peds. I used to think it was OB that got the short end of the stick in Family. Now I think it’s peds. If your interest is kids with adults, I think med-peds is a better route.

This was true of the family medicine programs that rotated with us in residency. They did one month of Peds ED (where they saw fewer and lower acuity patients than our peds interns), one month of Peds wards (where they saw lower acuity patients), maybe 1 month of newborn nursery (usually more like 2 weeks, and they'd see the infants of the mothers they followed for OB), and a month of ambulatory pediatrics which was really just peds clinic like 2-3 half days per week with the rest being FM clinic. I know they saw some peds in their own clinic, but anything complicated usually ended up in our panels since we were literally across the street.

 

[hallowmann]

This was true of the family medicine programs that rotated with us in residency. They did one month of Peds ED (where they saw fewer and lower acuity patients than our peds interns), one month of Peds wards (where they saw lower acuity patients), maybe 1 month of newborn nursery (usually more like 2 weeks, and they'd see the infants of the mothers they followed for OB), and a month of ambulatory pediatrics which was really just peds clinic like 2-3 half days per week with the rest being FM clinic. I know they saw some peds in their own clinic, but anything complicated usually ended up in our panels since we were literally across the street.

This is all very program dependent. Where I did my cores in med school, the FM residents barely saw Peds patients in clinic and since there was no affiliated Children's Hospital or Peds residency, inpatient volume was basically non-existent except for the newborn nursery or NICU.

That is a very different picture compared to our categorical FM residents where I'm training. They do a month in Peds ED (same complexity and volume of patients as the Peds residents - often 2nd or 3rd years), a month of Peds ambulatory (again simply alternating patients in the gen peds faculty clinic with the Peds interns), a month of NICU (again alternating patients with the Peds intern), a month of Peds inpatient as a junior on the Peds team (3 wks of days, 1 wk of nights, again as many and same acuity patients as the Peds interns), and a month in 3rd year of Peds specialty clinics (not sure of that one because we do more gen peds ambulatory to fulfill this compared to the categorical residents). They also do at least 2 blocks each in second and third year on the FM OB service where they round on newborns of the FM OB patients, although volume is obviously lighter than the Peds newborn nursery service. There are lots of Peds in COC clinic, but depending on the clinic there are more or less. I still think the majority of Peds patients see the Peds residents/attendings, but the FM department recently started an "in-school" clinic for underserved youth weekly to get a bit more volume. I think that's an elective though.

 

[MedicineZ0Z]

This was true of the family medicine programs that rotated with us in residency. They did one month of Peds ED (where they saw fewer and lower acuity patients than our peds interns), one month of Peds wards (where they saw lower acuity patients), maybe 1 month of newborn nursery (usually more like 2 weeks, and they'd see the infants of the mothers they followed for OB), and a month of ambulatory pediatrics which was really just peds clinic like 2-3 half days per week with the rest being FM clinic. I know they saw some peds in their own clinic, but anything complicated usually ended up in our panels since we were literally across the street.

This is very heavily program dependent. We do the full ED/clinic/critical care time/inpatient and never see any lower acuity than the Peds residents on average. And definitely not fewer in number.

I suspect *most* of these FM opinions are coming from East coast folks. The referral central of the world.

 

[VA Hopeful Dr]

This is very heavily program dependent. We do the full ED/clinic/critical care time/inpatient and never see any lower acuity than the Peds residents on average. And definitely not fewer in number.

I suspect *most* of these FM opinions are coming from East coast folks. The referral central of the world.

Other than your blindingly ignorant geographic generalization, I agree with this.

The university hospital where I went to med school had FM residents taking the same call/clinic patients as the peds residents. The university hospital where my wife did residency definitely treated the FM residents as second class citizens, giving them fewer and less complicated patients.

I think the idea setup is a place with a dedicated peds area at an unopposed program. We had a standalone women's/children's hospital. Every admitted pediatric patient went to us with peds hospitalist attendings. We did 90% of the newborns (some private patients), and the rest we got if they needed level 2 NICU care. The subspecialists from the tertiary center came over 1 day/week and we rotated with them when they were there. The only thing we didn't have was a PICU and very few FM programs do that.