Monday, December 12, 2011

Guest post: Med Peds

In medical school, I started off wanting to do Family Practice.  I always knew that I wanted to do primary care.  With Family Practice, I would be able to see the whole spectrum of ages, and care for the whole family across generations.  While I was in the midst of planning my 4th year rotations, a friend suggested that I consider Med Peds.  It was about the same time that I realized how little Peds rotations are required in Family Practice, and how much OB was required.  I knew that I wasn’t going to do OB, so it seemed like a complete waste of time. 

I ended up matching in Med Peds, and realized after the first 3 months of internship when we switched specialties that I was in deep trouble.  (My program, typical of many Med Peds programs, has residents switch from Medicine to Peds every 3 months and so on.)  Throughout my residency, I felt like I was constantly behind all my categorical colleagues.  I was also tired of having to do so many inpatient and ICU rotations.  That’s what happens when you try and cram two 3 year residencies into 4 years. 

When I got pregnant in my 4th year, I was forced to give up my international rotation.  I was very upset, and felt that I was being punished for being a woman and pregnant.  (This harkens to all the blog entries and posts about residency requirements for maternity leave, time off, etc etc.)  There were too many core rotations to do, and so I couldn’t do a “fluff” rotation when I was already going to take time off for maternity leave.  (I took 8 weeks off after having a C-section for a premie, and then in the midst of trying to establish breastfeeding, went back to outpatient clinic 2 half days a week 2 weeks afterwards, and also had to do a rotation that involved reading books and writing papers.  After all that, I had to make up 2 weeks at the end of residency.) 

In retrospect, I would have just forced myself to pick either Medicine or Peds.  It was too stressful trying to do both.  At heart though, I do enjoy being a Med Peds doctor.  I still enjoy taking care of the whole spectrum of ages, and feel that I received excellent training despite feeling behind my categorical colleagues during residency. 

The best part of it is that after practicing for a few years in a more traditional setting with lots of inpatient call, I now have a job that is 100% outpatient.  I see patients Mon to Fri, and have no weekend and no overnight inpatient calls.  Yes, I do have to be available 24-7 to answer telephone calls, but it’s a world of difference from having to go in to the hospital in the middle of the night.  With primary care, it’s entirely possible to find a group that does purely outpatient.  Additionally, you have the option of doing urgent care or being a hospitalist, and these types of options are far better in my mind than traditional outpatient plus inpatient duties.  With the increasing popularity of hospitalists, both adult and peds (though peds is now just starting to catch on), there are now more and more options for practices that allow you to work more regular hours where you can actually see your kids.  It will be not prestigious or lead to awards and recognition if you are looking for a purely outpatient job, but as long as you don’t aspire toward a distinguished academic reputation, then you have options. 


  1. I think just about every Med Peds resident feels like they are in "deep trouble" sometime into intern year. And it tends to last for a while -- the 1st part of the second year is the worst for lots of us. That said, most of us end up doing fine on both sets of boards, and the majority continue to practice both medicine and pediatrics in some form as attendings. The practicing med-peds docs in primary care in this community are some of the very best. I personally opted to go for fellowship training, and now am a med-peds rheumatologist, which I love. Residency was hard, but absolutely worth it.

  2. It seems like a great specialty for people who are interested in particular in the transition from peds to adult medicine. At least that's what all my friends who are applying in med-peds say. Have you found that to be the case in your practice?

  3. As a Canadian, it's interesting to me how many differences there are between American and Canadian residencies. I'd never heard of Med Peds before! Also, Internal Medicine is a minimum of four years (usually 5+ for subspecialties) in Canada. Interesting how the two countries structure things differently.

  4. Interesting from Australia too- i've laso never heard of Med Peds. Each of those programs is 5 years here, so the thought of combining them? How does it work? Are most of your patients adults or children?

  5. My classmates and other residents who trained in my program went on to do a variety of other things. Some are doing just subspecialty internal medicine or peds, some are doing combo subspecialty, some are doing other things such as CDC/public health related stuff. Some are hospitalists, some are in primary care. There are a few in particular that have really utilized the combination of internal medicine and peds. One person trained in peds heme-onc with the plan to do sickle cell care into adulthood. One trained in peds cardiology with the plan to do congenital heart disease into adulthood. One person trained in neonatology and palliative care (adult/peds) and is in both departments doing some very interesting research. We have some also that have trained in combined specialties e.g. endocrine, rheum, cardiology, etc.

    Old MD Girl - It's been particularly comfortable doing adolescents, particularly more adult issues in adolescents e.g. type 2 diabetes, hyperlipidemia, and also more pediatric type problems in adults e.g. Angelman syndrome, phenylketonuria, etc.

    Solitary Diner - In terms of Canada, that was something we'd investigated previously, since my husband is Canadian. At this point, as far as I know, Canada does not recognize Med Peds qualifications, which means I will never be moving to Canada. More residency?! Shudder!!

    Juggler - The ideal situation for a primary care doc is 50-50 between adults and kids. It's possible to build up such a practice, and that's how it was in my previous practice. Demographics-wise it's similiar to a family practice patient population, except that there is a tendency for family practice to trend toward older and geriatric populations, just because people generally like to bring their kids to pediatricians rather than family practice doctors if they are available. Plus family practice docs are generally less comfortable with more complicated peds patients.


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