As third year medical students you’re rotating through your general specialties and you think you’re seeing familiar faces but in new places. Isn’t that your newborn nursery resident who assigned APGAR scores, now leading the code in the medical ICU? Some of you may have had similar déjà vu experiences but rest assured, your mind isn’t fooling you. At 79 programs across the USA and Puerto Rico, Combined Internal Medicine and Pediatric residents walk (briskly) through the halls of the hospital carrying both PALS and ACLS cards in our coat pockets. Our minds have been shaped to think broadly and decisively. We carry an air of calmness from our critical care rotations yet we know when to appropriately turn to our goofy side to connect with our patients. Through four years of versatile training, we are training to be the 21st century physician.
The Combined Internal Medicine-Pediatrics (commonly referred to as “Med-Peds”) is a four-year residency-training program that leads to dual board certification in Internal Medicine and Pediatrics. While there are many combined training programs offered in the US, the Med-Peds residency is by far the most ubiquitous and popular program available. During the four years of training, residents undergo a rigorous schedule of rotations ranging from adult and pediatric wards, MICU, PICU, NICU, CCU, Med-Peds clinic and specialty electives. By graduation, residents will have completed a total of 2 years of adult and 2 years of pediatric training. The frequency at which residents switch from one “side” to another changes depending on the individual residency program. The end product is the same: Individuals who are prepared to deal with acute, complex, chronic and preventive care for both adult and pediatric medical conditions. The broad training creates an endless list of career possibilities. We each carve out a niche that best fits the career interest we have in mind.
The History of Med-Peds
In 1967, Med-Peds became the first combined specialty approved by any board and is currently the only accredited combined specialty by the Accreditation Council of Graduate Medical Education (2007). In 1968, Lawrence Cutchin, MD was the first physician to complete training in both internal medicine and pediatrics at the University of North Carolina. Given the success of his training, other programs soon followed suit. Accredited programs emerged in the 1970s and proliferated on the national scene in the 1980s. The programs attracted a diverse array of applicants with strong medical training, excellent clinical potential and diverse interests. Recognizing these unique qualities in residents encouraged other programs to consider starting residencies of their own. By the 1990s, there were 106 programs across the country. While budget cuts in the early 2000’s led to some program closures, interest in Med-Peds has regained momentum with 3 new programs opening in the last 2 years. In 2016, there will be 79 programs across the US and Puerto Rico offering Med-Peds training.
The Med-Peds specialty has the most residents of any combined program (about 1400) and the most graduates (about 8000). Although programs are smaller than their parent categorical programs, Med-Peds has maintained a high match fill rate at 99% in 2015 with only 1 position open after the match. US medical graduates filled ~ 84% of the available residency spots.
While board certification in two broad specialties appears a daunting task, the reality is that after 4 years of training, residents are well prepared to pass their boards. Between 2010-2015, the pass rate for Med-Peds graduates has been statistically equivalent to categorical residents.
A common question among medical students considering Med-Peds is “what careers do Med-Peds residents pursue after graduation?” About 50% of graduates go on to do primary care with up to 93% of those individuals caring for adults and children. Hospitalist medicine is another popular choice, chosen by 25% of recent graduates. The number of graduates pursuing fellowship changes from year to year but about 25% annually go on to pursue fellowship after residency. It is true that there are Med-Peds trained individuals who go on to practice primarily adult or pediatric medicine, but in practice many of those individuals are providing care in a niche of medicine only available to those who have training in all ages. Examples include an adult cardiologist caring for a population of emerging adults who were born with congenital heart defects– drawing on their training in adolescent development, management of congenital heart disease and knowledge of adult cardiology.
What are the career options?
The beauty of Med-Peds training is the unique variety of career opportunities available to its graduates. Individuals can choose to stay as general as possible due to comprehensive training that is ideal for a primary care practice, or trainees can move onto fellowship to carve out the most subspecialized niche that only those who complete a Med-Peds residency can effectively fill. Regardless of what you choose, you will undoubtedly incorporate the training you received in both specialties into your future career.
As mentioned previously, about 75% of graduates choose to stay in generalized medicine by either practicing in primary care (50%) or hospitalists (25%). More than 80% of graduates also maintain an academic affiliation in whatever field they choose. Many will go on to work right out of residency while others pursue additional training. Med-Peds graduates have career interests that go beyond patient care and are working in the policy and public health fields. Some examples include work with the Epidemic Intelligence Service through the Centers for Disease Control, policy work with USAID, and health services care for adults with developmental disabilities. If you choose to continue training beyond the four years of residency, there are many clinical fellowship subspecialty options as well. You are eligible to choose any Pediatric fellowship, any Internal Medicine fellowship, or a combined Med-Peds Fellowship. Combined fellowships are typically the length of a (pediatric fellowship + internal medicine fellowship) – 1 year. There are several subspecialties that lend themselves more specifically to the combined Med-Peds field, such as Infectious Disease and Global Health. Then there are other opportunities to specialize in one field (ie. pediatric pulmonary) and care for a unique population (ie. cystic fibrosis). Ultimately, this is a long way of saying there are many possibilities to make your career special and fulfilling through Med-Peds, and the best part about it – you’ll be surrounded by like-minded people who want to support you and your goals!
The next time you have an opportunity, sit down and chat with a Med-Peds-er. Our residency training fosters common threads in our thinking but each of us brings to the specialty a unique perspective on medicine, as well as an endless list of career possibilities. Each program has a different spin on training and regional differences between residencies provide adequate variation to allow each person to find the perfect residency match. Interest in our specialty is growing as the demand for people well versed in adult and pediatric medicine increases, so we encourage all of you to talk to us for more information. One of the things that all Med-Peds residents can agree upon is that we enjoy working in an environment supportive of our varied interests and we love sharing our excitement for Med-Peds with others.
If you are interested in learning more about the Med-Peds specialty, please visit the National Med-Peds Residents’ Association (NMPRA) website at www.medpeds.org. Especially for those people without Med-Peds programs at their institutions, we encourage you to reach out to us at NMPRA. We now cohost a subforum with SDN to answer questions pertaining to Med-Peds.
“2015 Match Data.” 2015.PowerPoint Presentation. 2 Aug 2015. Retrieved from: http://www.medpeds.org/what-is-med-peds/speaker-kit/
Newton, Dale. “In the Beginning: A Fast History of Med-Peds.” 2 Aug 2015. PowerPoint Presentation.
“Speakers Kit 2015.” 2015.PowerPoint Presentation. 2 Aug 2015. Retrieved from: http://www.medpeds.org/what-is-med-peds/speaker-kit/
A Special Thank You
We would like to thank Drs. Suzanne McLaughlin, Brown University Med-Peds Program Director, and Allen Friedland, Christiana Care Med-Peds Program Director, for their thoughtful comments and data used in this article.