Subspecialty Careers: Combined Internal Medicine and Pediatrics
The Discipline
Combined Internal Medicine and Pediatrics (Med-Peds) residency programs provide concurrent, dual training in Internal Medicine and Pediatrics and allow eligibility for board certification and practice in both disciplines. Physicians practicing Med-Peds see both adults and children in a variety of practice settings and practice styles. Practice settings range from outpatient primary care to inpatient hospitalist practice, and practice styles range from urgent acute illness care to the longitudinal chronic illness care of patients with congenital heart disease.
Recognizing the need for physicians with in-depth skills in the provision of care to adults and children, the American Board of Internal Medicine and the American Board of Pediatrics approved combined training leading to dual board eligibility in 1967. Since then, combined internal medicine-pediatrics residency programs have flourished, especially since the mid-1980s. Med-Peds attracts bright, capable physicians desiring a challenging career path either in primary care or further subspecialty fellowship training.
With their in-depth knowledge of both internal medicine and pediatrics, Med-Peds physicians can synthesize their clinical knowledge into care for patients spanning the spectrum from birth until death. They encounter a wide variety of patients and clinical scenarios: well baby visits, high risk deliveries, newborn assessments, common childhood illnesses, emergency room visits, basic gynecology care, inpatient adult and pediatric patients, outpatient adult and pediatric patients, adult and pediatric intensive care. Because of their dual training, Med-Peds physicians are uniquely qualified to care for adolescent patients, particularly children with complex and chronic conditions as they transition to adulthood.
Training
Med-Peds trainees and physicians receive the same in-depth training as their categorical pediatric and internal medicine colleagues. Recognizing a shared knowledge base, a Med-Peds residency is streamlined into four years of residency training. Residents change between their internal medicine and pediatric rotations every 3-4 months, depending on the residency program. By the end of four years residents will have completed core requirements for both categorical internal medicine and categorical pediatrics, including some elective time.
A frequently asked question regards the differences between Med-Peds and family medicine since both are trained to care for adults and children. Med-Peds training is four years, versus three for family medicine, and includes in-depth training in both internal medicine and pediatrics. Med-Peds does not include obstetrics/gynecology or surgical training like family medicine and completion of Med-Peds training allows for dual board certification in internal medicine and pediatrics. In practice, Med-Peds physicians are generally more narrowly trained to care for both healthy but also very complicated children and adults in great depth, while family physicians are trained to attend to the broader needs of a family in both health and sickness, with a clear focus on the primary care of the family unit.
Training Positions
For the 2013-2014 academic year there are 79 accredited training programs in Combined Internal Medicine and Pediatrics with 1,462 active residency positions. Program accreditation is granted by the Council for Graduate Medical Education (ACGME).
Certification
At the completion of residency training in Med-Peds graduates are board eligible for certification by the and by the American Board of Internal Medicine .
Fellowship
Med-Peds residents may choose to enter a subspecialty fellowship in either internal medicine or pediatrics, or both. Dual board eligibility may prove to be a competitive advantage to fellowship directors who are reviewing fellowship candidates. Many residents choose a fellowship where their expertise in both specialties will be beneficial. Med-Peds trained physicians have pursued nearly every type of fellowship training with cardiology, endocrinology and infectious disease representing the most popular fellowships. Combined internal medicine and pediatrics subspecialty fellowships can be streamlined via special arrangements with the fellowship directors and the boards.
Practice
There is a wide variety of practice settings and styles available to a Med-Peds physician. Primary care, inpatient care, subspecialty practice and urgent care are the most popular practice styles. Practice settings range from solo practice to large multi-specialty groups to academic medical centers. Some Med-Peds physicians pursue international health careers in the U.S. or other countries.