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Subspecialty Careers: Highlights about Careers in Internal Medicine: Combined Internal Medicine and Pediatrics

The Discipline
Combined Internal Medicine and Pediatrics (Med-Peds) is the dual training in and dual practice of Internal Medicine and Pediatrics. Physicians practicing Med-Peds see both adults and children in a wide 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 internal medicine and pediatrics, Med-Peds physicians can synthesize their clinical knowledge onto a life’s 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, adolescents, emergency room visits, basic gynecology care, inpatient adult and pediatric patients, outpatient adult and pediatric patients, adult and pediatric intensive care.

Procedures
Important procedural skills include those necessary for both an internist and a pediatrician. Med-Peds physicians report competence in the wide range of procedures commonly performed in outpatient and inpatient settings.

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 4 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 4 years, residents will have completed core requirements for both categorical internal medicine and categorical pediatrics, including some elective time.

Certification
At the completion of residency training, Med-Peds graduates are board eligible for certification by the American Board of Pediatrics, ABP, and by the American Board of Internal Medicine, ABIM.

Fellowship
Med-Peds residents may choose to enter a subspecialty fellowship in either or both internal medicine and pediatrics. Having dual board eligibility may prove more competitive to fellowship directors. 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; cardiology, endocrinology, and infectious disease are among 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
Med-Peds physicians practice in the wide variety of settings and styles available to internists and pediatricians. Primary care, inpatient care, subspecialty practice, and urgent care are among 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.

Major Professional Societies

Official Resident Website

Student Involvement
If you are interested in writing for the quarterly student Med-Peds newsletter or if you have any questions, please contact either Gitanjali Srivastava, MD at gitanjali.srivastava@mssm.edu or David Kaelber, MD at david.kaelber@case.edu, who head the National Student/Resident/Young Physician Med-Peds Subcommittee. They are actively recruiting interested medical students.

Back to July 2008 Issue of IMpact

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