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 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 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 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.

A frequently asked question regards the differences between Med-Peds and family medicine training and practice. Although both Med-Peds and family physicians are trained to care for both adults and children, Med-Peds training is 4 years instead of 3, includes more in-depth training in both internal medicine and pediatrics, does not include obstetrics/gynecology or surgical training, and allows for dual board certification. 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 2011-2012 academic year, there are 80 ACGME-accredited training programs in Combined Internal Medicine and Pediatrics with 1,422 active positions.

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

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

Professional Societies