As we field questions about Med-Peds, we will post them in the FAQ below. Click on the questions for answers. Let us know if you have more questions: email@example.com
- -What additional resources are available for Osteopathic candidates?
- Osteopathic candidates can access both the AOA and AMA websites, and view programs through the FREIDA website. If there are questions that are not answered directly by the programs that you contact, you may also submit questions to NMPRA.org and one of our osteopathic residents will get back to you in a reasonable time. Be on the lookout for local interest group meetings as well as regional and national conferences, where there is usually an osteopathic med-peds resident present and will be able to answer your questions as well. We can get a faculty member to come to your school and talk about med-peds at your next function.
- -How can I make myself a competitive candidate?
- The most important thing to being a competitive candidate is to perform well in medical school classes and strive to do well on every rotation. Excellent letters of recommendations, strong board scores, and extracurricular involvement are the most important aspects to a competitive candidate. You can become involved in med-peds at a local, regional, or national level and demonstrate your interest in med-peds. You can also join the National Med-Peds Residents Association (NMPRA) and stay in touch with med-peds events and news. You can submit an article for the NMPRA newsletter, attend regional and national conferences, or start a local med-peds interest group at your home institution. Lastly, certain med-peds programs offer a 4thyear elective, and you can expose yourself to med-peds fully by experiencing it as a clinical rotation.
- -If selected into an ACGME accredited program, does my intern year get credit as an Osteopathic Internship year?
- This varies from program to program. The one dually accredited med-peds program, allow residents to receive credit for their intern year as a traditional Osteopathic Rotating Internship (TRI). Graduates from this program are able to practice in all 50 states, including states that require an accredited osteopathic internship year including Pennsylvania, Michigan, Oklahoma, and Florida. Many allopathic med-peds programs have TRI programs that allow residents to construct their schedule in such a way to incorporate what is required into their first year of med-peds training so residents receive dual credit for their first year of med-peds training as an osteopathic intern year/allopathic med-peds year. Some programs in the nation require that the AOA waiver be applied for, and are willing to assist candidates in completing the appropriate procedure. While this rule is changing, it is best to directly ask the program director, as well as the residents in the program to see what they have done in the past.
- -How can I find out which programs have accepted D.O.’s before?
- The Fellowship and Residency Electronic Interactive Database Access System (FREIDA) is an online database that you can search all residency programs in the nation. By specifically searching Internal Medicine-Pediatric programs, you can access direct links to individual program websites and browse through the resident listings on their site. You may also ask your medical school academic affairs officer for a list of graduates from your school that pursued med-peds and which program they were accepted. You can access FREIDA at http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page
- -What are the average scores for USMLE and COMLEX for osteopathic candidates matched/accepted to Internal Medicine-Pediatrics programs?
- Our unpublished data suggests that the COMLEX average is 538 for Step 1, 559 for Step 2, and 573 for Step 3. Those that took USMLE had an average score of 214 (lower than the average allopathic score of 230) for Step 1 and 230 (lower that the average allopathic score of 240) for Step 2. These are however averages, and may vary from program to program and the range of scores is large.
- -Should I take USMLE and COMLEX, or does COMLEX alone suffice?
- The answer to this question is program specific and complex. Many allopathic med-peds programs do accept COMLEX board scores, however it is best to email the specific programs and ask them directly. Depending on the region of the nation, certain programs are more “D.O. Friendly” and do not require USMLE. Unpublished data of 158 osteopathic med-peds residents (almost 50% of those osteopathic physicians that matched into med-peds over the past 10 years) suggest that 39% of osteopathic applicants have taken USMLE 1 and 24% have taken USMLE 2 in addition to COMLEX. You can also contact osteopathic residents at those programs (or alumni from your school) to see what strategy they employed.
- -On average, how many osteopathic candidates match into an Internal Medicine-Pediatrics Residency program?
- Based on the 2012 National Residency Matching Program (NRMP) data, 9% (34) of all intern positions that matched into Internal Medicine-Pediatrics programs were osteopathic candidates.
- -What is the regional variation of osteopathic applicants to Internal Medicine-Pediatrics?
- Data from 2014 indicates that osteopathic physicians comprised approximately 24% (22 osteopathic applicants/ 92 total US graduates) of the total med-peds applicants from Northeast U.S. medical schools, 10% (15 osteopathic applicants/ 147 total US graduates) of applicants from Central U.S. medical schools, 13% (19 osteopathic applicants/ 151 total US graduates) in the Southern U.S. medical schools and 18% (9 osteopathic applicants/ 49 total US graduates) from U.S. Western medical schools. Overall the number of applicants to Internal Medicine-Pediatrics from allopathic medical schools was relatively smaller in number from the Western medical schools, therefore increasing the percentage of osteopathic physicians from West schools applying to med-peds programs. Overall, approximately 14.8% (64 osteopaths) of all applicants to med-peds programs were osteopathic graduates. This number has significantly increased since 2000, when osteopathic physicians comprised only 7% of the total applicants to med-peds programs.
- -Can osteopathic candidates apply to allopathic Internal Medicine-Pediatrics residency programs?
- Yes, osteopathic candidates are eligible to apply to Accreditation Council for Graduate Medical Education (ACGME) accredited med-peds residency programs. The application is through Electronic Residency Application System (ERAS) and requires an application, board scores, letters of recommendations, transcript and a Dean’s letter. Candidates are invited to interview at individual residency programs after review of an applicant’s entire portfolio. We recommend that your application be ready at the time ERAS opens accepting applications in early September.
- -How many osteopathic Internal Medicine-Pediatrics Residency programs are there in the nation?
- At this time, there is only one ACGME-AOA dually accredited 4 year combined med-peds program, which is at Geisinger Health System in Danville, PA; the remainder of the med-peds programs (79) are allopathic training programs.
- -What combined fellowships are available and what advantages are there to combined fellowships?
Med-Peds graduates have entered virtually every subspecialty (fellowship). Fellowship program directors will often combine adult and pediatric fellowship programs for our graduates where both adult and pediatrics fellowship programs are available in the same academic center. Examples have included: infectious diseases, allergy/immunology, critical care, cardiology, endocrinology, rheumatology, pulmonology, nephrology, gastroenterology and more. Those that choose this path will usually take 4 boards: General Pediatrics, General Medicine, Subspecialty (adult), and Subspecialty (pediatric).
Graduates of combined fellowships can fill unique niches and unique needs. A Med-Peds nephrologist, for example, can provide pediatric nephrology care to a community that might not have nor afford a full-time pediatric nephrologist while also providing adult nephrology. A Med-Peds subspecialist may serve as director of specialized centers serving adults and children such as bone marrow transplant units, congenital heart disease clinics or cystic fibrosis centers. More information about Fellowships for Med-Peds can be found in the Med-Peds Fellowship Guide.
- -Should the program I choose have many Med-Peds trained faculty?
- Regardless of how many Med-Peds faculty a program has, a large part of your teaching will be done by faculty from the categorical programs. Be sure to evaluate the categorical faculty in both departments. The additional benefits of having Med-Peds trained physicians on faculty or in the community are to help be role models and mentors for you in practice and to provide career counseling.
- -Is it important for a Med/Peds program to have a Med-Peds trained director?
- Most programs currently have a combined director. There are, however, excellent programs that are led by internists or pediatricians. In both cases, programs are reviewed by the Accreditation Council of the Graduate Medical Education to assure a minimum standard regardless of the type of training of the program director.
- -Is it important for Med-Peds programs to have combined Med-Peds continuity clinics?
- There are advantages/disadvantages to a combined clinic and advantages/disadvantages to attending Medicine and Pediatrics clinics on alternating weeks. The Accreditation Council of Graduate Medical Education allows both types of experiences and focuses programs to maintain a minimum amount of patients seen in both age groups in either experience.
- -How do I judge the relative strengths of Med-Peds programs?
- There are no ratings of med-peds programs. A med-peds program relies heavily upon both the departments of Internal Medicine and Pediatrics to provide the resources for successful training. Therefore, in evaluating the quality of a Med-Peds program, one should carefully evaluate the two categorical programs. Applicants should also look at the Med-Peds specific portions of the program (curricula, combined meetings, faculty, and resources). Coordination, communication and cooperation are essential components to a successful program. Each med-peds program has its own personality and it is the fit of your personality with the program’s that makes the relationship and match work.
- -Should I rank “back-up” categorical programs?
It all depends. If you must be in a certain geographic location or hospital then ranking certain categorical programs might be wise. Overall there are more med-peds positions offered in the match than there are people that match into med-peds. If you have a well rounded portfolio then getting a med-peds position should not be too difficult. Most program directors want to see well rounded people who can handle both age groups and who are good with transitions and communication with families.
Please make sure that your letters of recommendation do not confuse program directors. If you do choose to apply and/or rank other programs, make sure your letter writers understand this. We sometimes see letters of recommendations that clearly state “he/she would be an excellent Obstetrics/gynecology resident”.
Med-Peds programs have a nice representation of allopathic physicians, osteopathic physicians and international medical graduates.
- -Aren’t Med-Peds programs extremely competitive?
- Med-Peds programs have been more competitive than Internal Medicine programs as a group, and generally comparable to Pediatric programs as a group. The competitive nature will vary, however, from one program to the next and will also depend on the record of the individual applicant.
- -How many Med-Peds programs are there?
- Currently, there are over 79 Med-Peds programs offering around 350 first year resident positions each year - this makes up almost 7 percent of the medicine and 13 percent of the pediatric categorical positions.
- -Is it possible to keep up with both fields of internal medicine and pediatrics after I graduate?
- Although it is more challenging, it can be done. In fact, being familiar with the advances of one area enhances your practice of the other area. Most of us feel that the extra effort to keep up with two fields is well worth the trade-off for the ability to care for patients of all ages, including families and patients with complex medical problems.
- -Don’t most graduates choose one field or the other after they graduate?
- Most graduates that are in primary care practice in both fields. Depending on the community needs, ratio of physicians to patients and interest of the physicians, the ratio of pediatric to adult patients might vary.
- -Will I be able to pass both boards when I graduate?
- Review of data from 1997-2007 from both the American Board of Internal Medicine and American Board of Pediatrics continue to show that the passing rate for graduates of our med-peds programs is the same as categorical medicine and categorical pediatrics graduates.
- -Aren’t Med-Peds Programs more difficult?
Because Med-Peds training incorporates all of the important elements of two, three-year training programs into one four year Med-Peds program, Med-Peds residencies can be perceived to be more rigorous. However, only 9% of those that start a med-peds program transfer out (which is less than internal medicine and family medicine but equivalent to pediatrics). A great deal of the material to be learned is shared between the two specialties and a good understanding of an area in one specialty enhances the understanding of that area in the other specialty. Residency programs often take advantage of this by offering combined adult and pediatric electives rotations or conferences.
Medical knowledge is only one aspect of being an excellent physician. Being a successful med-peds physician, requires excellent communication skills and an ability to adapt quickly and transition well.
- -How does Med-Peds training differ from Family Medicine training and how do I decide between the two fields?
Much of the difference between Med-Peds training and Family Medicine training depends on your perspective and your personal career goals. The difference is best appreciated by remembering that Med-Peds is a four-year curriculum that focuses on two specialty areas. Family medicine however has a broader scope and includes areas such as obstetrics and surgery in a three year program.
Both are excellent career choices. Many med-peds graduates that are specialists or primary care physicians work with or get referrals from family medicine colleagues.This table below illustrates some of the requirement differences between the two training programs:
Years of Training 4 3 Percent Ambulatory 36% 50% Number of Required Pediatrics Rotations 24 months 4 months Number of Required Adult Rotations 24 months 8 months Maternity Care 0 2 months Gynecology Required 1 months General Surgery 0 2 months Sports medicine, orthopedics, rehabilitation medicine Required 2 months Emergency Care 1 1 Intensive Care 8 months Required
- -How are combined programs regulated? What Boards examinations do I need to take?
- Med-peds programs must be reviewed and accredited by the Accreditation Council for Graduate Medical Education (ACGME) in a similar fashion as family medicine, internal medicine and pediatrics programs. Programs that are accredited can recruit new residents into their programs. The ACGME conducts a paper review and site visits of all med-peds programs and evaluate each program with regard to its curricula, outcomes and administrative support. After completing your med-peds training successfully, you may take both board examinations (certification) in internal medicine (American Board of Internal Medicine) and pediatrics (American Board of Pediatrics). Maintenance of certification (MOC) in both disciplines and boards is encouraged and desirable. A price discount is applied towards the cost of maintenance of certification in both boards. As well, certain parts of the examination in 1 board may be used towards the other board.
- -What kind of outpatient practices do Med-Peds physicians enter?
- Med-peds physicians practice in a variety of environments. In most areas of the country, med-peds primary care physicians are considered extremely valuable and they have many job opportunities. About a third of med-peds primary care physicians work with other dual-trained physicians; while the majority also works with pediatricians, internists, and family physicians in multi-specialty group settings. Many stay involved in teaching residents and/or medical students.
- -What can I do when I finish my training in a Med-Peds residency?
- A Med-Peds residency is one of the most versatile residencies available. After 4 years of residency training, med-peds graduates have a wide host of opportunities available to them including private practice, academics and teaching, hospital practice (hospitalist), research, public health, global health (international practice), transitional care (survivors of childhood cancer or congenital heart disease as examples) and combinations of the above. Approximately 75% - 80% of our graduates choose opportunities in this category. This percentage is higher than those that graduate from internal medicine or pediatrics programs. Med-Peds graduates can pursue further training (called fellowship) in subspecialties in internal medicine, pediatrics or both. Because of our dual training, there are over 20 fellowship types and combinations that are available to med-peds physicians. Examples of fellowships are cardiology, infectious diseases and allergy/immunology. Approximately 20% - 25% of our graduates choose opportunities in this category.
- -How do I apply for dual fellowships?
- NMPRA has put together a thorough, helpful guide on this very topic. Written by those who have gone on to apply and complete dual Internal Medicine-Pediatrics fellowships, the NMPRA Fellowship Guide will prove to be a life-saver.
- -How many Med Peds residents go on to sub-specialize?
- About 25% of graduates go on to sub-specialize in either Internal Medicine, Pediatrics, or both.
- -How many Med Peds graduates practice Primary Care?
- More than 50% of graduates go on to flourish in primary care. Even within primary, many med peds physicians tailor their practices to an area of interest. For example, some Med Peds physicians provide transitional care to children and adults with chronic diseases such as Cystic Fibrosis or Sickle Cell Anemia.