MedPeds residents were asked in a 1989 survey about residency programs they had inquired about, applied to, or ranked, in addition to MedPeds. Nearly half of all those surveyed had also inquired about Internal Medicine alone, while only about one-third had also inquired about Pediatrics alone. About one-third also inquired about family practice. Interestingly another 9% inquired about other programs. When the final rank list was turned in by those who became MedPeds residents, 28% also ranked Internal Medicine alone, 18% also ranked pediatrics alone, and 14% also ranked family practice. Only 2% also ranked a program not listed above.
Harrison's Principles of Internal Medicine
Thanks to a donation by BIAXIN, NMPRA will be giving away a textbook for the best resident essay: Why I Chose MedPeds?
Email your submissions to Essay@MedPeds.org
Special thanks to Sean McLean of Abbott Laboratories
* Residents at U Rochester, Mt. Sinai, and SUNY-Brooklyn are putting together a MedPeds meeting in the New York City area.
* A MedPeds conference is planned in Toledo, OH March 5, 1999. Contact cmikeb@pol.net for more information.
* The AAP meeting will host the MPPDA meeting in Chicago in April, 1999.
* The Second Annual Chicago Area MedPed meeting and NMPRA will meet in Chicago during the AMA meeting June, 1999
* The Southern Medical Association will meet Nov 19-21, 1998 in New Orleans. NMPRA will have a booth to promote MedPeds and there will be a meeting for interested MedPeds residents. The SMA offers FREE admission for residents to their conferences.
* The recent AAP meeting in San Francisco had several small meeting for MedPeds issues.
(States listed in parentheses do not currently have Med/Peds residency programs)
by Norman E. Toy
135 Delaware Ave
MedPeds Recruiter
Buffalo, NY 14202
Global Medical Search, Inc.
(800) 937-5223
gmsinfo@global-medicalsearch.com
When I first spoke with William Feldmann, MD, he was in search of a MedPed opportunity in Southeastern New Hampshire. I was able to find him a practice which he was satisfied with, and where he has been working for the last year and a half. We spent some time recently talking about aspects of his search, and the results.
NT: Were you the first, and are you the only MedPed physician within the hospital system that you are a part of?
WF: Yes, and yes.
NT: How did you, and how did the hospital, handle
either marketing you, or communicating to the community how your training
in the two disciplines could fulfill their need?
WF: How did the hospital do it? Badly!
NT: Really?
WF: Yeah. ...When I initially got here, we were short
a doctor, so it didn't make a whole lot of sense, I guess, to advertise this
to the public, because we already had more patients than we could handle
at the time. But it would have been very helpful had they gone to some effort
to educate the other doctors in the area, as to who I was and what I was.
...But they really didn't expend any effort in that direction at all.
NT: Did you make any request, or did you propose any strategy for them?
WF: Unfortunately, [for] most of... the people who finished my year who
went out and joined other groups, the hospitals did a significant amount
of education in the community. I just assumed they would go ahead and do
that. We actually talked about a couple of things, briefly, and to me it
just seemed like, Oh, yeah, every hospital that hires you is going to do
the advertising, and that didn't happen. ... I'm very clear [now]... when
I send out correspondence, like, I'm sending you this patient to evaluate
him for such and such. I'm very clear that I sign it William Feldmann, M.D.,
board certified in Internal Medicine; board certified in Pediatrics. It
says that very specifically on my business card because the name of the practice
is Salem Family Practice, so it's important. But I would have preferred
that [the hospital] sent off some fliers, at least to the other doctors.
They're in the process of doing that now, because we're up to full strength.
NT: Do you think the key to MedPeds being successful in a community is,
not so much communicating to the patients, but to the other doctors?
WF: ...I thinks it's both. The way things are right now, some people
are changing insurance plans, sometimes yearly, or in some large companies,
they're often picking a new primary care doctor. So, getting out the information
to them that I do both [Medicine and Pediatrics] is extremely important,
and I've had a hell of a struggle getting the insurance companies to understand
it. And that's a big deal, because when some one switches and they pick
up the book of providers, Family Practice, Internal Medicine and Pediatrics
are listed separately. ... Sometimes I'll get on the phone personally and
explain it to them, and they'll say, "Well, you can only be listed in one
place."
NT: That's going to take a little doing then, for them to comprehend.
WF: It does...but eventually you can explain it to them.
NT: Are there any objectives, or hurdles within your practice that you feel remain to be overcome?
WF: I have a delightful practice. ...We're making a transition from urgent
care to primary care, and that requires a different level of support staff,
a receptionist, secretary, and that sort of thing. In addition, it has been
quite the struggle for me to get them to understand that internist approach
things in a different way than family practitioners do. And when we do a
complete physical, we do a complete physical. It takes more time. We do
more testing. We're looking for more trouble basically. ...I have seen family
practioners book fifteen minutes for a complete physical. And it's in my
mind, completely inappropriate, but it's sometimes hard to make them understand
that, Yes, I'm working with family practioners, but I don't do things the
same way. And the difficulty is compounded by trying not to offend your
family practioner colleague.
NT: Is there any general advice that you would give to a MedPed resident who is coming out into the job market.
WF: Think very hard about the things you're willing to compromise on,
and be accommodating about. ...In residency, we all thought things were
going to be golden once we were the attending, once we were private physicians,
once we go "out there." It doesn't get easier, it's just a different set
of challenges. The other incredibly important things is, keep up. Don't
let yourself fall behind, because it's a long distance to fall. They kept
telling us that in residency , and we kept saying, "Yeah, yeah, I'm just
trying to survive the days," but you have to keep reading, you have to keep
learning, and you can learn something from anybody. Just keep your eyes
and your ears and your mind open.
NT: What about if a MedPed physician
is considering becoming the first MedPed doctor within a community, or practice,
like you did. Is their any general advise that you would give to that person?
WF: Yeah, you have to be sure that during the interview process ...assuming
you are going to do what I did, which is, join a family practice group, you
have to make very clear to everybody that your interviewing with, how your
training is different than theirs. It's important that they understand that
you're trained in something different, so that if there's any possibility
for friction between you and the other [doctors] in the area, that it's addressed
before you take the job. If the medical community you are joining is not
flexible, and not open, you may find yourself banging your head against the
wall, and it can be a real problem. I, fortunately, have not had that difficulty.
I'm in the department of medicine at the hospital, and the department of
pediatrics, but I only take service call for medicine. ...But you have to
make sure that the bylaws of the hospital will accommodate this, because
a lot of hospitals, their bylaws are very rigid, and there need to be changes
to accommodate this.
The lapel pins for the National MedPeds Residents' Association are here! The cost of the pins is $5.00 each, or $4 each if ordering 10 or more pins (plus a $3 shipping & handling charge).
Send checks to:
Jeff Bates, MD
34 Beachcomber DR
Belton, TX 76513
The color scheme is red & white with gold trim. Order today for your whole program!
In a 1989 survey MedPeds residents were asked to identify their practice plans after residency. MedPeds residents reported that after residency 92% expected to handle inpatient pediatric and 91% expected to handle inpatient internal medicine patients as a part of their practice. In terms of ICU care, 49% planned to handle adults and 38% planned to handle pediatrics. Actual procedures to be performed were also anticipated with 84% expecting to suture, 57% planning to perform neonatal intubations, 51% planning to insert UACs, and 48% planning to float Swann- Ganz catheters.
Schubiner, H, Schuster B, et al. The perspectives of current trainees in combined internal medicine-pediatrics. Results of a national survey. AJDC. 147(8):885-9, (Aug 1993).