By way of introduction, I am a resident in Internal Medicine/Pediatrics at St. Joseph's Hospital & Medical Center in Paterson, NJ. A colleague and good friend from medical school, Jeff Bates, came up with the concept of this newsletter in order to interact with other Med/Peds (MP) residents across the country. When we began the search for a medical specialty, we had a great deal of difficulty finding out information about MP programs and we would like to make it a little more accessible to those following us. We would also like to establish a network of residents already involved in programs to share ideas. Before starting in my residency I couldn't locate any residency requirements for MP. To date it is still difficult to find this information (and getting harder to interpret what guidelines we have). The one thing that I can honestly say helps in making a decision to follow this path is doing a clerkship in a hospital that has a program. However, not all medical students have this luxury. Fortunately we happened to do clerkships in university hospitals in the NE (Seton Hall and Mount Sinai) that had MP programs. We convinced each other to go into MP without knowing anyone else already in the field or planning to apply. There were no pamphlets, journals, or organizations that we could find who published necessary information for this decision making. Recently we have found that there is Med/Peds Program Director's Association (MPPDA) and there is a new and currently provisional, MP section under the American Academy of Pediatrics (AAP).
This newsletter is a first attempt to determine if any other MP residents would be interested in an informal, non-political newsletter and possible association for residents. This would give us a forum to communicate with our peers in the other programs throughout the country. It could be started simply with a monthly newsletter with minimal expense ($0.32/person/issue) and wouldn't require any annual meetings (assuming some of us may be a little busy). This could also serve as primary care for what appears to be one of the greatest problems with MP residencies: Drop Outs!
This association could help the residents that often feel they don't belong. With Medicine on one side and Pediatrics on the other, the MP residents can often feel lost in the middle. Those most at risk are the second and third year residents at small programs. When they see their friends in straight Medicine or Pediatrics getting ready to finish, more than one MP resident has gotten cold feet and bailed out of the program to do one or the other. If you haven't heard, this happens over and over at many programs; as much as 33% by some accounts. Fortunately there have been others transferring in to keeping the numbers up. Those who have created the AAP MP section came up with three goals that we too, could address in our own informal way:
Study shows we are mostly Primary Care
A new survey of the MPPDA shines the light on all those questions about what we are going to do after residency. Seventy-four program directors provided information on their 708 MP graduates from the years 1987 to 1993, which showed that 68% of MP graduates are practicing as generalists. You can reassure all those doubters that 85% do practice both internal medicine and pediatrics. Another 7% found their nitch in the ER and 21% entered subspecialty training. Of the subspecialists, half continue to see both adults and pediatric patients. If you were wondering how we compare with other programs, it seems that only 35-45% of internal medicine graduates and 67% of pediatric graduates go on to practice primary care. Family practice holds out with 95%, but that argument is another article in itself.This brings up a very important nitch for MP physicians. Say you move into a small-to-medium
sized community with a few family practitioners -- maybe even a pediatrician or an old time
internist with a nice quiet practice. A MP physician could take care of the ward service in the
community hospital for all of these colleagues and, most importantly, do it well.