In order to help students interested in Med-Peds obtain as much information as possible, the National Med-Peds Residents' Association has teamed up with the Med-Peds Program Directors Association (MPPDA). 

We have compiled answers to questions frequently asked by medical school students considering Med-Peds.  All the answers were written by Med-Peds Program Directors through the MPPDA.  Click on the links below to see how Med-Peds Program Directors answer the following questions.

1. What can I do when I finish my training in a Med-Peds residency?
2. What kind of outpatient practices do Med-Peds physicians enter?
3. How are combined Med-Peds programs regulated?
4. How does Med-Peds training differ from Family Medicine training and how do I decide whether Med-Peds or Family Medicine is right for me?
5. Aren't Med-Peds Programs more difficult?
6. Will I be able to pass both boards when I graduate?
7. Don't most Med-Peds graduates choose one field or the other after they graduate?
8. Is it possible to keep up with both fields of internal medicine and pediatrics after I graduate?
9. How many Med-Peds programs are there?
10. Aren't Med-Peds programs extremely competitive?
11. Should I rank "back-up" categorical programs?
12. How do I judge the relative strengths of Med-Peds programs?
13. Is it important for Med-Peds programs to have combined Med-Peds community clinics?
14. Is it important for a Med-Peds program to have a Med-Peds trained director?
15. Should the program I choose have many Med-Peds trained faculty?
16. Are there geographic differences in Med-Peds programs?
17. What combined Med-Peds fellowships are available and what advantages are there to combined Med-Peds fellowships?

Additional information about many commonly asked questions can be found in the Introduction to Med-Peds pamphlet, as well as the Medical Students Guide to Combined Internal Medicine and Pediatrics Residency Trainingand the Med-Peds Fellowship Guide.

After reviewing this information if you have additional questions, please e-mail your question to askaresident@medpeds.org.

FAQ Answers

1. 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.

2. 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.

3. 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.

4. 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.

The amount of outpatient time and ambulatory rotations in both med-peds and family medicine are comparable by virtue that med-peds training is 12 months longer.  Family medicine does require more ambulatory time in their continuity practice and more instruction in psychiatry.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. Are there geographic differences in Med-Peds programs?

As you can see, med-peds has many more programs and resident positions in certain parts of the country. Graduates from our programs are located virtually in every state.

17. 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.