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DOM launches new Med-Peds Residency Program

Department of Medicine

The CU Departments of Medicine and Pediatrics have launched a new, combined Internal Medicine-Pediatrics program aimed at filling an unmet need for physicians schooled in both specialties.
“There are a growing number of conditions which span pediatrics to internal medicine and there is a need for primary care physicians and subspecialists who can care for these complex patients regardless of their age,” said Dr. Suzanne Brandenburg, director of the DOM’s internal medicine residency. “There is also room in this part of the country for a highly regarded medicine-pediatrics training program.”

The new four-year postdoctoral program will accept four residents per year, who will become board eligible in both specialties upon completion. It will become the 78th combined Med-Peds program in the country, but one of the few in the West.
“People are begging for it,” said Ben Hale, a fourth-year medical student who recently established a Med-Peds interest group for CU School of Medicine. “When I travel and people hear I am from Colorado they always say they wish we had a program like this here.”

Realizing that there was some overlap in the curriculum covered by 3-year Internal Medicine and 3-year Pediatrics training programs, the University of North Carolina and the University of Rochester launched the first combined Med-Peds training programs in 1967.

Today, it is the largest combined specialty offering available, with roughly 1,300 residents in training at 77 schools around the country, and 6,000 practitioners who have completed it, according to the National Med-Peds Residents Association (NMPRA).
But the supply of training programs is not meeting demand. In 2012, 560 applicants nationwide vied for 362 Med-Peds slots.

Dr. Joe Kay, an associate professor of medicine and pediatrics at CU, says he went into Med-Peds after graduating from medical school at State University of New York, because he loved working with children and he loved the complexity of internal medicine. He also saw a lack of physicians able to take care of children with conditions like congenital heart disease, cystic fibrosis, childhood cancer, and early-life organ transplants once they reached adulthood.
“More children are surviving with complex disorders, and I did not want to be a doctor who, when my patient turned 18, had to give up their care because I wasn’t qualified to take care of them as adults,” said Kay, who did his training at University of Michigan and now specializes in congenital heart disease.
As interim director for CU’s new program, he says Med-Peds-trained doctors can be a particular asset to rural communities, which might not have the population base to support a pediatric practice but need someone trained to deal with more complex pediatric cases when they arise.

“Family physicians are very good at taking care of common problems, from geriatrics to gynecology, but it is impossible to be trained in everything,” he says. “The advantage a Med-Peds doctor has is that they are trained in all the complex pediatric conditions as well as the complex internal medicine conditions. They can work alongside family physicians and add a dimension of care that they would not have otherwise.”
Programs vary, and CU has not nailed down specifics yet. But Med-Peds typically involve 24 months of pediatrics training and 24 months of internal medicine training, with residents switching between medicine and pediatric rotations every 3-6 months. The programs do not provide formal obstetrical or surgical training. And Kay stresses they are not intended to be a replacement for family medicine, but rather, a supplement.
With 24 subspecialties and fellowships, from cardiology and infectious disease to critical care and endocrinology, Med-Peds trainees have an array of post-residency options and potential career paths.
Fifty percent go into primary care, with between 77 and 93 percent working with both adults and children. Twenty-five percent pursue fellowship and subspecialty training. And 15 percent become hospitalists, according to NMPRA. Nearly 40 percent remain involved in education.
“Having this here will bring a new depth to both the internal medicine and pediatric departments,” says Kay. “And with the primary care doctor shortage that we envision in this country, having extra trainees like this will really help to meet patient needs. It’s an exciting step to advance medicine in Colorado.”
CU is currently conducting a national search for a director of the new Med-Peds residency program, and hopes to welcome its first four trainees in the Summer of 2014.