Originally 12/18/08...

Clearly, I get in trouble when I talk on the phone and work on the computer at the same time. I thought I was deleting old drafts... turns out I was deleting actual, completed posts! At least I've saved copies of all of them in my email, so now I'll re-post them! Here's the most recent... Yes, I'm behind. It's been a few months. I don't even have a good excuse- senior year of med school leaves a lot of free time! Well, except for traveling to interviews... but I think one reason I haven't been on here lately is because I've discovered facebook. If you already know about this little gem, just skip down a few lines where the real meat begins. But if you don't have a facebook (fb) account, hear me out. A friend from Pittsburgh recently moved to Texas, and she told me I should get on fb because it's a great way to stay in touch, and she's been surprised how much she enjoys it. I would never have explored such a thing on my own- I totally relate to all of you who don't want to play with "risky" internet websites or end up connected to someone you don't really know, etc, etc. But for Keeley's sake, I checked it out. You find people you know, and request them as "friends." If they ok it, you become friends and can see each other's information. But anyone who isn't your friend can only see your name, picture, city, school... very limited information. You're totally in control of who sees what. But beyond that- it's incredible! I have reconnected with multiple friends I'd lost touch with over the years! It's been so exciting to reconnect with so many people... and it's a way to sort of know what their doing and know how to contact them when I want to without having to send frequent emails to multiple people. Is it clear what I mean? We all cross paths with people for a time that we'd like to stay in touch with but as we move in different directions, we just don't have enough time to regularly correspond with all the wonderful people we've met over time. Facebook lets you share information about yourself- and see their info- so that you're in touch, feel connected, but it doesn't require a lot of time! It's also been an amazing place to connect with people that are still in my life. I have a lot of "friends" who are current classmates... but as we all do different rotations, we don't see each other that frequently. Fb has given me a great way to talk with them more frequently, to know when they're sick and need prayer, to encourage someone who's stressed about residency interviews... it's both a blessing and a ministry. So check it out, and add me as a friend!!! Ok, now for the real meat of this post. I promised to discuss most-med school training, and as I'm in the midst of interviewing, now's a good time. To start with, residencies basically fall into 4 categories: the non-patient care, the medical, the surgical, and the "surgical subspecialty" which are a mixture of medical and surgical. So as a 4th yr in medical school applying to residency, here are your options (this is not meant to be an inclusive list, only exemplative): If you are headed for non-patient care, that means you're looking at something like radiology or pathology. (You can actually still have patient contact in these fields, but a lot less than in other areas). The medical options are also sometimes considered the "primary care" options: these include internal medicine (adults), pediatrics (yes, that's kids), family medicine, and med-peds (I'll discuss later family med vs med-peds). But there are some other medical options also- neurology and psychiatry are 2 that come to mind. Emergency medicine and dermatology would be others (althoug derm could also be a surgical subspecialty... Then there's your surgical- basically you do a general surgery residency. Surgical subspecialties include urology, neurosurgery, ENT and opthalmology. All of the options listed about are residencies you could choose and begin right after medical school. Now- what about internship? It used to be that the first year after med school was called "internship" and the rest of the years were "residency." As a result, in your first year out of med school you were an "intern" and then you became a "resident." BUT- doctors who specialize in internal medicine (any doctor trained to medically care for adults, who are done with all their training) are called "internists" and clearly patients can easily confuse an "internist" with an "intern." So for the most part, all of the training after med school is called "residency" (althoug we still do use the term intern for 1st yr residents...) NOW- the length of residency varies with the specialty. Medicine, peds and family med are all 3 yrs. I think psych is 3 yrs too. I honestly don't know how long path and radiology are- probably 3 or 4 yrs. Gen surg is at least 4 yrs, I think. Neurosurg is 7 yrs if I'm not mistaken! What have I left out? Oh, ENT and optho and the other surgical subspecialties are mostly 3-4 yrs. Emergency med is 3 yrs too. OH! Ob/gyn is a big surg subspec- it's 4 yrs. Anyway, you get the idea. As I explained previously, after residency you can do fellowship if you want to further specialize. For example, after a pathology residency, you could just do general pathology- a little bit of everything- or do a fellowship- you could focus on neuropathology or renal pathology, or cancer pathology, and so on. Same thing for radiology- you could focus on neuroimaging, or "interventional radiology" (that's when you use radiology to actually perform procedures- it's a way for radiologists to have more patient contact). Emergency medicine basically only has one fellowship, which would be to specialize in peds, but you can also do peds ER by doing a pediatric residency and then the same peds ER fellowship. There might a few other possibilities- disaster medicine is a growing field in EM. After general surgery you could go a LOT of directions- cardiothoracic, vascular, GI, transplant... oh, I think plastic surgery has it's own residency, just like neurosurgery. So after either of those I'm not sure if there are fellowships. Oh, you could do a pediatric neurosurgery fellowship... Basically all fields have a peds fellowship (neuro, derm, psych...) If you do a surgical subspecialty (ENT, optho, etc) peds is probably the only fellowship option- you're pretty much fully specialized from the start. The primary care areas- medicine, peds, and family- are very different. It's after these residencies, by doing a fellowship, that you go into cardiology, rheumatology, pulmonology, GI... but not neuro, uro, derm, as they have their own residency. See? Right! At least you see why it's confusing! To my grandfather, his dermatologist is no different from his cardiologist (who sees him once a year to say "yep, you're still healthy" even though he's 93!!!) But to a medical student, the path to derm is very different from the path to cardio. Ok, so what about family medicine vs med-peds? Well technically, I shouldn't have included med-peds in the list. Or, at least 3 yrs I shouldn't have. Because med-peds is a combined residency- it's like doing internal medicine and pediatrics. Now, if the combined program didn't exist, and you wanted to be an internist and pediatrician, you'd have to do a 3-yr medicine residency and a 3-yr peds residency. But there's overlap in what you need to know for the 2 specialties, and there actually a number of people who want to do both, so combined programs have been developed to let you do both in a total of 4 yrs instead of 6. Other combined programs also exist- lots of them, in fact! Pitt has one called the "triple board" where you do pediatrics, psychiatry, and child psychiatry (which is really like doing 2 residencies and a fellowship)- the equivalent of 8 yrs- in 5. Like I said, lots of them exist- medicine with emergency, family with psychiatry, neuro with radiology... it's a long list. But most of them are not too common- only a few schools in the country will offer any given combination, and only a few people each year choose them. I think part of the reason is because you have to know a lot more specifically what you eventually want to do when you're still only in med school. But med-peds is a bit different. It's by far the most common combination, and is the only one now certified as it's own program. What do I mean? Each residency (surgery, dermatology, etc) is certified by the ACGME (sort of like JCAHO for hospitals or the organizations that regulate universities...) ACGME has requirements for each (each surgery program must ____ and each resident must be able to ____ in order to graduate). Each specialty also has it's own boards. (So aside from the boards that all medical students take, at the end of residency you take boards specific to your specialty to be "board-certified" in that area.) In the past the med-peds programs simply med the requirements for pediatrics and the requirements for medicine... as long the med program was approved by ACGME and the peds program was too, the med-peds residency could exist. And graduates took the medicine boards and the peds boards at the end. It was only 2-3 yrs ago, because med-peds has remained so popular (there are ~80 programs in the country- in comparison, there are ~150 peds, 200 medicine and >300 family med programs) ACGME developed separate guidelines for med-peds and now individually reviews and certified med-ped programs separate from the medicine and peds departments they work with. (We do still take medicine and peds boards at the ends and are thus "certified" in both internal medicine and pediatrics. We can practice any amount of either or both, and can do any fellowship a medicine or peds graduate can do... and there are some med-peds fellowships where you can do, say rheumatology, for adults and kids). Med-peds is the only combined program with it's own ACGME standing- all the others still work like med-peds used to, riding on the certifications of whatever programs they depend on. But WHY med-peds? What's the difference between that and family medicine? Why should you care? Well, because med-peds is relatively new (it's been around since the 60's) and certainly less common than family med, many people are unfamiliar with it. So when I say I'm doing "med-peds", it's amazing how many people hear the "peds" and assume I'm just doing pediatrics. So for all the people who wonder what it is exactly I'm doing- here's the explanation! Family medicine is a 3 yr residency (there are fellowship options afterwards; sports medicine is a very common one.) During that time, they learn medicine, pediatrics, ob/gyn, some minor surgery and some basic emergency medicine. They do much more outpatient than inpatient, and much more adults than kids. Family medicine is a great option for people who want to be able to "do it all"- to be THE doctor for all of a patient's needs, to not have to refer them to another doctor except very rarely. This is especially good for rural areas where it's hard to get to other doctors, for international healthcare (where there often aren't other doctors) and for underserved areas (populations, often immigrants, who don't have much access to healthcare and are unlikely to be willing to trust or able to pay a specialist). The family doctor can do all the basics- heart disease, prenatal care, sports physicals, etc. But they don't do as much inpatient, and don't usually do the more complicated cases (disability medicine, maybe complicated geriatric care...) Med-peds, on the other hand, spends 4 yrs doing just medicine and peds. No ob/gyn, no minor surgery. Our goal isn't so much to work in an area where we're the only MD- we just want to take care of all ages. Family medicine has a heavy focus on the family- a patient's experience of illness is greatly affected by their family, culture, beliefs, etc- and they really enjoying knowing and caring for all members of the family. Med-peds has that option too, but the focus is more on development and life span- seeing an individual through all ages, being able to follow them through childhood, adolescent, adulthood... Med-peds is great for adults who have "childhood" diseases and disabilities, and kids with "adult" diseases. Because of how the time in residency is spent, we also do more in the hospital and in very sick or complicated patients. I've learned to have respect for my classmates who are going into family medicine- but they see themselves practicing in rural or underserved areas, whereas I see myself working closely with a community hospital, relying on having other doctors and services available but being able to care for all ages. The diving lines between "child" and "adult", or "adult" and "geriatric", or so artificial. I love being able to see the patient has having a continuous life, instead of childhood "stopping" and adulthood abruptly beginning.... and for patients with chronic diseases or disabilities, it's so useful for them to be able to stay with the doctor who knows them and their medical history- and for them to know their doctor! One last thought- it's a popular theory in medical school that personalities attract like personalities- you can pretty much predict what specialty a person will go into based on their personality. There are certainly exceptions (it's always fun to see who in the class surprises you!) but for the most part, it seems to be true. Pediatricians are very different from surgeons... and "med-peders" are very different from family docs. Like I said, I have great respect for my classmates going into family med, but I "fit" SO much better with the med-peds people! It has been so much fun to meet the med-peds residents at my school, as well as the residents I meet as I interview, and even my fellow med-peds applicants. We all, with very few exceptions, tend to get along instantly and have fun together- I would have a VERY different experience interviewing for family medicine, based on my experiences with the various programs in Pgh. Funny how that works. But it's great to know I'll not only love what I do, I'll enjoy the people I'm doing it with! This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License.