Finding A Practice Arrangement with Call Coverage
by Norman E. Toy
Med/Peds Recruiter

As a Med/Peds recruiter, one subject I spend a lot of time discussing with the majority of Med/Peds residents searching for their first job is "What about the Call Coverage?" The main objective of most of my Med/Peds candidates is to find a practice opportunity with other Med/Peds. With their unique mix of internal medicine and pediatric training, it is only natural to want to work with like-trained physicians. This has certainly created a challenge for me. I look high and low; and far and wide for every Med/Ped practice I can find. The fact is, however, there are not enough opportunities available for all of the 400 or so graduating Med/Ped residents to join other Med/Peds groups. The obvious reason for this is that there have not been enough Med/Ped residency programs putting physicians out into the field until recently. So, what's the alternative?

While I have made no formal survey, I think I can safely say that the majority of Med/Ped residents take jobs either with family practice groups, or with some mix of primary care doctors -- internists, pediatricians, and family practitioners. This latter arrangement seems to be the most acceptable alternative to joining a group of Med/Peds, but also requires a creative solution to sorting out who gets the pediatric patients, who gets the medicine patients, and who covers for pediatrics when the Med/Ped is not on call. Having a few family practitioners helps with the call arrangements since they, like the Med/Ped, can cover both adults & peds.

Many Med/Ped residents object to working with family practitioners and I always ask the question "Why?". One concern I hear is that if a family practice group brings in a Med/Ped then the Med/Ped will only get the sick patients and not a more traditional cross-section of patients. One Med/Ped recently told me he actually appreciates these special cases because that is what he is trained for. He finds that seeing difficult cases keeps things interesting, and diminishes the potential for boredom. Similarly, another Med/Ped candidate told me that she did not go through four years of training in medicine and pediatrics to be a family practitioner. But, everyone does not feel this way. Another Med/Ped candidate of mine recently told me that she would have taken a critical care fellowship if she wanted to be an intensivist. The bottom line is, it is important to find out what the group's expectations are before you make the deal.

Another concern I have heard about family practice groups is that the pediatric component might be weak. Some Med/Peds are reluctant to turn their very sick kids over to the group's family practitioners when they aren't on call or when they go on vacation. I have been told that this is a very real concern but can be worked out as long as the family practitioners are open to input from their Med/Ped colleagues. Once again, this openness needs to be judged before joining the group. The office dynamics, the "chemistry" between the doctors, and the philosophy of the group has to be right. If there is a sense that one's work will be compromised, then the search must go on. Obviously, each of these concerns can be overcome and family practice and Med/Peds can complement each other because I hear of Med/Peds joining family practice groups every day.

When it comes to call coverage, quality of life issues can be as important as quality of care. Being on call every night, or every other night, is becoming a thing of the past. If a community fails to meet the challenge of providing a mix of internists and pediatricians, and does not have a Med/Ped within their network, it is important to remember that there is still a "pioneer" aspect to Med/Peds. If the geographical area is right, the contract offer is fair, and the medical community is strong and supportive, you must keep in mind that someone has to be the first Med/Ped in an area; and it might not be so terrible if that someone is you.