Children with chronic illnesses are sometimes lucky enough to spend 18 years with the same pediatric specialist — a doctor who knows their history, their needs, and can provide the right care at the right time.
But when those children grow into teenagers and then enter adulthood, that means graduating from their pediatric practice. Transitioning to the right adult primary care physician — one who is experienced with managing their specific chronic illness — is crucial to their future health and wellness.
Fortunately, Rochester has a group of physicians trained specifically for these patients.
The University of Rochester’s Internal Medicine-Pediatrics training program was the first such program of its kind in the country, and it’s still recognized as one of the very best. Future doctors are trained in the interconnected but very different worlds of pediatric and adult medical care, and they learn to shift fluidly between the two disciplines so they can help make patients’ move from pediatric to adult care successful and safe.
After four years of training, its graduates are board-certified to practice both pediatric and adult internal
medicine. They can choose from a variety of career paths, including primary care practice, subspecialty practice, research, public health, hospitalist positions, and international health practice.
The program began in 1967 as a rotating internship, and then became a board-certified, combined “Med-Peds” training program in 1974.
Being a Med-Peds graduate “gives you an ability to counsel families that is much richer, because when you’re working with a pediatric patient, you know what that disease will look like for them when the patient is 40 or 60 years old. That was an important part of training, especially given what I’m doing now,” said Tiffany Pulcino, M.D., M.P.H., who graduated from the program in 2008.
As Medical Director of UR Medicine’s Complex Care Center, Dr. Pulcino is helping patients with childhood-onset, chronic conditions gain access to adult primary care that is geared to their needs. Because the demand for this specialized care is growing, she also works with primary care practices in the region to provide consultation, education and referral services so they can improve their care for patients with complex conditions. Making wise use of finite health care resources is the kind of creative solution that the Med-Peds residency instills in its graduates.
The program builds in time for special training in health care advocacy, global health, medical education, and research, which encourages participants to follow their passion and to explore innovative approaches to health care challenges. “The structure of the program is really responsive to the needs of the trainee,” Dr. Pulcino said. “It enabled me to spend my fourth year of residency focused on building the delivery model for the Complex Care Center.” There are more than 80 Med-Peds residency programs in the country, but Rochester’s gives graduates exceptional preparation for any career path they pursue, said Brett W. Robbins, M.D., Director of the Medicine-Pediatrics residency training program at UR. He completed his Med-Peds residency here in 1997.
“Our graduates consistently report that their experience here has prepared them for whatever they want to do,” he said. “They have the skill set to compete for any further training or faculty positions out there, and they can choose from a vast array of options. They finish here total rock stars.”
In post-graduate surveys completed by their colleagues and employers, UR’s Med-Peds alumni consistently finish ahead of peers from other Med-Peds programs in the six major competencies of medical training: patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
Residents spend part of each week seeing patients at the Culver Medical Group pediatric-adult medicine practice. It’s an ideal environment to learn from physicians who are experienced Med-Peds community providers as well as dedicated instructors to future generations of doctors.
“That’s where your mentors are,” said Dr. Pulcino. “Those physicians train you to think like a Med-Peds doctor. You not only get clinical instruction, but also essential practice skills like billing, scheduling, charting.”
Dr. Pulcino is a native of the Rochester area, but only learned about the program while studying at New York University School of Medicine. “I decided on Med-Peds in medical school and looked for the best program in the country, and this was it. Its presence in the community, the maturity and excellent reputation of the program made it the right choice for me.”
One patient who benefited from Pulcino’s training was Stephanie Ramos, who was born with sickle cell disease. Pulcino’s care — and a coalition of sickle-cell specialists including Suzie Noronha, M.D., and Jeff Andolina, M.D. — eventually led to a bone marrow transplant which cured her of the disease.
“It’s a horrible disease. My body would just break down without warning,” said Ramos, 28, of Irondequoit. “To be free of it, words can’t really explain how I feel.”