Response to Dr Snellings: Learning From Other Combined Programs

Gregory P. Conners, MD, MPH, MBA

PRiMER. 2024;8:20.

Published: 2/29/2024 | DOI: 10.22454/PRiMER.2024.837001

To the Editor:

I applaud Dr Snellings for seeking creative ways to address the shortage of primary care physicians, as described in his recent letter to the editor.1 Specifically, Dr Snellings proposes a return of the family medicine-internal medicine (FM-IM) combined residency program. While some combined residency programs—most notably medicine-pediatrics (Med-Peds) residency programs—are flourishing, FM-IM combined residency programs seem to have gone extinct.2 The example of Med-Peds residency is instructive. While some Med-Peds combined residency graduates go on to practice subspecialties, many provide primary care, including to adult patients with chronic conditions more familiar to pediatricians. Compared with a 3-year residency in family medicine, internal medicine, or pediatrics, there is a clear value proposition for medical students considering Med-Peds combined residency3 and for departments of internal medicine and of pediatrics, medical schools, and hospitals to provide Med-Peds program sponsorship. Fortunately for family medicine, at least one study has shown that Med-Peds residency programs do not “rob” from family medicine residency programs.4

Now that the idea has been broached, appropriate next steps for those interested in a return of the FM-IM combined residency, or of other combined family medicine programs, are to consider both what is working well with Med-Peds and other combined programs, and what led to the withering of the previous iteration of the FM-IM residency, from the perspectives of medical students and of providers of family medicine and internal medicine training programs. Insurance payors and policy experts may also provide important perspectives. This may inform a path forward. As Dr Snellings notes, addressing America’s primary care shortage is an important goal!


  1. Snellings JE. Family medicine and internal medicine: let our powers combine! PRiMER. 2024;8:19. doi:10.22454/PRiMER.2024.657509
  2. Association of American Medical Colleges. AAMC ERAS 2024 Participating Specialties and Programs. Accessed February 20, 2024. https://systems.aamc.org/eras/erasstats/par/index.cfm?NAV_ROW=PAR.
  3. National Med-Peds Residents’ Association. Guide to Med-Peds. Accessed February 20, 2024. https://medpeds.org/medical-students/guide-to-med-peds/
  4. Melgar T, Frohna JG. Choosing a career in combined internal medicine – pediatrics: insights from interns. Fam Med. 2007;39(5): 326-330.

Lead Author

Gregory P. Conners, MD, MPH, MBA

Affiliations: SUNY Upstate Medical University, Upstate Golisano Children's Hospital - Department of Pediatrics, Syracuse, NY

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