Alumni/Donor Spotlight: Barbara Schuster '77M (MD), '80 (Res)

Barbara L. Schuster, MD,
'77M (MD), '80 (Res)

As she graduated from the University of Rochester School of Medicine and Dentistry and prepared to begin her residency at URMC, Barbara L. Schuster, MD had a vision for herself to complete a combined internal medicine and pediatrics program. “Med-peds was not an integrated program in those years,” she recalls. “However, I learned that the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP) allowed residents who completed 24 months of pediatrics residency and 24 months of internal medicine residency to sit for both specialty boards.” Nationally this option was very limited but the University of Rochester did offer it. For personal reasons, Schuster wanted to match in a residency in Rochester. The med-peds option was her first choice, but she did not match. Her second choice was the Associated Hospitals Program, a new primary care internal medicine program developed by Dr. Lawrence Young who had been the Chair of the Department of Medicine and a national leader in Internal Medicine. He was a member of the committee that convinced the ABIM and the ABP to accept the ‘2 years plus 2 years’ residency program for eligibility for dual pediatric and internal medicine certification boards. Dr. Young heard of a pediatric resident looking to do four months of internal medicine before beginning a position with the Indian Health Service and encouraged Dr. Schuster to consider a swap, giving her an opportunity to pursue some training in pediatrics. The two women swapped the remaining four months of their intern year. Schuster went into the pediatric intensive care unit as her first pediatric rotation and the neonatal intensive care unit as the last rotation of her internship, with a month on the pediatric surgery service and a month of wards in between.

After that, Dr. Young offered to develop a pathway for Schuster to complete a ‘2 years plus 2 years’  program in internal medicine and pediatrics, but the timing was not right for Schuster and her husband, and she declined Dr. Young’s offer. Instead, she chose to complete the Associated Hospitals Program in Internal Medicine (AHP). She remembers, “In those days, you could do eight months of internal medicine and four months of another specialty in the internship year and still qualify for board certification in internal medicine.” 

Though unable to complete a med-peds program herself, Schuster recognized its value for future residents. In 1981, she was on faculty at URMC and the Assistant Program Director of the Associated Hospitals Program. With the support of Dr. Rudolph Napodano, the AHP Program Director following Dr. Young, she convinced the Department of Pediatrics and the Department of Internal Medicine to adapt the ‘2 years plus 2 years program’ to a med-peds residency with increased resident positions and a 4-year curriculum. Working with the med-peds program at the University of North Carolina under the leadership of Dr. Andrew Greganti, a former URMC categorical internal medicine resident (1972-75), the National Residency Match Program (NRMP) granted a match suffix to be used by all institutions to recognize med-peds as a distinct program, although without independent accreditation. Over the ensuing years, supported by the Association of Program Directors in Internal Medicine and the Association of Pediatric Program Directors, in addition to the ABIM and ABP, the guidelines for combined med-peds programs were written. That was followed by formal curricular requirements, and eventually independent accreditation. The number of institutional programs increased as did the size of individual programs, though most remained small offering four to eight first-year positions. Schuster ran the program until 1995 when she left Rochester to accept a Chair of Internal Medicine position. Dr. Brett Robbins took over the reins and remains the current program director. According to Schuster, “Brett was a fabulous med-peds resident and is an amazing program director. Because of his leadership, I believe the U of R program remains the best.”

Schuster shares that in addition to pursuing a career in primary care, med-peds residents can go on to pursue any sub-specialty in internal medicine or pediatrics and occasionally a combined fellowship. As a subspecialist in cardiology, for example, they are comfortable caring for patients with congenital cardiac disease who are in the transition between pediatric and adult care. Schuster explains, “Children with chronic medical diseases in all specialties are now surviving. There are limited subspecialty fellowship positions in pediatrics, and small and medium-sized communities don’t have easy access to all the pediatric specialists that a big city can offer. Having the depth of a med-peds residency education can help sub-specialists who have completed only an internal medicine fellowship be comfortable caring for patients under the age of 16. International medicine is another area of interest for med-peds residents. When I was program director, we had many residents interested in missionary or global medicine where a doctor has to be prepared for dealing with patients of all ages. Someone who’s willing to pursue this combined program also has other mindsets, capacities, and skills which drives them. Some graduates have incorporated research into their career, but the majority become wonderful primary care doctors. UR was and is very well known for primary care. It all goes back to George Engel, and the biopsychosocial model. The medical environment and education are much more holistic, which has energized some former residents to take leadership in areas of health literacy and physician resiliency.”

As program director, Schuster learned a lot about her mentees and the evolution of their experience in residency. She was prepared for almost all her residents to come to her in October of their second year of the program in frustration as they continued to alternate internal medicine and pediatric rotations every 3-4 months. In addition to confronting the differences in residency expectations and processes, the second-year categorical residents had had twice the experience in their specialty. The med-peds residents were coming into a supervisory role at a slight disadvantage; knowledge in each specialty seemed to lag. Dr. Schuster would encourage them to persevere and work through the challenges, remembering why they chose to “go the med-peds route.” Schuster knew that by the time the med-peds residents made it halfway through the residency, at the end of the second year, the integration of knowledge and skills would rapidly rise. The residents would tell her that they no longer needed to think about whether they were caring for a pediatric patient or an adult patient. Schuster found that after that point in their training, both the internal medicine and pediatric departments loved the med-peds residents, who were trusted to cover either the adult ICU or the neonatal ICU. 

As she broke new ground in starting the med-peds program at the University of Rochester, Schuster was also a trailblazer as a female physician and one of the first women to hold a leadership position in the Department of Medicine. “When I became the primary care internal medicine program director, I was the only woman considered a division chief,” she recalls, “And now URMC has a woman as chair of medicine, Dr. Ruth O'Regan.” Schuster herself went on to chair the department of internal medicine at Wright State University’s Boonshoft School of Medicine in Dayton, OH. Then, she became the founding dean of the Medical College of Georgia (now Augusta University)/University of Georgia Medical Partnership in Athens, GA. Schuster shares that she is now a member of a committee for the SMD Women in Medicine Network and is a volunteer mentor in the Meliora Collective. She experienced setbacks in her own career as a woman, but now she works to guide others.

After Schuster left URMC, her former residents created the first med-peds resident award in her name, in gratitude for her mentorship. “I was very touched. It was a surprise and a true honor,” she says. This got her thinking, and she wanted to see how she could make an even bigger impact for residents in the program. “I wanted to give back, and to help fill the financial gap for the award. When the endowment yearly generated more than an appropriate gift to accompany the award, we had to figure out – what should be done with the rest? Money for resident travel was always difficult to obtain, so in consultation with Dr. Robbins and the program leadership, we decided to use the additional money to help fund sending the chief resident to an annual leadership meeting and broadly provide support for board preparation for all residents. It was all about supporting the education of the residents, monetary support that would not routinely be put into the program’s budget.”

Now looking back at the med-peds program she helped build, Schuster shares that she is thrilled with the results. “I am incredibly pleased with how the program has grown and evolved,” she says. “For almost 40 years the program has maintained itself. Obviously, there are enough students who care about med-peds and see that this approach to postgraduate education opens all career doors. I look forward to watching the med-peds program continue and flourish. It is challenging to simultaneously feel comfortable in internal medicine and pediatrics. You have to think broadly and integrate your knowledge and skills. But ultimately, it’s the best preparation for patient care.”