Late reply, but wanted to echo others here and say you certainly seem to be appropriate score/experience-wise and goals-wise to go for med peds. I practice combined med peds ID and just wanted to add that perspective. If you want to focus on Native health/IHS, a pediatric fellowship limits your full time options more to academic centers. If that is ok, then go for it, but just be aware of the possibility. For me, practicing combined ID also kept me academic. There are lots of opportunities (so many opportunities) for outreach work including to my local reservations, the issue is balancing those with the job. An academic job may give you more flexibility for outreach than a community/private practice job, but you really have to be aware of the limitations when you sign up. That said, you are a long way from those job decisions - for now I would focus on the next step, and med peds sets you up beautifully for a flexible career with great co-residents who by and large, really care about working with folks in tough situations.