Hi--I know that you can do a 2 year fellowship for pure CCM after IM without doing pulmonary, but how viable is that for getting a job afterwards? Do most hospitals prefer you to be pulmonary boarded too? I assume a lot of the smaller units might not need a full-time intensivist, would they be effectively excluded from your job hunt after?

I don't see why a hospital would toss out your job application if you were CCM only, without pulmonary. Other specialties can go CCM without doing pulm (surgery, anesthesia, EM), and the American medical system seems to be hurting for trained intensivists, period. Others actually in the system may have other (more informed) opinions, and I defer to them.

I was talking to one of our private practice pulmonologists and he was saying that they envision the practices growth being dominated by the need for 24/7 ICU coverage as that becomes the expectation at bigger hospitals. So for them, hiring some CCM only people is entirely possible. Unfortunately, it is not here yet so the actual need is hard to predict.

What's one more year anyway? CCM through IM is 2 years, Pulm/CCM is 3. I am interested more in CCM than Pulm but with fewer and fewer programs offering just CCM via IM, Pulm/CCM is the standard. Also, with Sleep Med training through Pulm/CCM, you can sit back and relax from your ICU shifts and make bank doing sleep studies.

1) Jobs: there are clearly LESS jobs for CCM only, 90 % need the combo. Hard to find job in University setting with pure CCM only because most depts have either Anesth or Pulm/CC
2) Income: 160- 250 with usually 15 12H-shifts per month. Every state has job offers for CCM. see nejm.org job section
3) Overall Pulm/CC combo better choice

This is from an insiders first hand experience

Also inside knowledge for a large university medical center:

starting IM teaching hospitalist: 120K
starting PCCM asst prof: 140K
starting CCM night attending: 180K for 3 10 hour nights per week.

I've seen several hospitals with CCM only. This is likely the wave of the future. Hospitals will subsidize the CCM practice to have 24 hour in house coverage. The pulmonologists will like it because they can spend more time on sleep and outpatient. I don't see any job shortages for the IM CCM only trained people. Don't do pulm if you don't like it or want to practice it.

I was referring to the private sector with above income figures.
Agree with above post that there will be jobs in pure CCM.
I personally would not like to do outpatient pulmonary med (Asthma, COPD and incurable intersititial lung dz).
Overall, there is a huge difference in income potential if you take the money+ benefits and break it into hourly wage. Typically it is around 100$/h in non-university hospitals. South pays best (as usual).
Again, one negative aspect of pure CCM is the small number of academic jobs in the big university hospitals after training (for those interested). However, plenty of jobs in teaching hospitals all over the country, if you enjoy interacting with housestaff.

A flipside is competition for the fellowships: the combined CCM/Pulm fellowships are a harder "get" than straight CCM (I don't know why, but the money thing might be part of it - EM types frequently say that "I don't want to be doing bronchs all day" when they say why they want to do CCM). I don't know if there are specific Pulm only fellowships (as I would think, for that angle, CC is part and parcel).

Inpatient pulmonary consultation practice and billing in addition to critical care practice can be a drive. Also, unlike GI, bronching all day is unlikely even in busy practices.

Pulmonary only fellowships exist but are less popular. Some are tied with allery/immunology. They tend to be less competitive.

The "bronchs all day" is hyperbole by EM types. I guess it equates to "I don't want to do it at all".

Inpatient pulmonary consultation practice and billing in addition to critical care practice can be a drive. Also, unlike GI, bronching all day is unlikely even in busy practices.

Pulmonary only fellowships exist but are less popular. Some are tied with allery/immunology. They tend to be less competitive.

What institutions have pulm fellowship tied to allergy?

Until recently, Vandy had a Pulmonary/Allergy fellowship consisting of 3 years. This was probably possible because the Allergy/Immunology division is tied in with Pulmonary/CCM. You will not find formal listings for combined Allergy/Pulmonary but some fellowships can be flexible and training tailored if there is significant crossover amongst subject matter.