Is it a good idea to SOAP into a sleep medicine fellowship now and then pursue a pulmonary/critical care fellowship afterwards?
Or should I just apply to pulmonary/critical care next cycle and then pursue sleep medicine only after a pulmonary/critical care fellowship?
that's not a bad idea. the sleep medicine (provided its pulm sleep faculty) will provide good letters for you and some research opportunities. the only potential shortcoming is the lower pay relative to hospitalist. but sleep fellowship is rather chill (relatively speaking) and you should have plenty of downtime to work on things
but yes if you can snag one of these sleep fellowships then go for it. several former residents I know did this same pathway you are contemplating now and they all got PCCM within one or two years.
sleep on top of PCCM makes you a more hirable doctor down the line anyway
anyway think about things more closely. if you truly still want cardiology then still try for it.
but just know there is quite a lot of "cardiac disease" overlap in pulmonary and sleep. i'm not just talking about critical care and shock management.
A lot of cardiac dyspnea gets sent my way in the community for pulmonary evaluation.
I use my EKO Core 500 stethoscope all the time for murmur analysis and phonocardiography, order plenty of echos in my office (through a third company ultrasound company - I obviously cannot interpret and bill own own echos. though i will do POCUS echo sometimes to get a quick volume assessment for certain cases), do EKG stress tests (which is built into a CPET test - Internists in the boonies do EKG stress tests al the time), manage PH (from a handful of Class 1/4, but plenty of 2s and 3s), co-manage CHF/pleural effusion, and CAD indirectly through treating OSA.
sure I am not doing Holter monitors, TTEs, vascular ultrasounds, or nuclear stress tests like a gen cardiologist, but I am doing PFTs, CPETs, POCUS Lungs, 6MWTs, and portable sleep studies.
i've made a handful of CAD, severe valvular disease, or arrhythmia diagnoses when I am referred dyspnea/chest pain first before cardiology. once i do I use internist level of management goes on basic therapy then send to the respective cardiology subspecialist (whether interventional, EP, or CHF)
so I get to pretend to be the general cards for a little while.
sure I am not titrating entresto or anything like that, but I have to keep up to speed on "internist plus" level of cardiology management as I get plenty of referrals for dyspnea that turns out to be primary cardiac. most of the CPETs I do (other than deconditioning) end of being primary cardiovasculd limitation
pulmonary does not have anything as big and money printing as a nuclear stress test but that's okay. doing a Type 1 sleep study (i.e. in lab PSG for sleep medicine doctors only) would pay close to the nuclear stress. but that requires the sleep medicine board and doing a lot more preparation overall.
bottom line outpatient pulmonary is as profitable as outpatient cardiology and there is "plenty to do." you can't go wrong going this pathway
plus the CCM makes sure you keep most of your IM skills so you can truly "handle everything" that comes your way
