Career options in pulmonology(?)...

[BlackNDecker]

Is there a difference in a pulmonologist and a intensivist? Is intensivist even the correct word? I am an M2 and REALLY enjoying the respiratory pathology. I was surgery gung-ho in the beginning but am falling for the "art" of the physical exam. I am curious about lifestyle, $, demand, and different career options.

Thanks in advance.

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[AJM]

Is there a difference in a pulmonologist and a intensivist? Is intensivist even the correct word? I am an M2 and REALLY enjoying the respiratory pathology. I was surgery gung-ho in the beginning but am falling for the "art" of the physical exam. I am curious about lifestyle, $, demand, and different career options.

Thanks in advance.

Yes and no. You can be a pulmonologist and an intensivist, or you can just be a pulmonologist, or you can just be an intensivist. The most common route to do critical care from IM is to do a pulmonary/critical care fellowship, in which case you would be both a pulmonologist and an intensivist. There are a few programs out there where you can just do pulm or just do critical care, but most people do the combined program.

After you finish a pulmonary/critical care fellowship, you have a TON of flexibility as to what you want to do. Many pulmonologists will primarily work in ICUs, many will never want to see the inside of an ICU again and just want to focus on the pulmonary patients, and many will do a combination of outpatient/inpatient pulmonary plus ICU work. It's really up to you and what your style is. Lots of people will start out doing mostly ICU work and then as they get on in their careers and lose energy for the ICU, they might transition to mostly outpatient pulmonary. If you're more of an outpatient-type of a person you can also get additional certification in sleep medicine and run a sleep clinic, which has been growing in popularity among pulmonologists, primarily for lifestyle reasons.

The lifestyle is highly variable depending on how you want to tailor your career. But even among pulmonologists who focus in the ICU, the lifestyle has become much better. ICU's these days are turning into more of an ER-type of lifestyle, where you work in shifts. As far as demand, the demand right now is incredibly high for intensivists, given recent studies that have shown greatly decreased mortality rates in ICUs run by intensivists as compared with those run by physicians with no specialized training in critical care. There is also an extremely high demand for sleep specialists at this time. I don't mean to say that prospects are bad for pulmonary, it's just that it's so incredibly good right now for sleep and critical care. The job prospects for pulmonary are good, but it again partially depends on which areas you would like to focus in. For example, if you are willing to do 1-2 months a year of ICU, you will get many more job offers than if you solely wanted to do pulmonary.

 

[BlackNDecker]

Yes and no. You can be a pulmonologist and an intensivist, or you can just be a pulmonologist, or you can just be an intensivist...

...The job prospects for pulmonary are good, but it again partially depends on which areas you would like to focus in. For example, if you are willing to do 1-2 months a year of ICU, you will get many more job offers than if you solely wanted to do pulmonary.

Thanks for the help.

Would you still begin in IM if you intended to do a combined program? Is Pulmonology/Intensivist considered a fellowship? What is the length of time involved?

If the ICU is becoming more like shift work, I imagine the compensation is probably falling in line with the ER as well?

I'm an M2 so forgive me for not knowing some of these things already.

 

[AJM]

Thanks for the help.

Would you still begin in IM if you intended to do a combined program? Is Pulmonology/Intensivist considered a fellowship? What is the length of time involved?

If the ICU is becoming more like shift work, I imagine the compensation is probably falling in line with the ER as well?

I'm an M2 so forgive me for not knowing some of these things already.

Sorry I wasn't more clear -- pulmonary/critical care is the standard fellowship to do. It's possible to separate them if you want, but the vast majority of pulmonologists get there by doing a pulm/cc fellowship. There are something like 140 pulmonary/critical care fellowship programs in the country, and only about 20 or so straight pulmonary programs. The pulm/cc fellowship is 3 years, although most competitive academic programs are moving towards 4 years, and it is done after an IM residency. If you just want to do pulmonary without critical care, the fellowship is 2 years. Take a look at the IM fellowships FAQ at the top of the forum for more details.

I don't know what the compensation is for ED physicians. The figures I have heard in the past for pulmonary salaries are an average around 230K for about 3 years into practice, but those numbers are probably outdated. I don't know what the salaries are for pulmonologists who are mostly intensivists, but my guess is that it's higher.