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Celsus

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Hi I was wondering if anyone could give me some insight into the salary for pulm/cc with and without a sleep fellowship. I know alot depends on type of practice but a ballpark would be nice. Im trying to decide between that and anesthesia/cc and income is really the only thing I am having a hard time evaluating. Thanks
 

Eidolon6

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Compensation is regional. In my practice search (in the West, Mountain West), starting packages are ranging from 220k to 270k, without sleep training. Remember however that those numbers are often inflated and don't represent things like overhead. Also most practices provide a "guaranteed income" for the first year or so (which is really a loan that you pay off by staying with the practice), until you get your own crop of patients and billing picks up. Needless to say, its complicated and has a lot to do with what kind of practice you plan to enter. The compensation is still pretty good and you can safely expect to make >200k-300k when settled down somewhere.
 

chemamr

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Compensation is regional. In my practice search (in the West, Mountain West), starting packages are ranging from 220k to 270k, without sleep training. Remember however that those numbers are often inflated and don't represent things like overhead. Also most practices provide a "guaranteed income" for the first year or so (which is really a loan that you pay off by staying with the practice), until you get your own crop of patients and billing picks up. Needless to say, its complicated and has a lot to do with what kind of practice you plan to enter. The compensation is still pretty good and you can safely expect to make >200k-300k when settled down somewhere.

is it true that pulmonologists work around 68 hrs/week? and maybe PLUS emergencies? :eek:

thank you in advance
 

Eidolon6

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The offered call and work schedules for the different practices I've been exploring vary quite a bit...everywhere from home q3 home call with days covering both clinic and ICU to a call cycle system where one person is the ICU "point-man" and the rest of the practice is in clinic or on administrative duty during the week, taking call in say a q6 to q8 day cycle. That means the tank is the person taking the hits in the ICU for that week and is probably worked the hardest. As for hours per week...you can probably expect to average over 50 to 55 hrs per week, not including call duties (home versus in-house). The in-house call places seem to have q7-q10 day in-house call, which is reasonable.

All this being said, pulm/ccm docs are typically the hardest working/hardest worked group in the hospital. In addition to dealing with the underserved pulmonary population, they are also somewhat considered "super-hospitalists" who the surgeons and other medicine subspecialties (esp. cardiology) lean heavily upon to manage sicker inpatients and ICU patients. The most common phrase I hear from orthopods is "I'm just an orthopod...I don't know how to..." Of course most of us pulm/CCM folks have responded to more than one FOOBB (Found On Ortho, Barely Breathing) and feel obliged to *assist* them and other specialties in not assassinating their patients. This does include being available for the in-house or post-op emergencies.

This argues for a change in reimbursement as orthopods, neurosurgeons and cardiologists can make double or triple that of a full time pulm/CCM doc, though the brunt of the patient care workload outside of the procedures performed falls to the hospitalist or ICU doc. There are loopholes in Medicare and other billing mechanisms at which a doc can request a fraction of the surgeon/proceduralist's billing for a procedure for post op management (~15% or so). This is great in theory but employing it (thereby digging into another physicians income) may be alienating or insulting to those requsting consultation. The fact of the matter is that billing needs to be more homogenized such that two hours in the OR doesn't monetarily equal two weeks of non-procedural hospital care. The other trick is that surgeons don't get paid for post-op care (its rolled into the cost of the procedure), so they have an incentive and motivation to get patients off of their service, out of the hospital and out of their hands as quickly as possible to free up more time for them to do more billable procedures. This, as one could see, makes them more likely to hand the patient off to another physician as quickly as ethically possible.
 
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