Demand for Outpatient Pulmonology

[intmed2014]

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I have a questions being a resident and having little exposure to outpatient side of things:

What is the demand for outpatient bread and butter pulmonology?- As attendings seem to do more of outpatient pulmonary as they grow older. If you choose not to do CC, is there enough pulm to supplement your practice? I have only rotated through county and there seems to be a high demand...but there is a high demand for basically everything at county.

How proficient are graduating fellows in bronchoscopy?- Variably by program I'm sure. One private attending I worked with in CC said the role of bronchoscopy in outpatient setting is limited (maybe he was comparing to EGD/Colon in GI and Left Heath Cath in Cardiology). How regularly are these procedures in outpatient setting?

Thank you for time! Hope to cross paths at some point in the future.

 

[jdh71]

I have a questions being a resident and having little exposure to outpatient side of things:

What is the demand for outpatient bread and butter pulmonology?- As attendings seem to do more of outpatient pulmonary as they grow older. If you choose not to do CC, is there enough pulm to supplement your practice? I have only rotated through county and there seems to be a high demand...but there is a high demand for basically everything at county.

How proficient are graduating fellows in bronchoscopy?- Variably by program I'm sure. One private attending I worked with in CC said the role of bronchoscopy in outpatient setting is limited (maybe he was comparing to EGD/Colon in GI and Left Heath Cath in Cardiology). How regularly are these procedures in outpatient setting?

Thank you for time! Hope to cross paths at some point in the future.

Lots of demand for out-patient pulmonary. LOTS. Unfortunately with the current payment structure you will make less doing straight pulmonary than doing both pulm/cc or just cc, but it's still not bad and I think one of my partners was offered 275k for plus rvu bonus for out-patient only pulm after they decided to bow out of the unit.

And your "CC" attending is full of **** with regards to bronchoscopy (CC docs are barbarians when it comes to bronchoscopy). You bronch all the time looking for a diagnosis, especially in the w/u of ILD. Plus EBUS is basically becoming standard of care for lung cancer staging.

 

[Hernandez]

Snot spelunking isn't as fun as a diagnostic bronch. And I do far more diagnostic bronch's than life saving CC bronch's.

 

[intmed2014]

Thanks for the reply. On an outpatient week, how many diagnostic bronch's are usually done?

 

[Hernandez]

Thanks for the reply. On an outpatient week, how many diagnostic bronch's are usually done?

Depends on your practice. Where you're located, and who, you're affiliated with, I'd assume a VA would have a higher number than many other practices, fly over country will have less pulmonologists per capita, and have you set up some sort of agreement with rads to be responsible for all the lung nodule screening referrals. It also depends on the week, some weeks I do none, some weeks I do double digits.

 

[jdh71]

Thanks for the reply. On an outpatient week, how many diagnostic bronch's are usually done?

Depends on the week. When your practice is ramped up, not unusual to have at least an afternoon full.