flexibility question

[6ft3dr2b]

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I have a question about IM and its sub specialties (specifically pulmonary). I just wanted to know how flexible a Dr could be with his practice. I am interested in primary care as well as sub specialty procedure skills. However, I would like to practice them in an 80 primary care:20 sub% ratio. I just wanted to know how feasible that is or how realistic that is. So for example I would like to have an outpatient practice where I see all types of patients. Lets say one is a chronic smoker and he needs PFTs and a bronchoscopy. I would like to be able to perform those procedures (say 2x/week) and then follow up.

Thanks

 

[Reddpoint]

If you are in private practice you can be as flexible as you want. The reason why this is not done normally is because it is difficult to stay up to speed in multiple fields. Also I frankly would probably want to go a full time pulmonary specialist rather than a someone doing it 20% of the time. You could always consider family practice which is much more procedurally oriented than IM.

 

[6ft3dr2b]

I'm considering FM vs IM because of primary care. However, I would like to perform procedures.

 

[howelljolly]

Family Practice gives you the flexibility to do procedures. When you are in residency you can make the effort to get added qualifications in specific procedures by doing many of them under supervision. Im pretty sure that during your career you can take courses to add more procedeures to your arsenal.
Some common examples are OB/gyn procedures, vascectomy, suturing of laceratoions, sigmoidoscopy, biopsies and FNA.

I did a quick internet search and found a few programs that also train you to do stress tests and PFTs.

Where I did my FP rotation, they did echocardiograms and ultrasounds right in the office, on a few patients every week.

Come to think of it, I dont actually know what they did the echo once they obtained it. I guess they'd send the test data to the respective specialist for a diagnosis.

 

[dragonfly99]

Hmmm...if you really do like procedures, then fp may be the way to go.

As far as going IM, then pulm/critical care but only doing pulmonary stuff 20% of the time, people usually don't do that. The reason is after devoting 3 extra years to learning a subspecialty and taking a board certification exam to call yourself a pulm/critical care specialist, people usually don't want to go back to doing primary care all day. Also, primary care pays poorly vs. specialty care, so you'd be losing money (doing a 3 year fellowship as opposed to working at an attending job) in order to learn stuff that you'd only be using part of the time. As far as doing PFT's, you don't have to be a pulmonologist to do those...some general med and fp docs do those in their offices. Usually I think techs and nurses do them though...it doesn't really pay to have a doctor spend time doing that.

If you're really unsure about whether you want to do pulm/critical care vs. primary care, you might want to just go to an IM residency that has a strong pulm/critical care department at the main teaching hospital. That way your options are still open in 2 or 3 years (as far as doing fellowship or not).

You might be able to do a pulmonary fellowship (without the critical care component), but I'm not really sure. I know some people do straight critical care (no pulmonary) but usually folks don't do pulmonary by itself, as far as I know. Somebody correct me if I'm wrong.

 

[howelljolly]

There are 22 Pulmonary Disease fellowships out there. They are two years in length.

Pulm/CC fellowships are 2 years of pulmonology and one year of critcal care as an added qualification. Its the same added qualification that allows an ID or Nephro specialist to get CC boarded in one additional year. So, maybe you can end a Pulm/CC fellowship in 2 years and just board in Pulmonary Disease. In general, programs out west have a focus on Pulmonology whereas east of the Mississippi they focus on critical care. But, I doubt the program will be pleased with you leaving after two years.