Interventional Pulmonology?

[Handsome88]

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Is this a new specialty? Any information about it? What do they do exactly and how does it differ from Pulm/CC? What future does it have? Can we do this as a fellowship after Pulm/CC?

 

[jdh71]

Is this a new specialty? Any information about it? What do they do exactly and how does it differ from Pulm/CC? What future does it have? Can we do this as a fellowship after Pulm/CC?

Not really a new "specialty". Interventional pulmonary will do more specialized airway procedures using a bronchoscope, including more specialized types of biospies (EBUS, super-D or both), stenting, bronchothermoplasty, valves, and maybe even some lasers. EBUS has shown quite a bit of value in lung cancer staging and bronchothermoplasty may be an ok way to go for bad asthmatics, some of the other stuff really isn't panning out much IMHO, and requires a case by case selection of appropriate patients. It's mostly the pulm guys doing this kind of stuff after a pulm/crit fellowship +/- and extra "interventional" year. The CT surgeons can do some/most of this stuff too, but from my view are kind of leaving a lot of it to pulm, which frees them up to do other "bigger" things, I'm not seeing much of turf battle.

It's not a special boarded sub-sub specialty, but it could end up that way in a decade, who knows. The future is reasonable good, with the caveat, there only so much work to go around, so for a given area and population you don't need a ton of people doing this, so if you want to be able to pay your bills ONLY doing this kind of work, you'll have to practice where you'll get enough cases.

 

[VJWDO]

It is in the match now so it is a sub-sub specialty. It looks pretty cool if you are fine with becoming a procedure monkey. There is basically a need for 1-2 in most practices/hospitals and therefore you just do the challenging bronchs that no one else wants to do. At least that's how it is at Duke. They do Rigid bronchs which are pretty cool. Our IP guys also do pleuroscopy and pleurex catheters. Duke has an awesome program and the attendings are really amazing and fun to work with.

 

[jdh71]

It is in the match now so it is a sub-sub specialty. It looks pretty cool if you are fine with becoming a procedure monkey. There is basically a need for 1-2 in most practices/hospitals and therefore you just do the challenging bronchs that no one else wants to do. At least that's how it is at Duke. They do Rigid bronchs which are pretty cool. Our IP guys also do pleuroscopy and pleurex catheters. Duke has an awesome program and the attendings are really amazing and fun to work with.

I'd argue it's not an "official" sub-sub-specialty until it has it's own board. It's just same old pulmonary guys doing more with scopes.

 

[emt30119]

If someone was interested in doing interventional bronchs following P/CC, do most academic programs prepare you well for this without an extra year of interventional specific training, or are there a hand full of programs that would be best to attain this training during the standard 3 year P/CC fellowship.

 

[jdh71]

If someone was interested in doing interventional bronchs following P/CC, do most academic programs prepare you well for this without an extra year of interventional specific training, or are there a hand full of programs that would be best to attain this training during the standard 3 year P/CC fellowship.

Not all programs are going to be as to train you equally.

With that said most of interventional Pulm is being a good bronchoscopist with an interest.

I do believe, off the top of my head that Mayo and Cleveland Clinic are doing some very very cool things that way. Though you may need to stay for an extra year if you want to get decent number of the whole barrage of things that fall under interventional Pulm.

 

[Bobblehead]

BID in Boston has an IP fellowship. There are no boards, just an extra year of training. A lot of IP is making sure you have a good relationship with your thoracic surgeons (and having them understand that you're not competition but rather value added).

 

[VJWDO]

I highly doubt you would get enough at any program to be considered an IP doc without doing an IP fellowship. You would have to do a lot of rigid bronchs, Pleuroscopy, perc trachs, cryo, stent placement, thermoplasty etc to be compete with IP trained docs and you are just not going to get that as a regular pulm fellow anywhere. I would say our procedure training at Duke is one of the best and I do not feel remotely comfortable with 90% of the things the IP docs do here. I am just a good Bronchoscopist (ie TBBX, EBBX, TBNA, Brushing etc.) who also is competent at EBUS (though I do not pretend to be able to get some of the sub centimeter nodes that my IP attendings get).

 

[emt30119]

Thanks for they replies everyone. Do most of the IP docs you are familiar with do IP exclusively or nearly exclusively, or do most of them also do a mix of bronchs, clinic, inpt consult, unit...

 

[jdh71]

I highly doubt you would get enough at any program to be considered an IP doc without doing an IP fellowship. You would have to do a lot of rigid bronchs, Pleuroscopy, perc trachs, cryo, stent placement, thermoplasty etc to be compete with IP trained docs and you are just not going to get that as a regular pulm fellow anywhere. I would say our procedure training at Duke is one of the best and I do not feel remotely comfortable with 90% of the things the IP docs do here. I am just a good Bronchoscopist (ie TBBX, EBBX, TBNA, Brushing etc.) who also is competent at EBUS (though I do not pretend to be able to get some of the sub centimeter nodes that my IP attendings get).

Ask Atul Mehta and he'll tell you MOST of interventional is just bring a good bronchoscopist - at least that is what he had told me. Interestingly enough, he thinks if you're going to be doing EBUS you should have have the extra year of interventional training, plus you'll get the rigid training then.

(I think I ran into your poster at ATS - it was interesting - not a creepy stalker just put two and two together - that area has always been an interest of mine since residency and I was checking out the posters in that room waiting for things to get started with one if my cofellows in one of the mechanical vent poster discussions)

 

[jdh71]

Thanks for they replies everyone. Do most of the IP docs you are familiar with do IP exclusively or nearly exclusively, or do most of them also do a mix of bronchs, clinic, inpt consult, unit...

The guys at the U where I am still do some more general Pulm and critical care but the bulk of their practice is seeing the IP patients as out patient consults and going procedures. At some places the (I think Mayo is like this) the IP guys just do IP. So I think under the correct practice set up in the right area it could be possible to only do IP.

 

[group_theory]

(I think I ran into your poster at ATS - it was interesting - not a creepy stalker just put two and two together - that area has always been an interest of mine since residency and I was checking out the posters in that room waiting for things to get started with one if my cofellows in one of the mechanical vent poster discussions)

You're here at ATS too? This is my first ATS conference (didn't go to SF last year) and I am amazed at the size of this conference (and number of attendance). Plus, this conference has a very international flavor to it - never seen so many international pulmonologist (not so much CC docs, but I guess most places outside the US the cc docs are not pulmonologists)

What do you think of the new Olympus rotating bronchoscope? Should cut down on the number of carpel tunnel syndromes that IP folks get after years working the scope

 

[jdh71]

You're here at ATS too? This is my first ATS conference (didn't go to SF last year) and I am amazed at the size of this conference (and number of attendance). Plus, this conference has a very international flavor to it - never seen so many international pulmonologist (not so much CC docs, but I guess most places outside the US the cc docs are not pulmonologists)

What do you think of the new Olympus rotating bronchoscope? Should cut down on the number of carpel tunnel syndromes that IP folks get after years working the scope

Yeah. That new rotating Olympus scope is the ish. The other thing that was really cool about it was that you can get instruments through it fully flexed. I also thought their portable scope with the little LCD screen was pretty sick.

As far as the conference goes its pretty damn overwhelming. I've never seen a poster hall so big and it always seems like there are three sessions you'd like to attend at any given time.

 

[gutonc]

The guys at the U where I am still do some more general Pulm and critical care but the bulk of their practice is seeing the IP patients as out patient consults and going procedures. At some places the (I think Mayo is like this) the IP guys just do IP. So I think under the correct practice set up in the right area it could be possible to only do IP.

FWIW, I work in a community/academic hybrid setting (I'm a University employee who has what is basically a private practice at a community hospital) and the IP guy who works there (for the community hospital group) that's 75% IP and 25% ICU (with residents but no fellows).

 

[Hernandez]

Ask Atul Mehta and he'll tell you MOST of interventional is just bring a good bronchoscopist - at least that is what he had told me. Interestingly enough, he thinks if you're going to be doing EBUS you should have have the extra year of interventional training, plus you'll get the rigid training then.

Ironically (maybe) I think one of CCF's IP protégés who authored April's point-counter point on the topic did not do the extra years training. Granted CCF likely gave him an pathway tract. Linear EBUS isn't that damn hard, I don't know what the fuss is about, granted, I'm not bad with a scope, and have a good run of Nav bronch and have better yields than many of my attendings so far.

You're here at ATS too? This is my first ATS conference (didn't go to SF last year) and I am amazed at the size of this conference (and number of attendance). Plus, this conference has a very international flavor to it - never seen so many international pulmonologist (not so much CC docs, but I guess most places outside the US the cc docs are not pulmonologists)

What do you think of the new Olympus rotating bronchoscope? Should cut down on the number of carpel tunnel syndromes that IP folks get after years working the scope

I prefer Chest to the blue journal, but I'll admit, I do prefer ATS to ACCP's meetings.

Rotating bronch's..pththththththt, I use my body to rotate as much as my hands

Yeah. That new rotating Olympus scope is the ish. The other thing that was really cool about it was that you can get instruments through it fully flexed. I also thought their portable scope with the little LCD screen was pretty sick.

As far as the conference goes its pretty damn overwhelming. I've never seen a poster hall so big and it always seems like there are three sessions you'd like to attend at any given time.

Just don't go using that scope on anyone with prions......😱

Had I'd know both y'all were there, I'd have made the drive.

 

[MintChocolateChip83]

I think they're creating a board exam to be administered for the interventional pulm subspecialty. According to the AABIP the first time it's gonna be administered is Dec 6, 2013. The letter also says that people aren't gonna be grandfathered in.

http://www.aabronchology.org/about.php#presmes

 

[jdh71]

I thought I told you I was going Hern. My bad.

 

[Bobblehead]

I think they're creating a board exam to be administered for the interventional pulm subspecialty. According to the AABIP the first time it's gonna be administered is Dec 6, 2013. The letter also says that people aren't gonna be grandfathered in.

http://www.aabronchology.org/about.php#presmes

This is not an ABMS recognized board exam though.

 

[VJWDO]

Ask Atul Mehta and he'll tell you MOST of interventional is just bring a good bronchoscopist - at least that is what he had told me. Interestingly enough, he thinks if you're going to be doing EBUS you should have have the extra year of interventional training, plus you'll get the rigid training then.

(I think I ran into your poster at ATS - it was interesting - not a creepy stalker just put two and two together - that area has always been an interest of mine since residency and I was checking out the posters in that room waiting for things to get started with one if my cofellows in one of the mechanical vent poster discussions)

Haha I won't take out a restraining order.

 

[Handsome88]

Anyone knows how much of an added salary does one get if they do an extra year of interventional pulmonology?
Also it seems like there are programs straight out of IM as a subspecialty now? So we can do interventional pulm without doing pulmcc? So can someone just do CC->IP, or even IP->CC and just do procedures all day along side the ICU coverage? That sounds like a sweet deal.

 

[Hernandez]

Anyone knows how much of an added salary does one get if they do an extra year of interventional pulmonology?.

$0

 

[SRT 1983]

From what I have been told by multiple IP doctors, IP is a money pit since reimbursement for bronchoscopy is not great and you should only do it if that's what you really want to do. Its way easier to generate revenue by doing pulmccm . I was/am really interested in IP and even my experience as a fellow at a very good east coast university program was minimal. Real IP is still mainly limited to large academic centers

No you need to do a 3 yr PCCM fellowship to apply.

 

[Anri of Astora]

Hi everyone,

Sorry to revive an old thread, but just wondering what the more recent atmosphere in IP has been like. Really enjoying bronchoscopy/EBUS far more than anything else I have done, and seriously considering doing an IP fellowship. I know the compensation is not great, but that is a lesser concern of mine. Are there jobs still? Are they limited to academic centers? How competitive is it to get a good fellowship? Are the work hours insane, or fairly manageable? Is it feasible to do a mix of outpatient pulmonology and IP? Are there turf wars with ENT/thoracics?

Are there are current IP fellows or recent graduates who can comment on their experience, and whether they would encourage pulmonary fellows to pursue IP?

Thanks!!

 

[deleted856465]

Hi everyone,

Sorry to revive an old thread, but just wondering what the more recent atmosphere in IP has been like. Really enjoying bronchoscopy/EBUS far more than anything else I have done, and seriously considering doing an IP fellowship. I know the compensation is not great, but that is a lesser concern of mine. Are there jobs still? Are they limited to academic centers? How competitive is it to get a good fellowship? Are the work hours insane, or fairly manageable? Is it feasible to do a mix of outpatient pulmonology and IP? Are there turf wars with ENT/thoracics?

Are there are current IP fellows or recent graduates who can comment on their experience, and whether they would encourage pulmonary fellows to pursue IP?

Thanks!!

You need to be part of a large referral network to really thrive. The best IP programs are usually affiliated with very large academic centers with big oncology programs and sometimes lung transplant. But certainly doesnt have to be. The prime example of a private practice IP group is the Chicago Chest Center. Totally private practice, large refreral network, nationally respected IP people. In terms of job hunt, obviously a much more limited market but also a limited pool of potential hires. Most people do a mix of either CC and IP or Pulm and IP starting out until they can build a practice, then many narrow down to only IP. Just keep in mind that diagnostic bronchoscopy and EBUS are not exclusive to IP. Other than in the most specialized centers, diagnostic bronchoscopy and EBUS are done by standard pulmonologists.

In terms of turf wars, it very very institution dependent. Places with a very traditional-minded thoracic surgery dept (aka their department chair or section chair is >60 yo), will be more negative towards IP. Younger thoracic surgeons seen the value in IP. In terms of money, yes IP as a field is often a money loser by itself but its value comes in patient retention and not being forced to refer patients out. I also think IP provides value in management of pleural disease.

 

[kushr88]

Also what are your guys thoughts on going to a pulm/cc place with IP fellowship already vs one without? I've heard both pluses and minus to both. The biggest one being one without you get to do more bronchs. I'm interested in a IP place with big device development so I've heard Stanford would be a good choice.