Job market projections for combined PCCM positions

[000_]

So obviously it's difficult to predict job markets even 5 years into the future, let alone 10, 20, 30, etc. years, but I've seen a number of threads on here from the past suggesting that CCM will become oversaturated and that combined pulm/crit jobs are already hard to find. It's been said that hospitals are preferring to just hire intensivists rather than hire people who rotate through ICU and pulm weeks. It's also been said that CCM overall is already saturated except for the most undesirable locations. All of those threads were several years ago so I'm wondering how that's changed since then

Personally, I think I'm really only interested in practicing both. I don't want to do ICU full time (too much burnout, too many 84-hour weeks, and you're chained to the hospital) and I don't want to do pulm full time (not enough money and not enough time off). My ideal would be more or less splitting it 50/50. However, I've heard that's hard to find outside of underserved areas so I'm not sure if I should start looking towards another specialty.

For those who are in the field, what have you heard and seen about the job market going forward? Are there any resources that I can use to inform myself about the job market?

---

Members don't see this ad.

 

[chessknt]

So obviously it's difficult to predict job markets even 5 years into the future, let alone 10, 20, 30, etc. years, but I've seen a number of threads on here from the past suggesting that CCM will become oversaturated and that combined pulm/crit jobs are already hard to find. It's been said that hospitals are preferring to just hire intensivists rather than hire people who rotate through ICU and pulm weeks. It's also been said that CCM overall is already saturated except for the most undesirable locations. All of those threads were several years ago so I'm wondering how that's changed since then

Personally, I think I'm really only interested in practicing both. I don't want to do ICU full time (too much burnout, too many 84-hour weeks, and you're chained to the hospital) and I don't want to do pulm full time (not enough money and not enough time off). My ideal would be more or less splitting it 50/50. However, I've heard that's hard to find outside of underserved areas so I'm not sure if I should start looking towards another specialty.

For those who are in the field, what have you heard and seen about the job market going forward? Are there any resources that I can use to inform myself about the job market?

You said it--unpredictable. ICU jobs might not come with the burnout you think they do and pulm not pay as bad as you think it does so your foundational assumptions are flawed in my opinion. You will be able to find combined jobs in smaller areas but you are correct that these are becoming separate fields. A large part of this is the transition from PP to employment under immense financial pressures put in play by the big lobbies to drive PP to extinction. Inpatient and outpatient arms, even in large facilities, are generally under different administrative arms that don't muddle finances. This makes it increasingly difficult, though not impossible, to hire someone under these different appointments.

If you are still looking at options cardiology suits this desire better. They have both inpatient and outpatient options all under the same umbrella as well as low key retirement type options reading images that doesnt require any patient interaction. They have an immensely powerful lobby and protect their income better than any other field in IM (aside from onc).

 

[000_]

You said it--unpredictable. ICU jobs might not come with the burnout you think they do and pulm not pay as bad as you think it does so your foundational assumptions are flawed in my opinion. You will be able to find combined jobs in smaller areas but you are correct that these are becoming separate fields. A large part of this is the transition from PP to employment under immense financial pressures put in play by the big lobbies to drive PP to extinction. Inpatient and outpatient arms, even in large facilities, are generally under different administrative arms that don't muddle finances. This makes it increasingly difficult, though not impossible, to hire someone under these different appointments.

If you are still looking at options cardiology suits this desire better. They have both inpatient and outpatient options all under the same umbrella as well as low key retirement type options reading images that doesnt require any patient interaction. They have an immensely powerful lobby and protect their income better than any other field in IM (aside from onc).

While I do want to keep that option open, the main problems with cardiology for me are that it's significantly harder to match and that I feel way more drawn to critical care than cardiology. My understanding is that RVUs are made in the clinic so I feel like it'd be hard to carve out an inpatient niche. There's CCU of course but a cardiologist isn't an intensivist (and the CCU isn't the MICU either). Even with crit care training, it's much harder to find cards/crit care jobs than even pulm/crit I would imagine.

I think it also depends on how flexible I can be with time off. If I can take 1 week off a month as a cardiology partner it might not matter if I don't like the field as much (emphasis on might). Unfortunately I think most cardiologists are employed nowadays, and good luck convincing some HR person to let you take 12 weeks off, even with a pay cut. The good thing about critical care is it comes with 26 weeks off intrinsically, but you have almost no free time the rest of the 26 weeks. It's why I was hoping PCCM would be a better choice - slightly less time off but you also get some weeks where you have normal hours and weekends.

 

[chessknt]

While I do want to keep that option open, the main problems with cardiology for me are that it's significantly harder to match and that I feel way more drawn to critical care than cardiology. My understanding is that RVUs are made in the clinic so I feel like it'd be hard to carve out an inpatient niche. There's CCU of course but a cardiologist isn't an intensivist (and the CCU isn't the MICU either). Even with crit care training, it's much harder to find cards/crit care jobs than even pulm/crit I would imagine.

I think it also depends on how flexible I can be with time off. If I can take 1 week off a month as a cardiology partner it might not matter if I don't like the field as much (emphasis on might). Unfortunately I think most cardiologists are employed nowadays, and good luck convincing some HR person to let you take 12 weeks off, even with a pay cut. The good thing about critical care is it comes with 26 weeks off intrinsically, but you have almost no free time the rest of the 26 weeks. It's why I was hoping PCCM would be a better choice - slightly less time off but you also get some weeks where you have normal hours and weekends.

Cards usually rotates weeks/days seeing inpatients (new consults, rounding on primary pts, ICU etc). CCU doesn't exist outside of academia. Advanced CHF guys will manage sick hearts in general ICUs (assuming they dont dump it on the ICU service).

I wouldn't worry about taking a week off, you can take half your ICU career off with the improved income from cardiology in comparison.