Pedi Pulm

[IMGPEDS]

I'm finishing up Intern year at a university based Categorical Pediatric Residency program and was hoping to gain some more insight in pediatric pulmonology. It seems like a fascinating field with some intensive care exposure while also having great follow up. I'm not sure why it's not popular but many programs go unfilled and there seem to be plenty of jobs for graduated fellows. Could anyone comment on:
- The general outlook of the field? (With almost 50% of fellowship spots going unfilled, is the field as a whole 'disappearing'?)
- The lifestyle as an attending? (Looking through job postings 1/4 weeks on as 'consulting attending' with 1/3-4 weekends on call on top of regular clinic schedule seemed typical, does this allow for a satisfying family/work balance?)
- The lifestyle as a fellow? (As compared to residency? Most programs seem to concentrate clinical time in the first year, I'm quite interested in research myself, what kind of hours should I anticipate?)
- Income as an attending (obviously depends academic/private HCOL/fly over state, but generally in line with primary pediatrician?)

Thank you for all your help!

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[BigRedBeta]

Field is not disappearing - but the types of patients that are becoming more common and in need of Pulm providers (the long term trach/vent dependent kids) are not necessarily the most inspiring patients to take care of (just my opinion, but one I've heard others mention as reason for not going into the field). The CF population also obviously represents a huge proportion of patients, but I think a lot more people are drawn to the field because of them. As we learn more about sleep and sleep apnea in children, more and more kids are getting sleep studies and using home CPAP/Bipap which is usually the peds pulm wheelhouse. Likewise as the NICU continues to improve survival rates, there are still plenty of ex-preemies going home on O2 that might get managed by pulm. So there are plenty of patients, but as an outsider, I'm not sure how many of them seem like an attractant patient population.

The mix of inpatient and outpatient, along with some procedural time for bronchs (though not as much as GI), is probably a draw for many. As an intensivist, I'm not sure what you qualify as "intensive care" exposure, because it's not like the pulmonologists are managing critically ill patients, but they do get involved frequently as patients are improving and getting ready to leave the ICU if they have conditions like asthma or long term ventilation needs. I have a great group of pulmonologists that I work with, but for the truly sick patients, there's usually not much they can add to my ventilator management. If it's a long term vent kid, I'll have them co-manage once we're off the hospital ventilators because they know the long term vents much better than I do, but again the kid is getting better at that point. For the sick asthmatics, we get consults early but the recs are always "continue current ICU therapies" and it's more for our/their workflow to get the kids to the floor faster when they are ready.

Income is roughly inline with general pediatricians to start. The MGMA data (couple years old and not broken down by region so there are limitations to it) I have access to shows that in the lowest quartile income is practically the same, starts to space out a tiny bit (4-8k) in the 25-50%ile range in favor of peds pulm and then the gap grows. Median Pulm salary $232,800 vs $228,400 for gen peds. Meanwhile at the 75%ile, it's $332,200 for Pulm and $288,100 for gen peds. Keep in mind though that there is an opportunity cost associated with going through 3 years of fellowship and the associated lost income, so at the median, you are still behind your co-residents who go into gen peds.

 

[IMGPEDS]

I guess I didn't realize the emphasis was so strongly on the chronic pulmonary disease population. Thanks for the insight!