Pulm Critical Care Hours and Salary

[Dryacku]

Just curious what are the avg hours of a Pulm CC doc???

Also what does salary range around for these docs?


thanks for any help

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[BMW19]

Sorry to add on to the OP but can someone describe what the responsibilities of Pulm/CC are for us 1st yr med students?

B-

Just curious what are the avg hours of a Pulm CC doc???

Also what does salary range around for these docs?


thanks for any help

 

[manning18]

Pulmonary Physicians manage basic Pulmonary disease, such as COPD, asthma (which can go to Allergy as well), Interstitial Lung Disease (Sarcoid, GoodPastures, etc.), Pleural Effusions in both the in-patient and out-patient settings. They can use their critical care background to manage Ventilators in the ICU. These days, a lot of Pulm/CC doctors have gotten into Sleep Medicine, which is lucrative. Basically, you run a sleep study on someone and prescribe BiPap or CPAP to help them sleep at night and follow up with them. The average hours are probably 50-60 or so per week. These averages are not that helpful, as the amount that you work depends on the amount of work you have to complete. Since you don't work for free, the more you work, the more money you make! Most days are probably pretty routine. However, in a Pulm/CC group, the calls must be pretty tough, since you have some critically ill patients. I have been told that the typical starting salary for a Pulm/CC doctor without Sleep training is around $220,000 per year. I think Sleep can add to that quite nicely, probably $5-15 K per month, depending on volume and whether or not the group already has a sleep specialist.

 

[BMW19]

Thanks for the post manning. How would it affect salary and hours if you just did CC and not Pulm? Would you pretty much just work in the ICU if you did CC only?

Thanks

BMW-

Pulmonary Physicians manage basic Pulmonary disease, such as COPD, asthma (which can go to Allergy as well), Interstitial Lung Disease (Sarcoid, GoodPastures, etc.), Pleural Effusions in both the in-patient and out-patient settings. They can use their critical care background to manage Ventilators in the ICU. These days, a lot of Pulm/CC doctors have gotten into Sleep Medicine, which is lucrative. Basically, you run a sleep study on someone and prescribe BiPap or CPAP to help them sleep at night and follow up with them. The average hours are probably 50-60 or so per week. These averages are not that helpful, as the amount that you work depends on the amount of work you have to complete. Since you don't work for free, the more you work, the more money you make! Most days are probably pretty routine. However, in a Pulm/CC group, the calls must be pretty tough, since you have some critically ill patients. I have been told that the typical starting salary for a Pulm/CC doctor without Sleep training is around $220,000 per year. I think Sleep can add to that quite nicely, probably $5-15 K per month, depending on volume and whether or not the group already has a sleep specialist.

 

[daelroy]

Lifestyle is dependent upon what you see. Many CC/Pulm will only see outpatient pulmonary and not do any hospital based critical care. Those doctors earn around 200K annually and work 9-5 with little call. The CC component can add more to salary but your lifestyle worsens. Pulm/CC is not very competitive and not a very desirable field. There are a lot of FMG's in the field. You work nearly the same hours as a cardiologist but won't see the type of money or prestige cardiologists pull down.

 

[spyrogyra1]

Lifestyle is dependent upon what you see. Many CC/Pulm will only see outpatient pulmonary and not do any hospital based critical care. Those doctors earn around 200K annually and work 9-5 with little call. The CC component can add more to salary but your lifestyle worsens. Pulm/CC is not very competitive and not a very desirable field. There are a lot of FMG's in the field. You work nearly the same hours as a cardiologist but won't see the type of money or prestige cardiologists pull down.

While all this is true, PCCM is the only true branch with has the charm of acute care medicine and does not carry the social crap.You can flex it any way you want. You can have pulmonarypredominat life or a CC dominant life.Either way you will like what you do. cards is plumbing to large extent- do a pulmonary consult month and you will know what I am talking about.
GL.

 

[chemamr]

deleted

 

[curious monkey]

anybody have an idea in terms of the rough percentages of the various types of patients one sees in the ICU. What I'm concerned about is as the patient population continues to increase, could that significantly increase the numbers of severe CHF, MI, COPD and thus be a place that is left to only manage pts that are dying...or will it remain a place where there still remains a large percentage of patients that can be sent home healthy.

 

[AJM]

anybody have an idea in terms of the rough percentages of the various types of patients one sees in the ICU. What I'm concerned about is as the patient population continues to increase, could that significantly increase the numbers of severe CHF, MI, COPD and thus be a place that is left to only manage pts that are dying...or will it remain a place where there still remains a large percentage of patients that can be sent home healthy.

Hmmm, are you saying that most patients who have had MIs or CHF/COPD exacerbations are dying or won't be left with a good quality of life? If so, you have a lot to learn....

If you want rough percentages of types of patients in MICUs, refer to any of the large recent critical care trials, since they always include a table that breaks down their study population into types of diseases seen. A good one to take a look at is Van den Berghe's Feb 2006 New England Journal artical on intensive insulin therapy in the MICU, since her study population is all-comers in the MICU who have an expected ICU length of stay greater than 3 days. You can look at the proportions there. Keep in mind that this study was done at academic centers, which tend to have sicker patients than at other hospitals.

As an aside, I moonlight at a community hospital ICU, and the types of patients I see there are much different than at the academic ICUs I usually work at. For example, at the community hospital, I see a lot of sepsis, DKA, NSTEMI (no cath lab at this hospital, so most STEMIs get transferred elsewhere), difficult post-op vascular or general surgery patients, and severe pneumonia. While we see a ton of sepsis, ARDS, and DKA at the academic ICUs as well, we also get a number of chronically ill patients or transfers from outside hospitals when they no longer have the resources to care for that particular patient.

Mortality is high in the MICU -- much higher than the SICU. So, yes, you'll take care of a lot of patients who will end up dying. While the difference between the MICU and SICU partially has to do with increased age and comorbidities of the patients, there are a lot of sick patients who are quite young. And you will have a lot of young patients who will die on you, even if they don't have any underlying chronic disease. Just because our population is getting older doesn't mean that young people don't get critically ill....

 

[Jmillerdoc]

Lifestyle is dependent upon what you see. Many CC/Pulm will only see outpatient pulmonary and not do any hospital based critical care. Those doctors earn around 200K annually and work 9-5 with little call. The CC component can add more to salary but your lifestyle worsens. Pulm/CC is not very competitive and not a very desirable field. There are a lot of FMG's in the field. You work nearly the same hours as a cardiologist but won't see the type of money or prestige cardiologists pull down.

A friend recently sent me this link and I couldn't help but comment. I am a hospitalist in a medium sized city in Oklahoma. I see an average of 17 pts a day with 3-4 in the ICU. I do all of my own critical care and the data bears out these facts at my facility and across the nation...involving a CC specialist in the care of my ICU pts only serves to increase cost and length of stay and does not improve outcomes.

I make a base salary of 250k a year and work a 7 day on 7 day off schedule, 14 days a month. I also see a few pts a week in a skilled care nursing home and do a few disability exams a month too. Everything together nets me about 330k a year. I probably work a total pf 17 days a month and I have an awesome schedule and lifestyle.

I cannot understand why anyone would want to do a few more years of training to do what I already do and make less! I wouldn't even start to consider doing a CC fellowship today unless I could be for certain I made at least three times what I made now....once you've tasted the lifestyle of what I do you are spoiled I guess.

It boggles my mind how they even fill one fellowship position a year with the salaries and lifestyle of a CC doc these days.

SW OK cowboy doc

 

[Commotio]

A friend recently sent me this link and I couldn't help but comment. I am a hospitalist in a medium sized city in Oklahoma. I see an average of 17 pts a day with 3-4 in the ICU. I do all of my own critical care and the data bears out these facts at my facility and across the nation...involving a CC specialist in the care of my ICU pts only serves to increase cost and length of stay and does not improve outcomes.

I make a base salary of 250k a year and work a 7 day on 7 day off schedule, 14 days a month. I also see a few pts a week in a skilled care nursing home and do a few disability exams a month too. Everything together nets me about 330k a year. I probably work a total pf 17 days a month and I have an awesome schedule and lifestyle.

I cannot understand why anyone would want to do a few more years of training to do what I already do and make less! I wouldn't even start to consider doing a CC fellowship today unless I could be for certain I made at least three times what I made now....once you've tasted the lifestyle of what I do you are spoiled I guess.

It boggles my mind how they even fill one fellowship position a year with the salaries and lifestyle of a CC doc these days.

SW OK cowboy doc

I don't even know where to begin with this asinine post. I'm sure having a hospitalist run an ICU in rural SW OK is perfectly acceptable. The acuity of your ICU is probably quite low compared to the ICUs in larger centers. I can tell you that no one at my hospital would be comfortable having a hospitalist care for a patient on ECMO, or the patient with severe DAH, or the lymphoma patient with ARDS on HFOV, etc. I'm not saying that hospitalists can't take care of ICU patients, but to pretend that you have all of the skills and the knowledge base that is necessary to take care of the full spectrum of critically ill patients is just ridiculous. FWIW, the pulmonolgists and medical intensivists at my institution and the other hospitals in our area make substantially more than $250,000 per year.

 

[PCCM fellow]

I don't even know where to begin with this asinine post. I'm sure having a hospitalist run an ICU in rural SW OK is perfectly acceptable. The acuity of your ICU is probably quite low compared to the ICUs in larger centers. I can tell you that no one at my hospital would be comfortable having a hospitalist care for a patient on ECMO, or the patient with severe DAH, or the lymphoma patient with ARDS on HFOV, etc. I'm not saying that hospitalists can't take care of ICU patients, but to pretend that you have all of the skills and the knowledge base that is necessary to take care of the full spectrum of critically ill patients is just ridiculous. FWIW, the pulmonolgists and medical intensivists at my institution and the other hospitals in our area make substantially more than $250,000 per year.

It is interesting to see the field of critical care from a hospitalist perspective. I am a second year pulmonary and critical care fellow in one of the top 10 programms in the country ( based on the US world and news ranking, yea I know that ranking is biased).
It is true that hospitalists can managed some patients in the ICU. This is typically true for patients ICU fellows called crapy admissions, like COPD exacerbation, septic shock ( fluid and vasopressor responsive), post op patients who are on a ventilator, drug overdose or alcohol withdrawl.intubated for airway protection, severe pneumonia and so for. To think that hospitalists can manage the type of ICU patients we see in quaternary level hospitals is unfair and probably dangerous. And the studies that I came across showed better outcome in a closed ICU. ( I may not agree with some of the study findings but that is the real data).
As you all know physician salary differs greatly from region to region and the type of practice. This is also true for hospitalists. In the midwest and south it is in the 200k range. In east coast( DC metro area and New York city) it can go as low as 160K. Hospitalists in the big cities has to do substancial moonlighting to suppliment their income. Pin pointing one case ( rural Oklahoma city hospital salary) and making that the base for decision for future residents will not be appropriate. That is also true for pulmonary and critical care physicians. In my University hospital last year graduates were hired as an assistant professors with a salary of 170k ( yea it is low!). some folks went to private practice with a salary range of 250-315 k. One guy was offered a spot in Alaska for 750k. So your salary depends greatly on the type of practice, where do you want to live and academic vs private practice.
In general with the aging population and demand for ICU care the demand for critical care physicians is growing. And across the board pulmonary and critical care physicians make more money taking all things in to account.( like if you compare a hospitalist salary Vs a Critical care physician in small Oklahoma city) .

 

[Moozy]

Agree with above.

Pulm/CC Salary ranges from 100-180K in academic settings overall. Around 180-250K starting in northeast and west; 250-400K in South and Midwest... not talking about remote areas which of course will pay a lot more. Then ofocurse in a lot of places where WRVUs are involved; a third year attending in Pulm/CC is making around 500K easily and work is all not that bad. Depends on the kind of practice you pick and how you are dividing the work load.

 

[Moozy]

I am in Pulm/CC and agree with most of what you have said. But how many centers will have ECMO. I am in the market now and I know how most of the hospitals are working. I agree that what you are saying is true for academic centers (that also big ones) but does nit apply to many hospitals even in the big cities. And not many Pulm/CC people go into academics. The $$$ difference is huge. Having said that, hospitals in private sector or reasonably decent sized cities will have hospitalists address main issues where the Intensivist is a consulting physicians and has the final say in general.

I don't even know where to begin with this asinine post. I'm sure having a hospitalist run an ICU in rural SW OK is perfectly acceptable. The acuity of your ICU is probably quite low compared to the ICUs in larger centers. I can tell you that no one at my hospital would be comfortable having a hospitalist care for a patient on ECMO, or the patient with severe DAH, or the lymphoma patient with ARDS on HFOV, etc. I'm not saying that hospitalists can't take care of ICU patients, but to pretend that you have all of the skills and the knowledge base that is necessary to take care of the full spectrum of critically ill patients is just ridiculous. FWIW, the pulmonolgists and medical intensivists at my institution and the other hospitals in our area make substantially more than $250,000 per year.

 

[Commotio]

I am in Pulm/CC and agree with most of what you have said. But how many centers will have ECMO. I am in the market now and I know how most of the hospitals are working. I agree that what you are saying is true for academic centers (that also big ones) but does nit apply to many hospitals even in the big cities. And not many Pulm/CC people go into academics. The $$$ difference is huge. Having said that, hospitals in private sector or reasonably decent sized cities will have hospitalists address main issues where the Intensivist is a consulting physicians and has the final say in general.

Hey Moozy, I agree with what you posted. I didn't intend to imply that ECMO is widely used or that every ICU patient is sick enough to require the care of an intensivist. I was simply refuting the idea that hospitalists are capable of handling all ICU patients without the input of a pulmonologist or medical intensivist. That seems very short-sighted to me.

 

[Moozy]

Hey Moozy, I agree with what you posted. I didn't intend to imply that ECMO is widely used or that every ICU patient is sick enough to require the care of an intensivist. I was simply refuting the idea that hospitalists are capable of handling all ICU patients without the input of a pulmonologist or medical intensivist. That seems very short-sighted to me.

I agree! Things will change for sure..