Pulm Only vs Pulm/CC

[NewYorkDoctors]

Any advantages/disadvantages of Pulm Only vs Pulm/CC?
Granted the sheer number of pulm/CC programs over pulm only makes this question relevant to only a small number of applicants.

But 2 years is better than 3. Though the only thing I see may be a downer is not being able to get a job anywhere you can and only limited to maybe the home institution or a smaller hospital that will allow you to do MICU in a non-tertiary care center?

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[deleted856465]

Any advantages/disadvantages of Pulm Only vs Pulm/CC?
Granted the sheer number of pulm/CC programs over pulm only makes this question relevant to only a small number of applicants.

But 2 years is better than 3. Though the only thing I see may be a downer is not being able to get a job anywhere you can and only limited to maybe the home institution or a smaller hospital that will allow you to do MICU in a non-tertiary care center?

Institutions with pulm-only fellowships tend to have lower perceived prestige, are usually smaller and have fewer research opportunities. All this will limit your future marketability and job prospects. In the grand scheme of things 1 year is not a big difference ot your career but can have significant impact on what kind of job/doors are open to you. Even if youre interested in community medicine, most Pulm groups contract with hospitals to staff their ICUs.

I would strongly recommend against doing a Pulm only fellowship but I'm sure you'll find people here telling you the opposite.

 

[NewYorkDoctors]

Certain Pulm Only state they have good relations with a CCM program and their fellows can usually go get the CCM year.
For an IMG with limited options, this would be a feasible plan right? in addition, doing an extra CCM year may entail more diverse ICU training (Neuro CT Cardiac Medical Surgical) than would a pulm/CCM fellow who would primarily get MICU/SICU?

 

[Mad Jack]

Institutions with pulm-only fellowships tend to have lower perceived prestige, are usually smaller and have fewer research opportunities. All this will limit your future marketability and job prospects. In the grand scheme of things 1 year is not a big difference ot your career but can have significant impact on what kind of job/doors are open to you. Even if youre interested in community medicine, most Pulm groups contract with hospitals to staff their ICUs.

I would strongly recommend against doing a Pulm only fellowship but I'm sure you'll find people here telling you the opposite.

Pulm applicants are strong candidates for completing one-year CC fellowships afterward though, so it's not like it closes CC to you down the line.

 

[CCM-MD]

The "lower perceived prestige" part I disagree with. Mayo, Sloan, NIH all have 2 year pulmonary fellowships, doubt anyone would say they have low prestige. And you will have no problem finding a pulmonary gig as long as you are flexible about location.

Shouldn't be difficult to add a CCM year afterwards if you are truly interested in it. If you are not interested in CCM, don't do it. You should be able to find a pulmonary only gig pretty easily. In my city Pulm and CCM have become separate. Most hospitals in the area have hired intensivists or have intensivists through a contracted company. Few have the old model of a pulmonary critical care group that rounds in the ICU and does outpatient pulmonary also. Those that still have the old model also have some physicians doing either one or the other. Most physicians are doing either Pulm only or CCM only even if they are dual trained. Compensation does favor critical care currently but there isn't a huge difference, and who knows what will be the case by the time you are done training. I don't think there is anything wrong with doing a 2 year pulmonary fellowship as long as that's what you want to do.

 

[deleted856465]

The "lower perceived prestige" part I disagree with. Mayo, Sloan, NIH all have 2 year pulmonary fellowships, doubt anyone would say they have low prestige. And you will have no problem finding a pulmonary gig as long as you are flexible about location.

Shouldn't be difficult to add a CCM year afterwards if you are truly interested in it. If you are not interested in CCM, don't do it. You should be able to find a pulmonary only gig pretty easily. In my city Pulm and CCM have become separate. Most hospitals in the area have hired intensivists or have intensivists through a contracted company. Few have the old model of a pulmonary critical care group that rounds in the ICU and does outpatient pulmonary also. Those that still have the old model also have some physicians doing either one or the other. Most physicians are doing either Pulm only or CCM only even if they are dual trained. Compensation does favor critical care currently but there isn't a huge difference, and who knows what will be the case by the time you are done training. I don't think there is anything wrong with doing a 2 year pulmonary fellowship as long as that's what you want to do.

You're right Mayo is a great program. NIH is a unique situation and doesnt have a lot of comparison to other programs. However, MSKCC is NOT considered a top tier program. A lot of MSKCC's fellowships outside of its onc associated fellowships are not considered top tier precisely because their patient base limits their exposure. I would argue that there are far more prestigious PulmCCM spots than there are Pulm only or CCM only spots.

Again, CCM only programs are the minority and trying to do Pulm then CCM will limit your city/preference options twice.

 

[Soccer171983]

Depends where you want to go. Marketability wise, pulm/cc offers more opportunities. Some places want dedicated critical care specialist training in their units especially when closed. In some smaller towns I do see pulm running icu's and it isnt an issue. I would say to do the research in areas you want to end up to get a better Idea. One point that many people told me when I was a applying was from a stand point of being "a doc in the box" meaning pulmonary was always a good fall back at minimum if you didnt want to spend your entire life in the icu especially as one gets older. I am finishing up my fellowship and likely will be doing both inpatient icu, inpatient pulm consults and outpatient pulm (clinic, ltacs etc). If you have the interest I would do both but if you hate cc and want nothing to do with it then don't do it for the hell of it.

 

[CDI]

Pulm/CC if interested in more inpatient.

Pulm/Sleep if planning more outpatient.

Makes the most sense...


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