pulmonary medicine

[PublicEnemy]

how difficult is it to get into a pulmonary fellowship? is it possible to work your way in after getting a good IM spot?

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[AJM]

As with applying to IM residencies, it is not that difficult to match into a pulmonary fellowship, however the top programs are very competitive. I don't know what you mean by "working your way in", but if you are at a good IM program, you shouldn't have too much trouble matching into pulmonary. If you want to get into one of the top academic programs, however, you will have to make yourself stand out, usually by having done some research, getting great evals, and having strong faculty support from your residency program.

 

[Code Blue]

Are you looking for strictly pulm or pulm / crit care? Both are not nearly as competitive compared to cards or GI for sure, but you still have to make yourself standout for the big named programs. Also as a generalization, east coast schools are more crit care heavy, and west coast schools are heavier into pulm. And also, care of getting yourself sucked into additional research years at the big named schools with pulm...

 

[AJM]

Pulm/critical care is much more common to do than straight pulm, although there are still a few straight pulmonary programs out there. The problem with straight pulmonary is that once you're done, you're not quite as marketable as everyone else who has done pulm/cc. The upside to it is that it's only a two-year fellowship as opposed to 3 years.

As far as the extra research year, a growing number of academic programs are now expecting that their fellows do at least 4 years. In fact all of the programs I interviewed at last year were effectively 4-year programs. At all but one of them I got the impression that while it was possible to do just the minimum 3 years, it was very much frowned on. The vast majority of the fellows at these programs do at least 4 years.

 

[bigtuna]

What are the top-notch Pulm/crit care programs? Is it the same places that have well respected IM residencies?

 

[AJM]

What are the top-notch Pulm/crit care programs? Is it the same places that have well respected IM residencies?

The top pulm/cc programs include (in no particular order): Colorado, UW, UCSF, Wash U, Chicago, Penn, Harvard Combined, BU, Hopkins. Sorry, don't know much about the southern programs.

 

[Eidolon6]

The top pulm/cc programs include (in no particular order): Colorado, UW, UCSF, Wash U, Chicago, Penn, Harvard Combined, BU, Hopkins. Sorry, don't know much about the southern programs.

Top southern programs include Vanderbilt, MUSC, Duke, UNC all with their special perks....Vandy is great in pulmonary HTN, Critical Care, ARDS, Pleural Disease (location of R. Light of the Light's criteria)....Duke has a world class lung transplantation program (they do the most in the world).....South Carolina has Steve Sahn and is strong in pleural diseases. UNC is the airways disease center, specializing primarily in Cystic fibrosis and other causes of bronchiectasis....critical care is not so strong there.

Other southern programs worth mentioning
Wake Forest- more community style program...but they do have an interventional pulmonologist with opportunities to train in that fairly niche modality. Tulane also has an interventional program.

I think Texas programs are a bit less strong, for what reasons, I don't know.

I'd say on pure scale, Colorado is the largest and probably most competitive. I've heard the program tends to eat fellows alive and got that sense when talking to some acquaintances. I'm not to sure about the northeastern programs (nor do I care really).

Remember, its easy to be starstruck by the big name programs...but if they don't offer you what you want....why go???

As for competitiveness...pulmonology is thankfully less so than GI, but good programs attract strong candidates...so research, strong clinical performance and a well respected IM residency helps.

 

[retroviridae]

By Colorado, does everyone mean National Jewish? Excellent program in pulmonary and allergy/immunology

 

[Eidolon6]

By Colorado, does everyone mean National Jewish? Excellent program in pulmonary and allergy/immunology

No, its the University of Colorado HSC's program. The National Jewish involvement is a component of the training, but not a fellowship in itself. You will also be involved with the University and VA hospitals.

 

[krkuhl]

a little bit off the subject here--more of an overal pulm/critical care question. i've heard some talk about making critical care doc's schedules like ER doc's--working 12 hr shifts or 16 hrs--no call, just shiftwork. anyone else hear anything about this? think it is plausible or will happen any time in the near future? i love the concept of cc care but afraid of the hours and burn out rate and there is nooooo way i could do pulm clinic for the rest of my life. hoping someone else out there has heard of this or know more about it...

 

[Code Blue]

a little bit off the subject here--more of an overal pulm/critical care question. i've heard some talk about making critical care doc's schedules like ER doc's--working 12 hr shifts or 16 hrs--no call, just shiftwork. anyone else hear anything about this? think it is plausible or will happen any time in the near future? i love the concept of cc care but afraid of the hours and burn out rate and there is nooooo way i could do pulm clinic for the rest of my life. hoping someone else out there has heard of this or know more about it...

I think at most private hospitals who can employ a decent number of intensivists -- it has already changed into shift work for a lot of places. I hear you about pulm clinic sucking ass, but I love CC medicine. Some places will allow you to do CC for a year or two to add on top of another fellowship -- like ID + CC, cards + CC (although I dunno why the hell someone would do that), etc..

 

[retroviridae]

I think at most private hospitals who can employ a decent number of intensivists -- it has already changed into shift work for a lot of places. I hear you about pulm clinic sucking ass, but I love CC medicine. Some places will allow you to do CC for a year or two to add on top of another fellowship -- like ID + CC, cards + CC (although I dunno why the hell someone would do that), etc..

Baylor has a 1 year stand alone CC fellowship

I know NIH will allow you to combine ID with CC.

 

[Eidolon6]

Remember though that straight CCM does not pay that well and some of the better billing procedures go the the Pulm/CCM folks who can perform consultations, thoracostomies, bronchs etc. Some hospitals do not extend privileges for such procedures w/o proof of adequate training in them...just something to think about if thinking of a private practice career. Additionally, a lot of academic medical centers have CCM tied to other departments such that hiring a CCM only trained doc makes less sense than a pulm or cards trained CCM doc...you can get more mileage out of em.

 

[imrep1972]

I hear you about pulm clinic sucking ass, but I love CC medicine.

Out of curiosity, what is it about pulm clinic that "sucks ass" in your opinion? I am still a ways off from making a decision, but I had been considering pulm/cc and would like to learn... Thanks!

 

[AJM]

A comment about the length of training for straight critical care: the ABIM regulations are for stand-alone CC programs for IM-trained fellows to be 2 years in length. It is only 1 year for CC fellows who have done an anesthesia residency.

The ABIM does allow you to do CC in just one additional year if you are tagging it on to another IM-subspecialty fellowship (ie renal, ID, cards, etc).

 

[AJM]

Out of curiosity, what is it about pulm clinic that "sucks ass" in your opinion? I am still a ways off from making a decision, but I had been considering pulm/cc and would like to learn... Thanks!

I assume when Code Blue was mentioning pulm clinic as sucking, he was referring specifically to asthma and COPD patients. I also dislike that area of pulm, as do most other people I know going into pulmonary. The thing is, unless you choose to subspecialize in COPD, these won't necessarily be the majority of your patients.

The patient mix can be highly varied. For example, you can see patients with new pulmonary infiltrates of unknown etiology, pleural effusions, lung masses/lung CA, TB, MAC, ILD, CF, pulmonary HTN, diaphragmatic paralysis, lupus, just to name a few. Many of these patients will have no diagnosis on presentation to pulmonary clinic, so if you enjoy being a diagnostician you would likely get a good amount of satisfaction from clinic.

Just my 0.02

 

[imrep1972]

I assume when Code Blue was mentioning pulm clinic as sucking, he was referring specifically to asthma and COPD patients. I also dislike that area of pulm, as do most other people I know going into pulmonary. The thing is, unless you choose to subspecialize in COPD, these won't necessarily be the majority of your patients.

The patient mix can be highly varied. For example, you can see patients with new pulmonary infiltrates of unknown etiology, pleural effusions, lung masses/lung CA, TB, MAC, ILD, CF, pulmonary HTN, diaphragmatic paralysis, lupus, just to name a few. Many of these patients will have no diagnosis on presentation to pulmonary clinic, so if you enjoy being a diagnostician you would likely get a good amount of satisfaction from clinic.

Just my 0.02

Thanks, AJM!

 

[Code Blue]

I assume when Code Blue was mentioning pulm clinic as sucking, he was referring specifically to asthma and COPD patients. I also dislike that area of pulm, as do most other people I know going into pulmonary. The thing is, unless you choose to subspecialize in COPD, these won't necessarily be the majority of your patients.

The patient mix can be highly varied. For example, you can see patients with new pulmonary infiltrates of unknown etiology, pleural effusions, lung masses/lung CA, TB, MAC, ILD, CF, pulmonary HTN, diaphragmatic paralysis, lupus, just to name a few. Many of these patients will have no diagnosis on presentation to pulmonary clinic, so if you enjoy being a diagnostician you would likely get a good amount of satisfaction from clinic.

Just my 0.02

Unless you work at a large tertiary referral center, the majority of your patients will still be COPD, asthma, and lung masses. Having done 2 months of electives in pulm because I was thinking about it at one point, I just found the patient population not to be my cup of tea in that they are mostly chronic players for which treatments are largely voodoo magic (steroids or no steroids?) -- rarely do you get a patient that can be "cured" of their ailment. Also, bronchoscopy as a diagnostic tool is fairly low yield unless you have an endobronchial lesion.

I personally enjoyed the CC part of Pulm/CC a lot more, but was worried that I was going to burn out on the CC and have to do Pulm which only marginally interested me. However, there is one aspect of pulm that was pretty interesting and it's sleep medicine -- absolutely fascinating physiology involved.

 

[retroviridae]

where in IM do we "cure" patients of their ailments? Maybe ID, except that the majority of ID is now HIV. Don't get me wrong, I hear you about COPD and that whole patient population. But in reality, most of IM is like that. Even vaunted cards is just dealing with old people with CAD and CHF and helping them along a little more (yes, I'm generalizing, forgive me).

 

[AJM]

Unless you work at a large tertiary referral center, the majority of your patients will still be COPD, asthma, and lung masses. Having done 2 months of electives in pulm because I was thinking about it at one point, I just found the patient population not to be my cup of tea in that they are mostly chronic players for which treatments are largely voodoo magic (steroids or no steroids?) -- rarely do you get a patient that can be "cured" of their ailment. Also, bronchoscopy as a diagnostic tool is fairly low yield unless you have an endobronchial lesion.

I personally enjoyed the CC part of Pulm/CC a lot more, but was worried that I was going to burn out on the CC and have to do Pulm which only marginally interested me. However, there is one aspect of pulm that was pretty interesting and it's sleep medicine -- absolutely fascinating physiology involved.

It's true that you are much more likely to see the more interesting stuff at large referral centers, however it is not necessary to be at an academic medical center if you want to avoid seeing too many COPD patients. I know several pulmonologists who work in community settings who deal very little with asthma/COPD. They've chosen to create other niches for themselves in subspecialties within pulmonary. This seems to be easiest to do for pulmonologists wanting to focus mostly in the ID realm, for example in TB, but they are certainly not limited to the infectious aspects of pulmonary.

I have also thought about sleep medicine -- but after doing sleep clinic and reading sleep studies, I find it incredibly boring. IMHO the one thing it has going for it is that it is very lucrative these days. Who knows - I may end up deciding to get certified in sleep as something to fall back on later down the road....

 

[ctwinkle30]

how difficult it is to get pul/pul cc on h1visa for a fmg with a residency in a univ aff comm hospital
which are the h1 friendly programs?

 

[spyrogyra1]

how difficult it is to get pul/pul cc on h1visa for a fmg with a residency in a univ aff comm hospital
which are the h1 friendly programs?

you'll have to wait till june 21st!

 

[chemamr]

about pulm medicine, with or without critical care, how is the lifestyle out there when you are an attending??? number of hrs/week??? urgencies???

thanks for answering guys

 

[mysophobe]

About straight pulm or cc, the op is at umdnj-som, which has a 2 year pulm fellowship and a 1 year cc fellowship that can be done separately or like a 3 year pulm/cc from what I understand.

 

[BMW19]

Is that 1 year CC after 4 yrs IM (1 yr. tradit. rot and 3 IM)?

About straight pulm or cc, the op is at umdnj-som, which has a 2 year pulm fellowship and a 1 year cc fellowship that can be done separately or like a 3 year pulm/cc from what I understand.